Robotic cardiac surgery

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Hospitals for cardiac arrest treatment


AHI Cardiac Surgery Team is the best in the world and has performed more than 18,000 heart surgeries and 3,000 complex cases, many of them considered inoperable and the Team was selected for PM’s Redo surgery.

What is a bypass surgery?


Imagine traveling by road and getting stuck in a traffic jam. To 'bypass' the jam, you take another route and join the same road back again. That's exactly what takes place in a CABG (Coronary Artery Bypass Graft surgery) or commonly known as bypass surgery.

Coronary Artery Bypass Grafting (CABG) is a surgical procedure done to create a 'bypass' around the blocked part of a coronary artery (blood vessels that supply blood to the heart) to restore blood supply to the heart muscle. The bypass is made with the help of blood vessels (known as grafts taken from the other parts of the body (leg, hand, chest wall, etc.)


Why and when is a bypass done?


When one or more of the coronary arteries becomes partially or totally blocked, the heart does not get adequate blood supply. This is called an ischemic heart disease or Coronary Artery Disease (CAD). It can cause heart pain (angina) or a heart attack (myocardial infarction).


CABG is one of the treatment options for ischemic heart disease. Bypass surgery is


advised for:



1. Disease of the left main coronary artery


2. Significant, multiple blockages in all three main vessels of the heart


3. Failure of angioplasty


4. When the efficiency of the left ventricle is reduced to less than adequate.




How is the surgery done?


1) Before the surgery


Once the patient has been diagnosed with a triple vessel disease and has been advised

to undergo a bypass surgery he has to plan accordingly.For a bypass surgery a stay in

the hospital of approximately 10 days is expected with a recovery time of a month after

the surgery to get back to the normal routine.


The patient is generally put on blood thinners after being diagnosed with a triple vessel

disease. So before the surgery the patient is expected to stop blood thinners 5 days

prior.


The patient plans with his surgeon or assistant doctors to surgeons and comes for

pre-operative investigations.


These are important as the surgery would not be carried out unless the patient is found

to be fit to undergo surgery.


This is important to avoid complications during surgery and to ensure a smooth

recovery.


With any deviation in the parameters the patient is treated for the same before being

taken for the surgery.


The pre-operative investigations include the following:


· Blood tests: includes CBC, Serological tests, blood grouping, blood sugars,


· Urine tests: creatinine, electrolytes


· Chest x-ray


· Ultra sonography


· Carotid and radial Doppler studies


· 2D Echo


· CT angiography of the internal mammary arteries


· Sputum and nasal swabs to check for any active infections in the body


· Lung function tests


a) Preparing the patient:


· On the day of surgery the patient is given medicines to reduce anxiety and then rolled

into the Operation Theatre (OT)


· Electrodes connected to ECG monitor are attached to the patient’s back to monitor the

heart’s activity during the operation


· Intravenous lines are then inserted into the veins of the wrist or arm for administration

of medicines and salt solutions


· One IV line is threaded up the vein all the way to the vena cava ( the biggest vessel that

carries impure blood from all the parts of the body to the heart) to allow administration

of medication directly to the heart.


· A Foley’s catheter is inserted into the patient’s bladder for collection of the urine. Urine

output helps to determine the functioning of the kidney.


· After the initial preparation the patient is anaesthetized by an anesthetist who then

carefully monitors the patien’ts vital signs throughout the operation.


· After the patient is anesthetized , a tube is inserted into the windpipe which is

connected to a respirator that performs the work of breathing.


· Another naso-gastric ( which goes from nose to the stomach) is inserted through the

nose to collect stomach fluids.


b) Surgery:


· For the surgery, first the chest is cut open at the mid line of the breast bone ( sternum)

and the sternum is separated.


· Then the internal mammary artery to be used for the surgery is separated from the

chest wall gently.


· Then the surgeon will work on the patients limbs to remove the vein or the artery.


· After this the grafting of the conduits is done.


· After several hours of grafting the chest closure is done in layers.


· The patient is then shifted to the ICU


In a traditional bypass surgery, the heart is stopped after connecting to the heart long

machine, which adds oxygen to the blood and circulates it to the other parts of the body

during surgery. This is necessary because the heart muscle must be stopped before the

grafting can be done.


However, in a beating heart surgery the heart lung machine is not used and the surgery

is performed on a beating heart. This method is know as an Off-Pump Coronary Artery

Bypass surgery (OPCAB) or beating heart surgery.


It allows the bypass to be created while the heart is still beating by using a device known

as 'octopus'. The advantage is a quicker recovery, fewer complications and better long

term outcome, especially in elderly patients and in patients with problems like kidney

failure, previous brain strokes, etc. Asian Heart Institute is one of the few centers in the

world that specializes in this type of surgery, performing nearly 100% of its bypass

surgeries on a beating heart with a very significant percentage using total arterial

grafting.


c) stay in the ICU:


· The patient stays in the ICU for 3-4 days depending upon his clinical condition after

which he is shifted to the wards.


· In the ICU the vitals are carefully monitored as it is the most critical stage after surgery.


Redo bypass surgery


A second or redo bypass surgery is needed if blockages develop after the first surgery. It

is complex and risky because after surgery, the heart and lungs stick to the breast bone.

A beating heart surgery using arterial grafts reduces the risk of a redo bypass surgery. At

Asian Heart Institute redo bypass surgery is also performed 'Off-Pump', thereby

suggesting the competence of the team.


Re-redo bypass surgery


Owing to the complications, a third bypass surgery is very rare.


Frequently Asked Questions After Bypass Surgery


1. When can I drive on my own?


It is wise to wait for 2 months after surgery, before driving on your own. This is the

amount of time it takes for the healing of your sternum (breast bone), which was cut

open during surgery. Any chance injury, can cause damage if driving is started too early.

Please consult with your surgical team before undertaking any activity after a bypass.


2. Can I travel by car?


Yes. You may travel by car as soon as you are discharged. However, for the first few

weeks, it is advisable to restrict your travel to less than two hours. If the drive is going to

be longer, then take a break every two hours and walk around for a few minutes.


3. Should I speak less?


There is no reason for you to 'speak less' after surgery. However, during the first few

days of your recovery, you might feel short of breath while speaking for a long period of

time. If so, your body is telling you to rest, and your may keep silent for some time.


4. Will eating curd or watermelon affect the


stitches and slow down the healing of the breast bone?


No. Eating curd or watermelon has no effect on your stitches and healing process.


5. When can I start climbing the staircase?


If there is an elevator, there is no need to climb stairs just for the sake of exercising. If

you do not have an elevator and have to take the staircase, you can do so as soon as you

are discharged. While climbing, pace yourself. Take a minute's rest after climbing 10-12

steps during the first week after discharge. As your walking capacity increases, there is

no restriction on climbing steps, as long as you do not run out of breath.


6. When can I go back to work?


It is advisable to wait for at least 2 months after surgery before returning to work.

However, depending on the condition of your heart, you may be able to start light work

after a month. Please consult with your doctor before returning back to work.


7. What about the blockages in the arteries, will they remain?


The blockages which are present is the arteries remain as they were. The 'graft' which

provides the 'new blood supply' is connected below your old blockages, thereby

providing adequate blood to the heart muscle.


8. After my surgery, why do I still feel pain in my chest?


To perform your surgery, your chest-bone was cut open and stitched together after surgery. It is quite normal to feel some pain or altered sensations in your chest region for a few months after surgery. However, this pain will be different from the pain of 'angina' which you might have experienced before surgery.

9. What are the restrictions after CABG?

For the first three months avoid swimming, driving, sex, breath holding exercises and yoga. This is because your heart is at time irritable and sensitive. It may lead to irregular heart beat and could be risky for you.


The AHI Advantage


The latest trend in healthcare is to have lesser invasive surgeries, i.e. surgeries which involve minimal cuts & ensure that patient has a faster recovery. Keyhole or Minimally Invasive Surgery (MIS) is a modern innovative surgical technique that reduces the patient's post-surgery distress & allows them to return back to their normal life in just a couple of days. In Minimally Invasive Surgery (MIS) is a modern innovative surgical technique that reduces the patient's post-surgery distress & allows them to return back to their normal life in just a couple of days. In Minimally Invasive Surgery, surgeons operate through tiny incisions with the help of long instruments and HD cameras. The AHI team is one of the leading experts in Minimally Invasive Bypass Surgery in India. The team has pioneered the LESS (Lower End Sternum Split) technique which entails only a two – three inch incision in the chest in order to carry out a coronary artery bypass surgery, thereby enabling patients to be discharged within 2-3 days. The LESS is advantageous for patients requiring less number of grafts. Depending on your condition your surgeon will decide whether you can undergo surgery through LESS technique.


Recovery/ Prognosis:


Recovery from the surgery takes time. The patient who has received a CABG can expect considerable relief from symptoms and in many cases, increase life span. It should be remembered however that the graft vessels are subject to fatty blockage at any increased rate, so care must still be taken to reduce the risk factors that cause the

original blockage.


You can do many things to reduce the risk factors like:


· Not smoking

· Regular exercising

· Control of vitals like Blood Pressure, sugar levels, cholesterol levels etc

· Rectification of other clinical conditions if any


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