The Department of Cardiothoracic and Vascular Surgery (CTVS) at Columbia Asia Hospitals offer a broad spectrum of the latest procedures in cardiothoracic and vascular surgery for adults and children. The surgeons in this department are highly qualified, experienced and are trained in reputed institutes. Coronary artery bypass graft (CABG) is the most common procedure performed and a vast majority of these are Beating heart surgeries. This decreases the length of stay in the hospital and reduces complications in patients.
The department has the capability to perform Video Assisted Thoracoscopic surgeries (VATS) in both adult and pediatric patients with lung diseases.
Surgeries are performed with minimal use of blood products and the surgeons have also successfully operated on patients who are Jehovah’s witnesses. Post- operatively patients are closely monitored in a dedicated intensive care unit.
The Department of CTVS at Columbia Asia Hospitals, is well supported by round the clock laboratory, ICU, radiology, and emergency services to ensure patients receive the highest level of care in a timely manner.
Treatments and Procedures
- Adult and pediatric cardiothoracic surgeries
- CABG (Coronary Artery Bypass Graft)
- Video-assisted thoracoscopic surgery (VATS)
- Reconstructive surgery for diffuse coronary artery disease
- Surgery for ischemic mitral regurgitation and post-infarct ventricular septal defects
- Re-do heart surgery (for both valve and CABG operations)
- DOR procedure for left ventricular aneurysms (left ventricular reconstructive surgery).
- Valve repair and replacements
- Stent-less heart valve surgery
- Grown Up Congenital Heart (GUCH) operations
- Open heart surgery for complex and simple congenital heart defects
- Vascular surgery for Bentall and valve-sparing operation for ascending aortic aneurysms with aortic valve disease.
- Minimally invasive surgeries for congenital atrial septal defect, aortic and mitral valve replacements
- Thoracic surgery
Anatomy Of The Heart
The human heart is a little bigger than the fist and is located just behind the sternum or breast bone, a little to the left. The heart pumps blood to the various parts of the body and receives blood with carbon dioxide, which is pumped to the lungs for oxygenation.
The heart has four chambers; the right atrium, right ventricle, the left atrium and left ventricle.
Blood from the body and head enters the right atrium of the heart through a large vein, the vena cava. From here, blood passes to the right ventricle to the lungs where it loses the carbon dioxide and gets more oxygen. It then returns to the left atrium of the heart, from where it flows to the left ventricle and thereafter to the various parts of the body and brain. There is a bundle of nerves in the wall of the right atrium called the sinus node from which electrical impulses enable the pumping action of the heart.
Preparations For Heart Surgery
- Blood tests, ECG, chest x-ray and ECHO are mandatory tests
- Your doctor will explain all about the surgery, its risks and benefits. You can clarify any doubts you may have. You will then have to sign a consent form.
- You will have to fast overnight. No water is permitted either.
- Bathe or shower with anti-bacterial soap.
- No makeup or nail polish is allowed.
- You should not wear any jewellery, watch or carry any money.
- You will be given a hospital gown to wear.
- Keep the identity band on your wrist.
- Follow the doctor’s advice regarding your usual medication.
- The hair on your chest may be shaved.
- Do not wear contacts, spectacles or dentures when coming for the surgery.
Complications Of Heart Surgery
Complications include the following but are not limited to these only:
Lung infection, urinary tract infection and wound infection are the commonest sites for infection after a heart surgery. Regular physiotherapy helps prevent infection in the lungs.
All patients receive antibiotics at the start of the surgery and the operation theatre protocols include strict infection control practices and hence,surgical site infection is uncommon. However, those with lowered immunity like diabetics, smokers and those on long-term steroids are prone to infections.
It may occur at any time after surgery within the first few days. 1-2% is the risk of getting a stroke. It is common for patients to make a complete recovery. Weaknesses on one side of the body or difficulty in speaking are the common symptoms. Those with a previous history of stroke or those with carotid artery disease are at a higher risk (10%).
It can occur in the first few hours after the surgery and may be due to the use of anti-coagulants during the surgery. The risk is about 5%. Sometimes, there may be bleeding from a small blood vessel and in such cases the chest is reopened and the bleeding is stopped.
In some patients, there may be improper renal functioning after the heart surgery, requiring dialysis. But this is usually temporary.
It can occur in chronic smokers and those with lung diseases. This may necessitate long-term use of ventilator support.
Atrial fibrillation and abnormal heart rhythm
it is seen in 25-30% of the patients after the surgery. Palpitations, sweating, nausea and dizziness are common symptoms. Some people have bradycardia, which slows the heart rate and may need a temporary pace maker.
It may occur in 1-2% of cases. Those who have had surgeries before have a higher risk.
Cardiac Critical Care Unit Or Cardiac Intensive Care Unit
This unit is a specialised area in the hospital for patients with heart problems to be continuously monitored. After heart surgery, all patients will be in the intensive care unit for at least 48 hours.
The cardiac critical care unit at Columbia Asia Hospitals is manned by highly skilled doctors, nurses and technicians, who continuously monitor patients. 1:1 nursing is available.
The patient is attached to a cardiac monitor and his / her blood pressure, temperature, pulse and respiratory rate are monitored. Chest drains may be in place but will be removed before discharge from intensive care unit. Pacing wires which if not in use, will be coiled and covered with a dressing. These are removed on about the fourth day after the surgery.
Physiotherapy will be started a day after the surgery and continued in the ward.
Commonly Done Heart Surgeries
Adult cardiac surgeries
- CABG (Coronary artery bypass graft): It is done using the beating heart surgery technique, where arterial graft is done on a beating heart with or without using a heart-lung machine. The graft is usually taken from the patient’s leg vein (saphenous vein) or artery inside the chest (internal mammary artery) to create a new route for oxygen rich blood to reach the heart. Grafts last for about 10-12 years. A heart-lung machine is used to circulate and oxygenate blood during the surgery. In the conventional method of surgery, a 10-12” long incision is made through the breast bone. The latest technique is the minimally invasive approach done through a laparoscope which reduces blood loss and shortens hospital stay. A heart-lung machine is not required for the minimally invasive approach. The laparoscopic method is preferred when the number of blocks is one or two.
- Surgery for ischemic mitral valve regurgitation and post infarct ventricular septal defects
- Valve repair and replacement is done when heart valves are damaged or diseased and do not function properly causing the heart muscle to work harder to pump the blood through the valve. The valves may not open fully or may have problems closing. Replacement is done with a prosthetic valve, which may be made from man-made materials or a biological valve taken from the pig, cow or human donors. The advantage of the man-made valve is that it lasts longer but requires long term use of anti-coagulants. The type of valve is decided based on age, occupation, size of the valve, your heart functions and ability to withstand anti-coagulants. Valve repair or replacement can be done by the conventional method or minimally invasive approach. A heart-lung machine is used to keep circulation of blood going.
- Redo surgery for valve replacement and CABG
- DOR operation for left ventricular aneurysms
- GUCH (grow--up congenital heart) operations are done for those who have congenital heart disease and have crossed adolescence without any symptoms.
Paediatric cardiac surgery
- Newborn heart surgery for babies less than 1 month of age
- Open heart surgery for congenital heart defects like holes in the heart and great vessels (atrial septal defect, ventricular septal defect)
- Blocks in the blood flow (aortic stenosis, pulmonary stenosis, coarctation of the aorta)
- Complex defects (blue babies) like single ventricle, tetralogy of fallot, transposition of great arteries (TGA) etc.
- Cosmetic approaches for congenital heart surgery: minimally invasive cardiac surgery
- Cath-based interventions and assessment for atrial septal defects, ventricular septal defects, patent ductus arteriosus and device closure
- Bentall operation for ascending aortic aneurysm with aortic valve disease. This is a cardiac surgery involving replacement of the aortic valve, aortic root and ascending aorta with re-implantation of the coronary arteries into a composite graft.
- Carotid endarterectomy along with CABG is done when atherosclerosis blocks both the coronary artery which supplies blood to the brain and coronary artery that supplies blood to the heart.
- Resection of cardiac myxomas
- Peripheral vascular surgeries for ischemic limbs like aorta femoral bypass, femoro popliteal / distal bypass grafting, axillo femoral bypass grafting are done as limb saving procedures and to reduce claudication pain and to help ischemic ulcers heal.
- In symptomatic varicose veins, endovascular laser therapy is being done routinely as a minimally invasive procedure with good results and in reducing symptoms and helps venous ulcers heal.
- On dialysis in renal failure patients, vascular access is created for haemodialysis. Creation of arterio venous fistulas, AV grafts with PTFE (polytetrafluoroethylene) tube grafts is done with good results.
Minimally Invasive Heart Surgeries
Minimally invasive heart surgeries are performed by specially trained heart surgeons. They perform the surgery through small incisions in the right side of your chest, between the ribs. The surgeon gets a better and wider view of the heart than in conventional surgery. In some instances, the heart-lung machine is used to bypass the heart and continue circulation even while the surgery is being done.
Minimally invasive approach is done for:
- Mitral valve repair and replacement
- Tricuspid valve repair and replacement
- Aortic valve replacement
- Atrial septal defect and patent foramen ovale closure
- Atrioventricular septal defect surgery
- Maze procedure for atrial fibrillation
- Coronary artery bypass surgery
- Saphenous vein harvest for coronary artery bypass
- Less blood loss
- Lower risk of infection
- Reduced trauma and pain
- Shorter hospital stay
- Faster recovery and quicker return to normal activities
- Smaller scars
Risks and complications include the following but are not limited to these only:
- Wound infection
- Irregular heartbeats (arrhythmias)