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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
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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¢ersofexcellence,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.