Centre of Excellence for Cardiac Surgery in India:
- Our state of the art hospitals in India have a 99.5 % success rate of performing most complex cardiac surgeries at the most affordable cost compared to similar modern facilities anywhere in the world.
- Highly Experienced and skilled US/UK Board certified team of heart surgeons and cardiologists work together to provide comprehensive, multidisciplinary care to patients suffering from heart diseases
- State of the art infrastructure, cutting edge technology providing care to patients Our doctors, nurses, technicians and heart experts bring the promise of unparalleled excellence in patient care
- Most Advanced Operation Theatres / Robotic surgery suite - State of the art equipment and monitoring devices necessary to successfully perform complex heart bypass, percutaneous valve surgeries, complex hybrid aortic aneurysm interventions and minimally invasive cardiac operations.
What is Heart Failure?
When the heart fails to function effectively despite medical intervention and is unable to sustain optimum blood pressure while doing minimal activity, it is known as end stage heart failure. Such patients are categorised as stage 3 (moderate), 4(severe) in the New York heart Association grading of heart disease. Such patients show signs of breathlessness, fatigue, and blood pressure fluctuation, rapid heart rate with minimal exertion or even at rest despite being on medications. These patients are sick and disabled. Such patients are candidates for heart transplant as their heart is unable to function effectively.
Why does it occur?
Such a condition occurs in patients who have had multiple minor or major heart attacks, coronary artery blockage, scarring of the cardiac muscle tissue, sustained high blood pressure or cardiomyopathy (abnormality in the heart tissue itself). These conditions result in repeated weakening of the cardiac tissue which results in reduced efficiency. Heart transplant remained the only lifesaving option for these people for many years. But the demand supply ratio is very poor. For such patients an artificial mechanical pump or the left ventricular assist device (LVAD) is a more feasible option and is now gaining more popularity as compared to transplant.
Symptoms of heart failure?
A person with end stage heart failure will demonstrate marked reduction in physical activity, shortness of breath with minimal activity, comfortable at rest, fatigue, swelling (due to shutdown of kidney function) rapid and irregular heartbeat. In extreme cases the patient may perceive discomfort even at rest and even slight activity increases discomfort.
How does normal heart function and what happens in heart failure?
A normal heart has healthy cardiac tissue which can conduct electrical impulses throughout the organ. The heart generates its own impulses which causes a rhythmic contraction of ventricles (lower chambers) and atria (upper chambers) resulting in smooth unidirectional flow of blood from the heart to the body.
What happens in the case of heart failure
The normal electrical conductivity of the heart tissue is lost resulting in
- Unsynchronised contraction of heart chambers,
- Increased (Tachycardia) or decreased (Bradycardia) rate of contraction of the ventricles or atria.
- There is blockage of the coronary artery (that blocks blood supply to the heart resulting in tissue death due to lack of oxygen).
Erratic contraction of the chambers of the heart results in gradually reduced blood flow from the heart to the various organs causing progressive multi organ failure in long standing cases.Blockage of coronary artery leads to ischemia (cell death due to lack of oxygen) of heart muscle which again affects the pumping capacity of the heart.
LVAD/ VAD Left ventricular Assist Device or Ventricular Assist Device
Left ventricular Assist Device or Ventricular Assist Device was once considered as a stop gap arrangement or a bridge to transplant in patients for end stage heart failure who were waiting for heart transplant. With advancement in medical technology, the quality of LVAD has improved to such an extent that patients have shown improvement in quality of life to a great extent
A tube passes from the device through the skin. This tube, called the driveline, connects the pump to the external controller and power source.
The pump and its connections are implanted during open-heart surgery. A computer controller, a power pack, and a reserve power pack remain outside the body. Some models let a person wear these external units on a belt or harness outside.
The power pack has to be recharged at night.
Benefit of LVAD -involves restoration of blood supply to the heart and other vital organs, time to rest for the heart, reduced fatigue and discomfort.
Side effects -include infection, internal bleeding, heart failure, kidney failure, stroke, device failure, blood clot and respiratory failure.
Implantable Cardiac Defibrillators
ICD or implantable cardiac defibrillator is a small pager sized electronic device that is fitted inside the chest. It prevents sudden death that may occur due to uncontrolled contraction of the heart muscles (Ventricular tachycardia or ventricular fibrillation). When the heart beats normally the device is inactive, but when irregular contraction occurs, the device delivers electrical shocks to normalise the abnormal rhythm.
The device is made up of a battery operated pulse generator and a set of leads. The device is placed under the skin near the collar bone or waistline and the leads are connected to the heart. The device is implanted under general anaesthesia and does not require open heart surgery. Once fitted, the device is tested before the patient is allowed to go home. The device records normal rhythm, recognizes abnormal rhythm, delivers shocks and records the date and time of event.
Cardiac Resynchronisation Therapy- CRT
A cardiac resynchronization therapy device is designed to treat heart failure.
The battery operated device sends small, undetectable electrical impulses to both lower chambers of the heart to help them beat in a more synchronized pattern. The leads between the heart and the device carry electrical signals to and fro. This improves the heart's ability to pump blood and oxygen to the body.
Implantable device system has a programmer, an external computer located in your doctor's office or clinic that is used to program the heart device and retrieve information from your heart device that will assist your doctor in your heart failure treatment.
CRT pacemaker and a combination CRT pacemaker with defibrillation therapy help to coordinate the heart's pumping action and improve blood flow. They can also speed up a heart that is beating too slowly.
In addition the CRT pacemaker with defibrillation therapy (CRT-D) also offers the ability to detect and treat dangerously fast heart rhythms, which some individuals with a damaged heart muscle may be at risk for developing.
Revascularisation therapy or Coronary Artery Bypass Graft (CABG)
The purpose of by-pass surgery is to improve blood flow to the heart muscle. The blockages in the artery supplying blood to the heart are not removed. Rather, blood is routed around the blocked areas in the arteries supplying blood to the heart. This entails the use of conduit. Conduits that are available are the veins from the leg, the saphenous vein, the artery from the inside of the chest wall called the internal mammary artery, and occasional an artery from the forearm, known as the radial artery.
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