The Heart Institute at Nanavati Super Speciality Hospital is a unique and dedicated institution of cardiac care, which has achieved a perfect blend of clinical excellence and aesthetic ambience. The department has a team of highly experienced and qualified faculty, providing 24x7 Interventional Cardiac Services, such as radial and femoral coronary angiography, angioplasty, peripheral and neurological interventions, paediatric interventions as well as electrophysiological ablation.
The department routinely performs complex cardiac procedures like Mitral-Valvuloplasties, Permanent Pacemaker Implantation, Cardiac Resynchronisation procedures, Automatic Implantable Cardioverter Defibrillator (AICD), Implantation and procedures for congenital ailments such as Coarctation of Aorta, Stenting and Patent Ductus Arteriosus (PDA) closure.
The Centre offers a full range of non-invasive and advanced diagnostic services including Ambulatory Blood Pressure Monitoring (ABPM), Head-Up Table Tilt (HUTT) Test, Coronary Computed Tomography Angiography (CCTA) as well as Nuclear Scans for Cardiology.
The division of Cardio-Thoracic and Vascular Surgery is an established centre for Coronary Bypass Surgery (CABG), Valve Replacement, Valve Repair, Aortic root and Aneurysm surgeries. Nanavati is amongst the few centres offering Minimal Invasive Bypass surgeries in the region and most cardiac bypass surgeries are total arterial revascularisation, off pump surgeries, making the Centre at par with the best in the world. The department also offers a complete range of diagnostic and therapeutic options, such as Endovascular Revascularization, AV Fistula Construction, Deep Venous Thrombosis (DVT) Treatment, Peripheral Bypass procedures and Peripheral Angioplasty.
New highlight in the heart institute - Catheterization Lab
Recently, AlluraXper FD 10 System has been installed. This machine is the first of its kind in Mumbai. It has many excellent features like big screen (LED 56"), swing camera and dose reduction. All these features make this machine unique and better as compared to those in other Cath Labs. One can have 1 to 6 images on the screen with no change in table position as the camera swings in various standard views automatically. A dedicated Intensive Cardiac Care Unit (ICCU) adjacent to Cath Lab and Cardiac Operation Theatre (OT) is fully equipped to handle all cardiac emergencies.
Beating heart Surgery or Coronary Artery Bypass Graft Surgery (CABG)
There is a long history of extraordinary cardiac services and successful heart surgeries that have saved many lives. The cardiac surgical treatments have come a long way and is enhancing multi-fold through innovative techniques and researches. Today, one of the most common and recommendable surgeries to restore blood flow to the heart is beating heart CABG (Coronary Artery Bypass Graft Surgery). It’s a safer alternative to the traditional treatments where the surgery is performed while the heart is still beating.
The process is done to restore the supply of blood flow to the heart which has been restricted by the build-up of plaque or toxins in the blood vessels. In CABG, a surgeon performs the entire surgery while the heart beats are still on. This involves rerouting of the blood round the blocked portion of artery using a new piece of an artery from another part of the body; the reason it is also called OP-CAB (Off-Pump Coronary Artery Bypass Graft Surgery).
In a traditional set-up, a heart-lung machine takes over the functions of the circulatory system while the surgery is still on. But in the grafting off-pump method, neither the heart is stopped nor is a heart – lung machine used. So, OP-CAB becomes technically demanding for both surgeons as well as anaesthesiologists. Performing or ‘sewing’ on a beating heart is quite a challenge. For this the doctors use stabilization system and special tools to immobilize and position the area of the heart where they need to work. Here they don’t use the pump hence it is called off-pump surgery.
Both, OP-CAB and the conventional on-pump surgeries restore blood flow but comparatively OP-CAB offers the patients less risk for complications and side effects. On the other hand, contemporary surgical method can do away with the chances of bleeding, strokes, kidney failure and cognitive problems.
Heart Valve Surgery
Heart valve surgery is an operation which treats the faulty heart valves so that the heart functions properly to keep the blood flow normal. There are different valves in heart which are crucial for one-way blood flow mechanism in heart. These valves, if damaged or dysfunctional have to be repaired or replaced to keep up with the normal functioning of heart. During valve repair or replacement surgery, the breastbone is divided, the heart is stopped, and blood is sent through a heart-lung machine. Heart valve surgery is an open-heart surgery through the breastbone and into the chest and it takes four to six hours for the operation to complete.
The role of valves and the purpose of surgery
There are four valves in the heart namely mitral valve, tricuspid valve, pulmonary valve and aortic valve. These valves open and close periodically and control the natural flow of blood. Valves have flaps or door-like structures at their ends which open with each heart-beat and then close tightly to prevent the back-flow of blood. But when there is a disorder in the mechanism, it affects other structures of the heart and the blood blow. But with modern heart valve repair and replacement procedures, these issues can be fixed and the heart valves can be brought back to its normal functioning.
Types of heart valve surgeries
To preserve the heart valves which are damaged, doctors and surgeons suggest a surgery. Doctors can suggest valve replacement or repair depending upon the type of case. Doctors will discuss the benefits and risks of each procedure and recommend you the surgery accordingly. However, if the damage is very mild it can be treated with medicines. So, mainly the two different procedures are heart valve repair and heart valve replacement.
Heart Valve Repair Surgery
The repair surgery is done when the valves are faulty but in a repairable condition. It is performed using a sleek and long tube structure (catheter) and clips, plugs and other devices. In this procedure, a doctor inserts a catheter with a balloon on the tip into an artery in your arm or groin and takes it to the affected valve. The balloon is then inflated to expand the opening of the heart valve. Later it is deflated and removed. Procedures involved in heart valve repair are:-
• Patching the holes or tears in valves
• Reconnecting the flaps (leaflets or cusps)
• Removing excess tissues from valves
• Structural support (Replacing cords)
• Separating the fused flaps
• Valvuloplasty- Tightening the outside of valves with ring-like device
• Decalcification (To remove excess calcium build-up)
Heart Valve Replacement
When the heart valves degenerate over time and are too damaged to be repaired, cardiothoracic surgeons recommend heart valve replacement. The method involves removing the faulty heart valve and replacing it with a mechanical valve or biological valves. This generally involves replacing the aortic and mitral valves.
Mechanical valves- For this they use plastic or metal in the replacement. These materials are long lasting and durable.
Biological valves or bio-prosthetic valves- These are specially prepared natural valves from animals like cows and pigs and human donors.
Auto-graft- Sometimes, a patient’s own tissue can be used for valve replacement
Considerations for heart valve surgery
• Understanding the heart valve problem in patient
• Assessing the risks and circumstances
• Extent of damage of the valves
• Age of the patient
There are different factors, situations and circumstances which enable the surgeons to decide whether a repair or a replacement is required. In some cases, a redo surgery is also recommended after the repair and replacement of the valves
Minimally Invasive Coronary Bypass Surgery (CABG)
There has always been a variety of techniques doctors use to perform a cardiac bypass surgery. As far as possible doctors make it a point to operate in a way that causes less damage to the body. So, for a greater control, less side effects and pain; the cardiac surgeons recommend the newer form of heart surgery called Minimally Invasive Coronary Artery Bypass or MICS CABG. It is a break thorough approach and an advanced technique which involves a small incision on the chest and provides faster recovery and lower risks for complications.
The goal of Minimally Invasive Cardiac Surgery is same as any other coronary bypass surgery – to improve blood flow to the heart and to alleviate chest pain. But the difference is that instead of making a long incision, doctors operate between the ribs which causes less pain and damage. The traditional open heart surgery requires the doctors to make a large/long cut through the breastbone (sternotomy) which causes more pain, damage and loss of blood.
Minimally invasive surgery is performed from the left side of the chest using a high-definition endoscopic system (insertion of a tiny camera for the better view). With highly advanced instruments, advanced techniques, skilled surgeons and clinicians, the surgery is performed very safely making it one of the most recommended procedures in bypass heart surgery. Also, it is an off-pump or beating heart operation but a pump-support may be required if the heart of the patient is weak.
Minimally Invasive Heart Surgery may be performed to treat a variety of heart conditions including Mitral Valve repair, Aortic valve replacement, Coronary artery bypass surgery, Atrio-ventricular septal defect surgery, patent foramen ovale closure etc.
The advantages of Minimally Invasive Surgery as compared to Open-Heart Surgery:-
Each and every part of the body has a different definition in a medical language and so are the surgeries related to it. There are highly specialized fields focussing on various diagnosis and treatments. No wonder, Vascular surgeries are one of those wide varieties of skilled procedures performed to treat the diseases and defects related to vascular system. A vascular system disorder is related to the disorders of the arteries, vein, capillaries and lymphatic circulation. Vascular surgery is an aspect which treats and repairs the network of blood vessels and reroute the supply of blood in a normal way.
From diagnosis and medical treatment to reconstructive vascular surgery and endovascular techniques; the vascular surgery includes a number of techniques to repair damaged, tightened or partially-blocked vessels. Few of the techniques and methods to mention are:-
• Complex aortic aneurysm- To repair the body’s largest artery called aorta. The aorta can at times widen, stretch or even burst due to infection or weakness.
• Vascular Bypass Or Vascular Graft- This surgery is performed to treat PAD (peripheral arterial blocks). When the arteries become hard or narrow, it gets difficult for the arms and feet to have a proper supply of blood. The Vascular Bypass includes cleaning of such blocked arteries. The graft used can be a plastic tube or a blood vessel taken from a patient’s body.
• Carotid artery surgery- The goal in treating this disease is to prevent a stroke. When there is immense pressure in carotid arteries, it can become severe and surgeons aim to remove blockage from the arteries. In this surgery, the affected carotid arteries are repaired through endarterectomy or grafting.
The basic aim of all these procedures of vascular surgeries is to reconstruct the repair vessels and arteries and reroute the blood supply to various parts and organs for normal functioning of the body. There are possibilities of many vascular conditions in nascent/early stage to be treated without surgery, radiology or invasive procedures. But the final decision always lies in the hands of surgeons.
Re-do or re-operative Heart Surgery
As the name suggests, re-do heart surgery signifies operating upon the same patient who has already undergone an operation in the past. This indicates a high difficulty level in a surgery and involves higher risk factors as one by-pass surgery has already been performed. However, numerous skilful and experienced cardiac surgeons have made the re-operative procedure common and recommend it for the heart to function more efficiently. The surgical procedure is also called Cardiac Surgery.
In a normal by-pass surgery, a new artery is taken which acts as a ‘graft’ to provide ‘new blood supply’ to the original artery. In simple words, the blockage remains there but it gets by-passed through a different route. Well, the aim of redo surgery is also the same which is to provide adequate blood to the heart muscle. But it gets far more difficult and complex because the new graft need place to be connected to the original artery. The old grafts which are already there cannot be considered again, hence in second time the surgery becomes more challenging and demanding. Extra care and patience needs to be taken by both doctors as well as patients undergoing redo surgery.
Re-operative heart surgeries may be performed for treating dysfunctional valves, for the bypass surgery, for aneurysm (bulging of blood vessels) repair, for inflammation of inner heart later due to artificial cardiac valve and for other heart failures and flaws.
Redo Bypass Surgery involves a long incision on the chest as it requires separation of the breastbone. Infact it is much more complicated than a regular CBDG procedure. CABG Redo is done on patients who are co-morbid with conditions like sclerotic coronary and non-cardiac arteries. This makes it a far more intricate and complex procedure. However, if you talk about the outcome, a redo operation can provide a longer life, less chest pain, less fatigue and more energy in future to the patients.
The procedures associated with this congenital heart surgery are :-