Dr. AKHIL KUMAR RUSTAGI
With recent advancements made in the field of cardiac sciences, despite the high prevalence in number of patients with some forms of cardiac ailments have been providing with new lease of life. Intervention without the open-heart procedures are not only the most innovative scientific approaches of the recent times but is also revolutionizing the treatment outcomes in most complex cases.
The latest advancements are also helpful in determining the functional significance in some tricky situations which otherwise would be seemingly borderline, such advanced procedures not only helps in treating the patients effectively, but also improves their quality of life. While various heart ailments annually account for atleast 50% of the overall comorbidities and even premature deaths in India, it is shocking to know that there is a rise in number of people in the age bracket of 25-40 years being susceptible. In India, it has been estimated that one in every four death is attributed to ignorance of the mild symptoms and is one of the leading causes of mortality among both males and females (between 25-35 years).
Cardiac interventions like balloon mitral valvoplasty, balloon atrial valvoplasty, atrial septal or ventricular septal defect closure and similar procedures for valves and congenital defects are a routine affair at cardiac centers. There is advanced technology in cardiac intervention like radial route primary PTCA for Acute heart attack, TAVI procedure for changing the valves without open heart and Mitra clip for repair of leakage in Mitral valve without open heart surgery which has revolutionised the treatment.
Trans-Aortic Valvular Intervention (TAVI)
With advancement in the field of cardiac sciences procedures radial route primary PTCA for Acute heart attack, TAVI procedure for changing the valves without open heart and redo surgeries has revolutionised the heart disease treatment by percutaneous technique. TAVR is a procedure where Aortic valve is implanted via peripheral arterial access. For severe heart failure treatment like ECMO, LVAD and Heart Lung transplant has given new lease of life in end stage heart diseases.
Mitra Clip
Valvular heart complications are another life-threatening complication, where valve replacement remains the last resort. But with recent advancements, catheter-based procedures of Mitra clip can help in repairing the leaking heart valves without surgery. Such cases, if left untreated can lead to enlarged heart, breathlessness and even heart failures. Till now, open heart surgery with repair or replacement of the valve had been the only possible treatment for such patients in India but it is often high risk and may not be beneficial. The MitraClip is a novel catheter based non-surgical repair of the mitral valve inside the heart and is performed in the Cath Lab like angioplasty where special catheters are inserted through the large vein in the groin and the catheter is passed from the right chamber of the heart to the left chamber of the heart by puncturing the partition called interatrial septum. Then under echocardiography and X-ray guidance a clip is put on the leaking mitral valve to decrease the leak which improves the condition of patient. The patient is normally ready to be discharged in 24-48 hours’ time.
Cryoablation of the heart
This is one such recent advancement which is very effective in cases of heart rhythm disorders. Being a minimally invasive procedure, surgeons make use of a thin flexible tube (balloon catheter) to locate and freeze the heart tissues (in a controlled fashion to temperatures as low as minus 80 degrees) that triggers irregular heartbeat, in order to restore normal heart rhythm. Being a completely safe procedure, the chances to impact the healthy tissues and surrounding structures is nil, and various studies have found this procedure to be significantly more effective than medications.
Micra AV pacemakers
The device, the latest in pacemaker technology is yet another revolutionary reform made in this field, is the smallest pacemaker in the world with a battery life of 15 years, weighing a mere 15 grams and has dual chamber capabilities. Till date, it has been implanted only in two other hospitals across India. The real-world use of Micra has shown a 63% reduction in major complications compared to traditional pacemakers. In comparison to the traditional pacemakers, the Micra AV is MRI compatible and there are no leads attached. Micra AV involves placing it in the heart via vein in the leg thereby eliminating the need for an incision in the chest and any possibility of infection. It is completely self-contained within the heart, thereby eliminating any potential medical complications arising from a chest incision and from wires running from a conventional pacemaker into the heart.
Trans-Aortic Valvular Intervention (TAVI)
With advancement in the field of cardiac sciences procedures radial route primary PTCA for Acute heart attack, TAVI procedure for changing the valves without open heart and redo surgeries has revolutionised the heart disease treatment by percutaneous technique. TAVR is a procedure where Aortic valve is implanted via peripheral arterial access. For severe heart failure treatment like ECMO, LVAD and Heart Lung transplant has given new lease of life in end stage heart diseases.
Minimally Invasive Heart Surgery Techniques are extremely beneficial for patients as the procedure requires less time, less blood loss, less pain and patient has to spend considerably less time in the ICU and hospital after the surgery. In fact, most patients resume their jobs and duties much faster and with renewed confidence and self-love. Among the heart diseases, occurring in adults the coronary artery disease is a very common and when clubbed with co-morbidities like hypertension and diabetes, it may lead to heart attack which may be fatal. Treatment of coronary artery disease is possible by bypass surgery and now the most advanced and latest technique of ‘Total Arterial Bypass’, which is superior to all other methods.
With the availability of versatile surgeon who are proficient in performing Surgery for Adult and Congenital Heart Diseases which includes CABG – Redo, Cardiac Valve Replacement, Coronary Artery Bypass Grafting (CABG), Heart Double Valve Replacement (Holes in the heart like ASD, VSD, TOI, PDA COA), our aim is to educate people on how to live a healthy lifestyle.
(Dr. Akhil Kumar Rustagi is Head, Cardiac Sciences and CTVS, Yatharth Super Specialty Hospital, Greater Noida)
