Expertise of Cardiologist & Cardio – Thoracic Surgeons · PDF fileExpertise of...

transcript

www.apollohealthcity.com

Expertise of Cardiologist & Cardio – Thoracic Surgeons

• 2500CoronaryAngioplastiesin2013,includingmanyrefinedprocedureslikeMulti-VesselAngioplasty,LeftMainAngioplastyandBifurcationLesions.

• 900coronarybypassproceduresincludingbeatingheartcoronarybypassoperationsin2013

• Pioneeredopen-heartsurgeriesandcardiaccatheterization,intheearly80’s.

• Achieveda99.6%successrateincardiacbypasssurgeries;over91%ofwhichwerebeatingheartsurgeries.

• IntroducedcuttingedgeprocedureslikeRoboticCardiacSurgeries,off-pumpandbeating-heartsurgery,eitherbythoracotomy(minimalinvasiveaccess)orclassicalsternotomy,trans-radialangioplastyandstenting,mitralvalvereplacement.

• FirsttostartPediatricCardiacSurgeriesinAP

• Largestseriesofaorticvalvereplacementswithstentlessheartvalvebioprosthesis.

• Performedsuccessfulheartsurgeryona2dayoldbaby,andsuccessfullyimplantedapacemakerona97yearoldpatient.

• LatestMguardstenttechnology,aspeciallydesignedMeshcoveredstentusedonAcuteMIcase.

• TheApolloHospitals,oneofthesixcentersinIndiatobepartofaglobaltrialonusingdrug-elutingbio-resorbablestents.Thenextgenerationdevices,whichrelievebloodvesselblocksthatwill

dissolvewithincoupleofyears.Thedeviceworkslikearegularstentbyrestoringbloodflowtoacloggedvessel.Italsocontainsadrugthatisslowlyreleasedtohelpthehealingprocess.

• ApolloHospitalsHyderabadlaunchedastate-of-the-artcardiacfacility‘CentreforAdvancedCardiacCare’(CACC),withdedicated,highlyqualifiedandexperiencedcardiologyandcardiothoracicteams,skilledtechnologistsandsupportstaffablybackedbyamodernmulti-specialtymedicalfacility.TheCenterisequippedwithstateoftheartmodernflatpanelcardiaccatheterizationlaboratoryandhasacquiredlatesttechnologyincludingFractionalFlowReserve(FFR)andIntravascularultrasound(IVUS).

• EndovascularAneurysmrepairfor2largeaneurysmssimultaneouslyperformedatApolloHospitals

• Apollo Hospitals, Hyderabad per-formed coronary angioplasty usingabsorb-BVSforthefirsttimeinIndia.

• WehavebestheartfailuremanagementteamincludingECMOtreatment.

• RegularpostgraduatespecialtytraininginCTVS,InterventionalCardiology,PediatricCardiacSurgeriesandinterventions.

• Endovascularandsurgicalrepairsofaroticaneurysms.Carotidstenting,pheripheralangioplasty,andstentingforlegischemia.

• WehavethebestoutcomesforCatheterdirectedthromoblysisforDVT,AlcoholseptalablationforHOCMandVenousangioplastyfordialysisofAVfistula.

The unit was recognized for its best results by the

India Today Magazine

Pediatric Cardiology

The first dedicated pediatric heart care center in the state of Andhra Pradesh

• Thefirsthospitaltohavesuccessfullycompleted4000interventionalandsurgicalcases

• Ouroverallsuccessratewas98%whichiscomparablewithanycentreinthewesternworld

• Thepediatriccardiacinterventionshavegrownby300%thisyear

Thededicatedpediatricheartcarecentreofferstreatmentformanycomplicatedcasesinvolvingprematurebabiesandinfants.

• ThisincludescomplexneonatalsurgeriesincludingArterialswitchoperation

• ThesurgerytechniquesincludePermembranousVSDDeviceClosure,uni–focalizationinchildrenwithVSDpulmonaryatresia,singlestagecorrection,ArterialswitchoperationinchildrenwithTGA–transpositionofgreatarteriesandValvoplasties

The cardiac and vascular services including Cardiovascular Medicine, Thoracic andCardiovascularSurgery,andVascularSurgeryareofferedunderoneroofwhichisextremelybeneficialforthepatientandhelpsthecoreteamtocollaborateonpatientcare.

The Medical Leadership Team

Dr. Vijay DikshitMBBS,M.S.(Surgery),M.Ch(ThoracicSurgery)

Dr. Sanjay Kumar Agarwal,MBBS;MS(GENERALSURGERY);MCh.(CTVS)

Dr. Sanjeev Kumar Khulbey,MBBS;M.S;Mch(CTVS)

Dr. P. Seshagiri RaoMBBS;MD(InternalMedicine);DM(Cardiology)

Dr. Sudhir NaikMBBS;MD(InternalMedicine);DM(Cardiology

Dr. Tripti DebMBBS;MD(Medicine)DNBCardiology

Dr. Nekkenti V. RayuduMBBS;M.D.(Gen.Med.)D.M.(Cardiology)

Dr. Avinash DalMBBS;MS,MCH(CVTS)SCTIMST

Dr. Anil DronamrajuMBBSM.S.(Surgery),M.Ch(ThoracicSurgery

Dr. B V PurohitMBBS;MD,DM

Dr. P.C.RATHMBBS;MDDM(Cardiology)

Dr. Manoj AgarwalMBBS;MD(Medicine),DM(Cardiology)

Dr. Badri NarayanaMBBS;MD(Medicine),DM(Cardiology)

Emergency Service

• Thefirstcomprehensiveemergencymanagementservicesinthecountryusingasingle,toll-freenumber

• ThefirsttostarttheconceptofPreHospitalcarewheretreatmentwillstartonsiteforeffectivemanagementofthepatient

• Supportedby5StateofArtEmergencyroomsstaffedbyclinicianscertifiedbyAmericanHeartAssociation

• EstablishedClinicalProtocolsforHeartManagement

• AirAmbulanceServicesforremoteareasandlife–threateningemergencies

1066 has saved many lives

Diagnostics (Risk Assessment)

64 Slice CT • ApolloHospitalsisthefirstinthecountrytointroducethis

sophisticatedcardiacinvestigation

• The machine helps to acquire high-resolution three-dimensionalimagesofthemovingheartandgreatvessels

• Enables the cardiologists to spot even the smallest ofblockageataveryearlystage

Technological Advancements

Trans-esophageal Echocardiography (TEE)

• Lowriskprocedure(complicationrate<.01%)

• Excellentevaluationofcardiovascularanatomy(mitalvalvelesion,LA,LAA,intracardiacmass/ASD/Thoracicaorticdissection)

• Assessmentofnative/prostheticvalvularfunction(Degree/Mechanismofresurgitationorstenosis)

• AssessLA/LAApathologyandfunctionpriortoDCcardioversion

• Assessmentofvalves forendocarditisandaccompanyingcomplicationssuchasabscesses (Balloonvalvotomy,deviceclosureofASD)

• IntraoperativeTEEtoassesstheresultsofvariousvalverepairandreplacement

• Physiological assessment of pressure drop across the Coronary Stenosis atmaximalHyperemiainducedbyAdenosine

• Donebypassingthepressureviathelesionandmeasuringpressuredrop

• Angiography forms thebasisofmost revascularizationdecisionbuthaswellknownlimitationinassessingblockswithintermediateseverities

• FFR – Physiologically based – describes the ratio of maximum flow in thepresenceofstenosistothetheoreticalmaximumflowintheabsenceofstenosis

• Simpleprocedurewithscientificevidence

Advantage :• Helpsinassessingthephysiologicalsignificanceof“intermediate”stenosis

• HelpsidentifyingthepatientswhowillbenefitfromAngioplastiesandStentingandwhowilldowellwithmedicalmanagement

• HelpsavoidunnecessaryangioplastiesandCABGsurgeries

• WithFFR,onecanbeconfidentwhetherastenosisneedstobetreatedwithastentorbypassormedicalmanagement

FFR (Fractional Flow Reserve)

Safe and can be performed by experienced hands

• Pharmacologicalstress(Dobutamine,Dipyridamole,Adenosine)

• EffectivemethodofevaluatingmyocardialischemiabydetectionofstressinducedRWMA

• AccuracyofstressEchoiscomparabletostressthallium/TcMIBISPECT

• Differentiateviablemyocardiumfromscaredmyocardium(whichmaypredictwhetherLVfunctionwillimproveafterrevascularization)

• Preoperativecardiacevaluation(predictorofperioperativecardiacevents)

• SurveillanceforCADaftercardiactransplantation

• Evaluatefunctionalsignificanceofvarietyofvalvularlesions(AS,MR,MS)

Stress echo cardiography

Benefits• Flatpanelsystemscanproduceanimageintwosteps:

• Dramaticallyreducesthepossiblenumberofsourcesforerror

• Chancesforimagedegradation

• Flatpaneldetectorsystemsgiveamorediscreteimageoftheanatomy

• Moreacuteanglesseparateoutvesselsthathaveatendencytooverlap,openingupthecoronarytreeforoptimalvisualization

Intra-Coronary Imaging• OCT&IVUS-Advancedintra-coronaryimagingtechniquestoguideand

optimizePCI

• OCT–Light–based–GivesexcellentImagestoaccuratelymeasurevesselsize,stentplacement.

• IVUS–Ultrasoundbased–HelpstoachievegoodoutcomesincomplexPCI

Cathlab

Risk Mitigation

Electrophysiology (EP) Study and 3D Mapping System (Carto 3)

EP studies are done to diagnose the cause and source of cardiac rhythm disorder

• InEPprocedure,multiplethinflexiblecathetersareinsertedintoabloodvessel(usuallyinthegroin)andguidedintothehearttomeasuretheelectricalsignalsfrominsidetheheart

• FirsthospitalinIndiatogetthelatest3Dmappingtechnology(Carto3)inarrhythmlamanagement

• 3Dmappingtechnologyhelpstheelectrophysiologisttoidentifythesiteoforiginoftheabnormalrhythmaccurately

Incatheterablation,theRFcatheterdeliversalowvoltage;highfrequencycurrenttodestroytheareasproducingabnormalrhythmtherebypreventingfurthertriggeringoftachyarrhythmia

• Advanced3DmappingsystemenhancestheaccuracyofdeliveringRFablationwhichtranslatesintohighsuccessrate

Benefits:

• QualityofCare:Mostcardiacarrhythmiascanbetreatedandcuredbycatheterablationtherebyeliminatingtheneedforlifelongtherapy

• QualityofLife:CatheterAblationcanrestorethequalityoflifeofthepatientleadingtoahappierfamilylifeanimprovedproductivityatworkplace

• SaveLives:Somelife-threateningVentrIcularArrhythmiascanbesuccessfullytreatedwithcatheterablationtherebypreventingsuddencardiacdeath

• CostofCare:Theoveralllifecyclecostsofcareforthepatientmayreducedduetothecurativenatureofcatheterablationtherapy

Radiofrequency (RF) catheter ablation

PET – CT FDG Scan

• Computedtomography(CT)andmagneticresonanceimagingplayimportantrolesintheassessmentofstructuralabnormalitiesofthecardiovascularsystembutPositronEmissionTomography(PET)andCTmaydepictinflammatoryprocessesbeforestructuralchangesoccur.

• Positronemissiontomography(PET)performedwithfluorine18fluorodeoxyglucose(FDG)hastheuniqueabilitytodepictmetabolicallyactivedisease,andinthisrespectitcomplementsothercross-sectionalimagingmodalities,whichprovidepredominantlyanatomicinformation

ApolloHospitals,HyderabadhasthemostComprehensiveNuclearMedicineFacilityintheState.It’sthefirstPETCTinIndiawithOnsiteCyclotron.PETCTgivesaccuratediagnosisofcardiovascularDiseases.PETCTisthegoldstandardfordeterminingCardiovasculardiseasesintheworld.Therangeofdiagnosisinclude

Nuclear Imaging

FDG Cardiac Viability

F-18fluorodeoxyglucose(FDG)istheradioactivesubstanceusedtodeterminemyocardialviability.FDGPETviabilitydatahashadanimpactondecisionmakinginpatientswithsevereleftventricular(LV)dysfunctionandthebenefitsofearlyrevascularizationhavebeenseeninpatientswithischemicviablemyocardium.

Ammonia Myocardial Perfusion

• TheabilitytoobtainquantitativevaluesofflowandmyocardialflowreservehasbeenperceivedasanimportantadvantageofPEToverconventionalSPECT,whichthereforeprovidesfunctionalinformationfarbeyondtheepicardialsectionofthecoronaryvasculartree

SPECT CT

NuclearmedicineimagingwhichhasbeenperformedformanyyearswiththeSPECTcamerahasbeenrevolutionizedbytheadditionofCT.Thishashelpedimprovelesionlocalization.Patientcomfortandconveniencehaveimprovedwiththeshorteracquisitiontime.SPECT-CTwillgiveimprovedimagequalityparticularlyincardiacscans.MUGAScans,myocardialperfusionimage,viabilityscanaredoneregularlyatthecentre

• 3DECHOMachineforMyocardialContractImaging&3DTransEsophagealECHO

• CathLab24x7withStateoftheartadvancedimaging

• IVUS

• FFR

• PrimaryPCI,RescuePCI,CompassionatePCI,HighlyComplexPCI

• LeftMainAngioplasties

• High-endCardiacdeviceimplants:MRISafepacemaker,CRT-P,CRT-D,ICD

• ChronicTotalOcclusion(CTO)Angioplasties

• OpticalCoherenceTomography(OCT)

Treatment

Sophisticated procedures

• Post-CABGAngioplastiesandAngiographies

• DaycareAngioplastiesandAngiographies

• RadialAngiographiesandAngioplasties

• TransulnarAngiographiesandAngioplasties

• Renalarterystenting

• CoronaryAngiographiesandAngioplastiesinrenalfailurepatients

• Veryelderlypatientinterventions

• ThoracicandAbdominalAorticAneurysminterventions(EVAR&TEVAR)

• Angioplastiesonsinglekidneysandtransplantkidneys

Coronary Artery bypass grafting (CABG)Coronary artery bypass – elective

• Minimalaccess(smallincisions,noCPB)

• Arterialgrafts

• HighriskCABG

Coronary artery bypass – emergency

• Postarrest

• ICU–ICUtransfer

Cardiothoracic Surgery• Heartoperations

• Lungoperations

• Mechanicaldevices–VAD(ventricularassistdevice),ECMO(Extracorporealmembraneoxygenation)

• Criticalcarepreandpost-surgery

• Trauma

Valve Surgery• Replacementandrepair:Aorticvalve,Mitralvalve,

Tricuspidvalve

• Lowriskcases–majority

• Stateoftheartvalves

• Advancedassessmentforhighriskcases

• AorticSurgery

- Surgical

- Interventional

- Hybrid

Heart Surgery : Emergency Operations • ProvideICUtoICUtransferafterpreliminaryassessment

• IschemicVSD(ventricularseptaldefect)/MR(mitralregurgitation)

• AorticAneurysmsurgery:Acute&chronicaorticdissectionsurgery

• Infectiveendocarditis(infectedvalves)–evenifpatientisverysickcanstillbeconsideredforsurgery

Heart Transplant

AmultidisciplinaryapproachtoEndStageHeartFailurewasenvisagedandaformalHeartTransplantProgramcommencedin2004.Sincethen,weareperforminghearttransplantoperationsincludingaHeartandLungTransplantation

Thoracic Surgery

• FullrangeofminimalaccessthoracoscopicsurgeryavailableforLung,Oesophagus,Thymus,Mediastinalmass,Thoracicduct

• Post–opICU

• Rehabilitation(TLC)

Mechanical circulatory support

• IABP–Intra-aorticballoonpump

• LVAD–leftventricularassistdevice

• ECMO–Extracorporealmembraneoxygenation–ForemostexperiencewithECMOpatientsinICUsettingincludingperiarrestECMO

• Acuteheartfailure–massiveheartattack

• Acutelungfailure–pneumonia/ARDS(AdultRespiratoryDistressSyndrome)

• MostexperiencedforVeno-VenusECMO

Day care AngiogramsFewhaveperfectedDaycareangiographytoalevelwheretheproceduresareperformedin3-5minutes,withsub-minutefluoroscopyinthevastmajorityofthecases.

Transulnar angiographiesFewhavebeendoingTransulnarangiographiesinthosewithverythinradialarterypulseandinthosewithanomalousradialarteries,allowingdaycareprocedureseveninthesecases.

IABP & assisted PCI TheincreasinguseoftheseadjunctivemethodsunderlinestheincreasinglycomplexnatureofthePCIswearetakingup,withsuccessfulclinicaloutcomes

Post-CABG angioplasties ThemostgratifyinghasbeenangioplastyforLIMALAD anastomoticsitecriticalstenosisviaLIMAgraft

Renalarterystenting,Coronaryangiography

Day care Angiograms

Closed-chestheartsurgeryisatypeofminimallyinvasiveheartsurgeryperformedbyacardiacsurgeon.Thesurgeonusesaspeciallydesignedcomputerconsoletocontrolsurgicalinstrumentsonthinroboticarms.

Robotically-assistedsurgeryhaschangedthewaycertainheartoperationsarebeingperformed.Thistechnologyallowssurgeonstoperformcertaintypesofcomplexheartsurgerieswithsmallerincisionsandprecisemotioncontrol,offeringpatientsimprovedoutcomes.

ApolloHospitalsHyderabadusesthestateoftheartdaVinciSurgicalSystem.ThedaVinciSurgicalSystemisdesignedtoprovidesurgeonswithenhancedcapabilities,includinghigh-definition3Dvisionandamagnifiedview.

RoboticSurgerybenefitsincludeLesspost-operativepain.Reducedtraumatothebody.Lessscarring.Shorterhospitalstays.Reducedbloodlossandneedfortransfusions.Quickerrecoveryandreturntonormalactivities.

Robotic Heart Surgery

Apollo Life Center Isadedicatedrehabcentreanidealplaceforpostsurgerypatientstorelaxandrecoup.

Post intervention care and rehabilitation:

Maintenance or secondary risk reduction :• HeartDiseaseSupportGroup

• DietDiaryServices

• CounselingtoFamilymembers

• PeriodicTalks/SessionswithConsultants

Rehabilitation:• CounselingtoPatientandFamilymembers

• Physiotherapy

• VocationalReadiness

• HeartDiseaseSupportGroup

• CustomizedDiet/Nutrition

• Smoking/AlcoholCessationSessionswithConsultantsinminimallyInvasiveCoronaryArtery

Post – operative care / Rehabilitation

ApolloHealthCityisthefirsthealthcityinAsiawithmultispecialties&centersofexcellence,preventivecareandwellnessservicesinasprawlingcampus.

Apollo has modern and sophisticated diagnostic equipment’s and facilities (ICU setups) like

a. CardiothoracicCCU

b. CentreforAdvancedCardiacCare(CACC)

c. Stemcellresearch

d. PreventiveHeartCare-ApolloHeartCheckandAdvanced

Facilities offered

Summary

• CardiologyDepartmentfocusesonholisticapproachtoCardiacCarethroughinvasiveandnon-invasive,therapeuticanddiagnosticservicesmanagedbydedicatedteamofdoctors

• Atdepartmentofcardiologywehaveadedicatedteamofcardiologistswhoworkintandemtoprovidecomprehensive,multidisciplinarycaretopatientssufferingfromheartailments

• Ourteamofdoctors,nurses,techniciansandotherheartexpertsaretheretoensureexcellenceinpatientarewithhumantouch.

• DepartmentofCardiologyatApolloHospitaliscommittedtoprovidehealthcareofinternationalstandardatanaffordablecost

• Ourhighlyqualifiedteamofcardiologistsalongwiththelatesttechnologyprovidesunmatchedpatientcareandclinicaloutcomesatparwithinternationalstandards.

• TheCenterofCardio-ThoracicSurgery,ApolloHospitalsisaCenterofExcellence,whichattractsnationalandinternationalpatients

• Cardio-ThoracicteamatApolloHospitalshastheexperienceofhavingperformedalargenumberofminimallyInvasiveBypasssurgeriesinthecountry

• FrominterventiontoCardio-Thoracicsurgeryandrehabilitation,theinstitute’sapproachhingesonTheCardiosurgicalunitthathasperformedawiderangeofsurgeries–fromNeonatalopenheartsurgeriestoAneurysmsurgeries,withexcellentresults.

Prevention and treatment of heart disease has led to the achievement of better outcomes and improved quality of life for thousands of cardiac patients who visits Apollo each year.

Expertise of Cardiologist & Cardio – Thoracic Surgeons · PDF fileExpertise of...

Documents