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IN THIS ISSUE WE WILL ELABORATE ON :  Advanced technical approach towards CAD at Desun

In the previous issue of DESUN Update we had discussed about the superiority in performing CABG at DESUN. In this issue we shall discuss about Advanced Technical Approach Towards CAD at DESUN.

Test                                                             What it Does

ECD or EKG (electrocardiogram)      Measures the electrical activity, rate, and regularity of your heartbeat.

Echocardiogram                                      Uses ultrasound waves to create a picture of the heart.

Exercise Stress Test                              Measures your heart rate while you walk on a treadmill. This helps to determine how well your heart is working when it has to pump more blood.

Chest X-Ray                                              Uses X-Rays to create a picture of the heart, lungs, and other organs in the chest.

Cardiac Catheterization                       Checks the inside of your arteries for blockage by inserting a thin, flexible tube through an artery in the groin, arm, or neck to reach the heart. Health care professionals can measure blood pressure within the heart and the strength of blood flow through the heart’s chambers as well as collect blood samples from the heart or inject dye into the arteries of the heart (coronary arteries).

Coronary Angiogram                            Monitors blockage and flow of blood through the coronary arteries. Uses X-Rays to detect dye injected via cardiac catheterization.

Why Desun Angiogram is Different from Others?

A) Comprehensive Closed Ended Package :

Desun offers unique close-ended package for angiogram which includes all pre-operative investigations, cost of dye, procedure charge, instrument cost etc.

B) Unique Pre-operative screening Method :

Desun is having a facility of unique pre-operative screening method which mainly maintains the transparency of package in terms of any clinical abnormalities.

At the time of admission we perform pre-operative screening procedure at 1/3rd price of the package.

Finally after getting confirmation from clinicians we proceed for further procedure which ultimately reflects the clinical accuracy & cost-effectiveness.

C) Advanced Technical Approach :

In Desun 99% cases are done through Radial approach, resulting:

·         Lesser chances of haematoma

·          Fastest recovery in the same day

·          Better clinical outcome

·          Clinically safe & secure in comparison to femoral approach

D) Day-Care Procedure :

As Desun is doing the day care procedure, we ensure the earliest & hassle free discharge in the same day.

E) Availability of 24x7 full timer Consultant :

·         Full time expert consultants are available round the clock for 365 days to handle each emergencies and every complex cases.

·          24x7 availability of assistance for Cardiac Cath-lab.

·          Radiology, Cardiology with other diagnostic & pharmacy are functional 24 hours.

F) Clinically Safe Comparison to Conventional Procedure :

Only at Desun within this cost-effective package we are regularly using the non-ionic dye which is the safest procedure for renal impaired patients.

WHAT IS CORONARY ARTERY DISEASE?

The arteries, which start out smooth and elastic, get plaque on their inner walls, which can make them more rigid and narrowed. This restricts blood flow to your heart, which can then become starved of oxygen.

The plaque could rupture, leading to a heart attack or sudden cardiac arrest.

How does Coronary Artery Disease (CAD) develop?

From a young age, plaque can be formed in your blood vessel walls. As you get older, the plaque develops & inflames the vessel walls. It raises the risk of blood clots and heart attack.

Inflammatory cells, lipoproteins, calcium & other objects travel in your bloodstream and mix with the plaque.

As more of these inflammatory cells join in along with cholesterol, the plaque increases, both pushing the artery walls outward and growing inward. That makes the vessels narrower.

Eventually, a narrowed coronary artery may develop new blood vessels that go around the blockage to get blood to the heart. However, if you’re pushing yourself or stressed, the new arteries may not be able to bring enough oxygen-rich blood to the heart muscle.

In some cases, when plaque ruptures, a blood clot may block blood supply to the heart muscle. This causes a heart attack.

If a blood vessel to the brain is blocked (usually from a blood clot) an ischemic stroke can happen.

If a blood vessel within the brain bursts, most likely as a result of uncontrolled hypertension, a hemorrhagic stroke can result.

Studies have found that taking low-dose aspirin each day may help prevent heart attacks and strokes in people who are 50 or older and at risk for heart disease.

What Is Ischemia?

Cardiac ischemia is a condition when Oxygen-rich blood flow is restricted to your heart because of an artery becomes narrowed usually by plaque or fatty materials. This can cause heart attack with or without chest pain and any other symptoms.

Ischemia happens most during:

·         Exercise or other exertion 

·         Eating  n Excitement or stress                     

·         Exposure to cold

CAD can get to a point where ischemia happens even when you’re at rest. This is a medical emergency and may lead to a heart attack. Ischemia can happen without any warning although it is more common in people with diabetes.

What are the Symptoms of CAD?

The most common symptom is angina or chest pain.

Angina can be described as :

·         Heaviness 

·         Pressure 

·         Aching 

·         Burning 

·         Numbness

·         Fullness   

·         Squeezing 

·         Painful feeling

It can be mistaken as indigestion or heartburn.

Angina is usually felt in the chest, but may also be felt in the:

·         Left shoulder 

·         Arms 

·         Neck 

·         Back

Symptoms are often subtler in women. Nausea, sweating, fatigue, or shortness of breath can join the typical pressure-like chest pain.

Other symptoms that can occur with CAD include:

·         Shortness of breath 

·         Palpitations

·         Weakness or dizziness

Diagnosing CAD:

To find out your risk for CAD, your health care team may measure your blood pressure, cholesterol, and sugar levels. Being overweight, physically inactive, unhealthy diet and smoking tobacco are risk factors for CAD. A family history of heart disease also increases your risk for CAD. If you’re at high risk for heart disease or already have symptoms, your doctor can use several tests to diagnose CAD.

CORONARY ARTERY BYPASS GRAFT SURGERY

What is CABG?

Coronary Artery Bypass Grafting (CABG), also known as Coronary Artery Bypass Surgery & popularly Heart Bypass or Bypass Surgery, is a surgical procedure to restore normal blood flow to an obstructed coronary artery. Obstructed coronary artery means when the coronary arteries are narrowed or occluded, most commonly by atherosclerotic deposits of fibrous and fatty tissue.

Clinical Presentation : 

A) Typical :

·          Angina

·         Chest discomfort

·         Breathlessness

·         Jaw Pain

B) Atypical :

·         Syncope

·         Vomiting

·         Unexplained sweating

·         Epigastric- discomfort

·         Myocardial infarction

·         Dyspnoea

·         Arrhythmia

·         Cardiac failure

·         Sudden death

·         Silent Ischemia

Indications for CABG :

·         Left main disease

·         Left main equivalent

·         Critical TVD

·         MI with its Mechanical complications

·          Chronic total occlusion

·         Length of lesion 13-18 mm - 30% re-stenosis

·         Bifurcation and ostial lesions

·          Vessel size  < 2.5mm - 37%  re-stenosis

                                    > 3.5mm - 7% re-stenosis

·          Diffuse In - stent Stenosis

·         Diabetes - better results with CABG

·         It is performed to relieve angina (a pain that radiates in the upper left quadrant of the body due to the lack of oxygen reaching the heart).

·         Unsatisfactorily controlled by maximum tolerated anti-ischemic medication

·         Prevent or relieve left ventricular dysfunctions (eg. LVH), and/or reduce the risk of death.

Symptoms for the procedure

Symptoms of coronary artery disease may include, but are not limited to, the following:

·         Chest pain

·         Fatigue

·         Palpitations

·         Abnormal heart rhythms

·         Shortness of breath

What are two main approaches of CABG?

Arterial Grafting :

The left internal thoracic artery (internal mammary artery) is diverted to the left anterior descending branch of the left coronary artery.

Venous Grafting :

In the other, a great saphenous vein is removed from a leg; one end is attached to the aorta or one of its major branches, and the other end is attached to the obstructed artery immediately after the obstruction to restore blood flow.

Why Desun is Superior in performing CABG?

A) Regularly performing Off-pump CABG :  A coronary artery bypass graft (CABG) is done without putting the patient on the heart-lung machine. Off-pump CABG permits surgery on multiple vessels within the heart by mechanically stabilizing it. Off-pump surgery is minimally invasive, as compared to surgery on the heart-lung machine.

Advantages:

·         Less number of Mortality rate

·         No aortic cannulation -> less risk of dissection, embolism

·         No atrial cannulation -> less atrial injury, arrhythmias

·         No cross-clamping -> less risk of plaque embolism, CVA, MI

·         No activation of co-agulation, kallikrein, inflammation caused by tubing -> less co-agulopathy, less bleeding, less transfusion

·         No cardioplegia -> no K+ load, fluid load, coronary air embolism

·         No risk of bypass machine failure -> air embolism

·         less equipment

·         less staff requirement

B)            Desun Performs minimally invasive cardiac surgery : Most cardiac operations today are performed through a sternotomy, which involves splitting the entire breastbone. Minimally invasive cardiac surgery encompasses a variety of operations performed through incisions that are substantially smaller and less traumatic than the standard sternotomy. Minimally invasive incisions measure about 3 to 4 inches compared to 8 to 10 sternotomy incisions. Specialized handheld and robotic instruments are used to project the dexterity of the surgeon’s hands through these small incisions in performing the operations.          

Standard Sternotomy Incision This 8 to 10 inch incision splits the entire breastbone.	Mini-Sternotomy Incision This 4 to 5 inch incision just splits the upper third of the breastbone.

Mini-Thoracotomy Incision This 3 to 4 inch incision is made between the ribs whereby no bone is cut.

Port-access Incision Robotic instruments are passed through several 1/2 inch incisions between the ribs.

What are the benefits of minimally-invasive cardiac surgery?

Minimally invasive surgery confers many advantages over standard approaches derived largely from the reduced trauma to the chest wall tissues. The benefits of minimally invasive cardiac surgery include:

·         Smaller incisions

·         Smaller scars

·         Reduced infection risk

·         Less blood loss

·         Less pain

·         Shorter hospital stays : Stays after minimally invasive operations are from 3 to 5 days compared to 5 to 7 days for traditional sternotomy-based cardiac operations.

·         Fewer physical restrictions : Patients undergoing standard incision cardiac operations are restricted from driving an automobile or lifting objects weighing more than 5 pounds while patients undergoing minimally invasive cardiac surgery are not subject to these restrictions

·         Shorter recovery time : Recovery times after minimally invasive operations are from 2 to 4 weeks compared to 6 to 8 weeks for standard sternotomy-based cardiac operations.