How DESUN’s Critical Care Team delivers stunning clinical outcomes!

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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.

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.

HEART SURGERY NOW? PAY IN INSTALLMENTS LATER

Your heart Patients Can Avail Desun’s Easy Installment Scheme !

Background -  In 2008 price of petrol was 38, now it is over 70 per litre.  However, in 2008 Coronary Angiogram (CAG) at DESUN was 7000 and even today it is still 7000.  We perform the largest number of CAG in this part of the country and also the highest number of Angioplasty and Bypass. Still there are a large number of patients requiring intervention after CAG but are not in a position to do so, because of the large ONE TIME payment involved.  DESUN is trying to address this problem in a patient – friendly manner.

DESUN ushers new era of Easy Payments for Advanced Heart Procedure:

For the first time in India DESUN has ushered in a new era of affordable advanced heart treatment for a wider section of our society.  Advanced heart procedures like Pacemaker, Angioplasty with Stent, Heart Valve Replacement, ICDs CRT are life saving but at the same time considered expensive by a large section of the society.  By breaking up the large one time upfront cost of these lifesaving procedure in easy monthly instalments such procedures have been brought within the reach of many by DESUN.

Non Treatment of Serious Cardiac Problems for being costly :

Of the people who are diagnosed with cardiac problems and need to undergo advanced heart procedures more than 70% of them are not in a position to de so, as they are unable to bear the burden of expenses involved at ONE TIME.  Hence they are often deprieved of such life saving treatment.

Ideal Medical Requirement not fulfilled because of the necessity of ONE TIME payment :

Most patients requiring Angioplasty are not in a position to pay the required amount at ONE TIME.  Therefore, doctors are left with no other alternative, but to save the life of the patient by implementing life saving measures.  For example, in such cases, less expensive non-medicated stent  within the patient’s budget, may have to be used when ideally ‘drug eluting’ stent i.e. medicated stent is recommended.  Same is the case of Pacemakers.  The developed world has shifted to Double Chamber Pacemakers more than 10 years ago as they are more effective and foolproof.  However, in India, even today more than 90% of the Pacemakers used are the old Single Chamber Pacemakers which have its own limitations, as they are less expensive than Double Chamber Pacemakers.

DESUN Easy Installment Scheme is a boon for patients with limited financial means :

Through DESUN’s Easy Installment Scheme life saving heart procedures will be within the reach of many more people.  Moreover, compromises need not be made as proper and latest technology can be implemented for the benefit of the patient, and that too within their means and financial capability.

DESUN’S INSTALLMENT SCHEME – WHAT YOUR PATIENTS NEED TO DO ?

1.    Provide us with copies of (no originals please)

●Last 3 months medicine prescription

●Last 6 months test reports.

●Copy of your prescription advising heart procedure.

2. Submit all the above documents EITHER

To the Assistant Manager (Installment Scheme) at DESUN HOSPITAL’s Admission Counter.

OR

Send the above documents by Speed Post addressed to the

“Assistant Manager, Installment Scheme”. DESUN Hospital & Heart Institute, Desun More, E.M. Bypass, Kolkata 700 107.

3.    Patients must write their own name and mobile number on the envelope.  We shall get in touch with them and also with you in the next few days.

FEEDBACK FOR PHYSICIANS, CARDIOLOGISTS & REFERRING DOCTORS :

Even when a patient opts for DESUN’s Easy Installment Scheme:

1)   We shall intimate you immediately along with the estimated cost.

2)   You may also be present during the procedure or surgery inside the OT or Cathlab.

3)   We are extremely regular in giving proper and timely feedbacks wherever you are.  You need not depend on someone visiting your area an d then only you will get the feedback of the patient.  At DESUN there is a separate CARDIAC PRODUCT TEAM that maintains contact with physicians and cardiologists regarding patients’ conditions and feedback. For further information on regular association with DESUN you may call 9903996804, 9007055111.