Expertise of Cardiologist & Cardio – Thoracic Surgeons · PDF fileExpertise of Cardiologist & Cardio – Thoracic Surgeons ... training in CTVS, Interventional ......

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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.

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• 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

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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)

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Emergency Service

• Thefirstcomprehensiveemergencymanagementservicesinthecountryusingasingle,toll-freenumber

• ThefirsttostarttheconceptofPreHospitalcarewheretreatmentwillstartonsiteforeffectivemanagementofthepatient

• Supportedby5StateofArtEmergencyroomsstaffedbyclinicianscertifiedbyAmericanHeartAssociation

• EstablishedClinicalProtocolsforHeartManagement

• AirAmbulanceServicesforremoteareasandlife–threateningemergencies

1066 has saved many lives

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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

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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

TEE

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• 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)

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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

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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

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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

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Incatheterablation,theRFcatheterdeliversalowvoltage;highfrequencycurrenttodestroytheareasproducingabnormalrhythmtherebypreventingfurthertriggeringoftachyarrhythmia

• Advanced3DmappingsystemenhancestheaccuracyofdeliveringRFablationwhichtranslatesintohighsuccessrate

Benefits:

• QualityofCare:Mostcardiacarrhythmiascanbetreatedandcuredbycatheterablationtherebyeliminatingtheneedforlifelongtherapy

• QualityofLife:CatheterAblationcanrestorethequalityoflifeofthepatientleadingtoahappierfamilylifeanimprovedproductivityatworkplace

• SaveLives:Somelife-threateningVentrIcularArrhythmiascanbesuccessfullytreatedwithcatheterablationtherebypreventingsuddencardiacdeath

• CostofCare:Theoveralllifecyclecostsofcareforthepatientmayreducedduetothecurativenatureofcatheterablationtherapy

Radiofrequency (RF) catheter ablation

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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

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FDG Cardiac Viability

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

Ammonia Myocardial Perfusion

Ammonia Myocardial Perfusion

• TheabilitytoobtainquantitativevaluesofflowandmyocardialflowreservehasbeenperceivedasanimportantadvantageofPEToverconventionalSPECT,whichthereforeprovidesfunctionalinformationfarbeyondtheepicardialsectionofthecoronaryvasculartree

SPECT CT

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

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• 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

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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

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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

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AmultidisciplinaryapproachtoEndStageHeartFailurewasenvisagedandaformalHeartTransplantProgramcommencedin2004.Sincethen,weareperforminghearttransplantoperationsincludingaHeartandLungTransplantation

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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

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Day care AngiogramsFewhaveperfectedDaycareangiographytoalevelwheretheproceduresareperformedin3-5minutes,withsub-minutefluoroscopyinthevastmajorityofthecases.

Transulnar angiographiesFewhavebeendoingTransulnarangiographiesinthosewithverythinradialarterypulseandinthosewithanomalousradialarteries,allowingdaycareprocedureseveninthesecases.

IABP & assisted PCI TheincreasinguseoftheseadjunctivemethodsunderlinestheincreasinglycomplexnatureofthePCIswearetakingup,withsuccessfulclinicaloutcomes

Post-CABG angioplasties ThemostgratifyinghasbeenangioplastyforLIMALAD anastomoticsitecriticalstenosisviaLIMAgraft

Renalarterystenting,Coronaryangiography

Day care Angiograms

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Closed-chestheartsurgeryisatypeofminimallyinvasiveheartsurgeryperformedbyacardiacsurgeon.Thesurgeonusesaspeciallydesignedcomputerconsoletocontrolsurgicalinstrumentsonthinroboticarms.

Robotically-assistedsurgeryhaschangedthewaycertainheartoperationsarebeingperformed.Thistechnologyallowssurgeonstoperformcertaintypesofcomplexheartsurgerieswithsmallerincisionsandprecisemotioncontrol,offeringpatientsimprovedoutcomes.

ApolloHospitalsHyderabadusesthestateoftheartdaVinciSurgicalSystem.ThedaVinciSurgicalSystemisdesignedtoprovidesurgeonswithenhancedcapabilities,includinghigh-definition3Dvisionandamagnifiedview.

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

Robotic Heart Surgery

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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.

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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

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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.