Cardiovascular and Thoracic Surgery
7 DoctorsOverview
The Department of Cardiovascular and Thoracic Surgery at Amrita is one of the busiest programs in the country. Over 2000 cardiac surgical operations have been performed annually. A fully functioning heart team will evaluate and decide the choice of treatment for complex heart conditions requiring surgery. The heart team includes 7 surgeons, 10 anesthesiologists, and 9 cardiologists with inputs from other subspecialists.
Diseases Treated
Coronary Artery Disease (CAD):
- Coronary Artery Bypass Grafting (CABG)
- Off-pump CABG (OPCAB)
- Total Arterial Revascularization
- Coronary Endarterectomy
Heart Valve Disease:
- Valve Repair
- Valve Replacement (Mechanical and Biological)
- Mitral Valve Repair Program
Aortic Diseases:
- Valve Sparing Aortic Root Replacement
- Bentall De Bono Procedure
- Aortic Arch Replacement
- Thoracoabdominal Aneurysm Repair
- Aortic Dissection
Hypertrophic Cardiomyopathy (HCM):
- Extended Septal Myectomy
Heart Transplant and Ventricular Assist Devices:
- Heart Transplant
- Ventricular Assist Devices (THORATEC HEART MATE 2, BERLIN HEART)
Minimally Invasive Cardiac Surgery (MICS):
- Minimally Invasive Coronary Artery Bypass Surgery
- Minimally Invasive Valve Repair/Replacement
Extracorporeal Membrane Oxygenation (ECMO):
- Venovenous ECMO
- Venoarterial ECMO
Pulmonary Thromboendarterectomy:
- Removal of Blood Clots in Lung Arteries
Thoracic Surgery:
- Lung Cancer Management
- Chest Wall Tumor Excision and Reconstruction
- Mediastinal Tumor Excision
- Bullectomy, Pleurodesis, and Lung Volume Reduction Surgery (LVRS)
- Decortication
- Thoracic Sympathectomy
- Thymectomy
- Mediastinoscopy
- Robotic Thoracic Surgery/Minimally Invasive Thoracic Surgery
Carotid Interventions:
- Carotid Endarterectomy
Features
- Adult Cardiac Surgery
- Pediatric Cardiac surgery
- Thoracic Surgery
- Minimally Invasive (Video-assisted) Thoracic Surgery
- Robotic Thoracic Surgery
- Centre for Excellences
- Mitral Valve Repair Program
- Centre for Aortic Diseases and Marfan Syndrome
- Centre for Hypertrophic Cardiomyopathy
- Robotic Thoracic Surgery Centre
Academy
Courses offered
- Fully Functional super-specialty training program for MCh degree in CVTS with current approval for two candidates per year.
- 2-year Fellowship in Pediatric Cardiac surgery
- BSc Cardiac Perfusion Technology
- BSc and MSc Physician Assistant in Cardiovascular Surgery
Conferences conducted (annually)
- 1st Amrita Heart Valve Conclave 2015 on Aug 21 and 22- Mitral Valve Repair--Invited faculty: Prof. Manuel Antunes, Coimbra, Portugal, Prof. Taweesak Chotivatanapong, Department of Cardiothoracic Surgery Central Chest Institute of Thailand, Prof. V.Mohan Reddy, Lucille Packard Children's Hospital, Stanford, USA and Prof. Justiaan Swanevelder, University of Cape Town, South Africa
- 2nd Amrita Heart Valve Conclave 2016 on Nov 12- Aortic Valve Repair- Learn from the Master-Invited faculty: Prof. Hans-Joachim Schäfers, Director, Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center in Homburg/Saar, Germany.
- 3rd Amrita Heart Conclave 2017 on Nov 18 and 19- MICS CABG --Invited faculty: Dr. Sathyaki. P. Nambala, Sr. Consultant and Chief of Cardiac Surgery, Apollo Hospitals, Bangalore, Dr. Chirag Doshi, Professor, CVTS, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad and Dr. Rajesh M Ramankutty, Chief Cardio Thoracic Surgeon
Caritas Hospital, Kottayam - 4th Amrita Heart Conclave 2018 on Nov 17 and 18- A workshop on Aortic Root Surgery --Invited faculty: Dr. Prem S. Shekar, Division of Cardiac Surgery & Surgical Director of the Heart and Vascular Center, Brigham and Women’s Hospital (BWH), Boston and Dr. Luigino Nascimben, Anesthesiologist, Division of Anesthesiology & Perioperative and Pain Medicine, Brigham and Women’s Hospital (BWH), Boston
- 5th Amrita Heart Conclave 2019 on Dec 14 and 15- Total Endoscopic Mitral Valve Repair—Invited Faculty: Dr. Patrick Perier, Cardiac Surgeon, Herz und Gefäss Klink (Bad Neustadt/Saale), Germany
- 6th Amrita Heart Conclave 2022 on Oct 22 and 23, 2022 - A workshop on Pulmonary Thromboendarterectomy-Learn from the Master--Invited faculty: Mr. David Jenkins, Consultant Cardiothoracic Surgeon, Royal Papworth Hospital, NHS Foundation Trust, Cambridge, UK
- 7th Amrita Heart Conclave 2023 on Dec 9 and 10, 2023 - A workshop on Aortic Surgery-Learn from the Master--Invited faculty: Dr. Joseph S Coselli, Professor and Executive Vice Chair, Department of Surgery, Baylor College of Medicine, Houston, Texas, United States.
Facilities
- 5 fully equipped state-of-the-art operation theatres
- 48 ICU beds
- 4 IABP Machines
- 1 ECMO Machine
- Maquet Vasoview 7 endoscopic vein harvesting system
- Da Vinci surgical system
- Karl Storz Video-assisted Thoracoscopic (VATS) unit with the latest Endochameleon HD endoscope
- Lerut Distending Mediastinoscope
- State-of-the-art Library with access to all leading journals
Ten Best Procedures Performed
- Heart transplantation
- Ascending aorta +aortic arch replacement
- Mitral valve repair
- Double switch operation
- Pulmonary thromboendarterectomy
- Off-pump CABG
- Arterial switch operation + VSD closure + COA repair
- Completion Fontan
- Norwood operation
- Robotic/Video-assisted thoracoscopic surgery
FAQS
Mitral valve repair is commonly used to treat mitral valve pathology due to mitral regurgitation. In mitral valve repair, the surgeon repairs part of the damaged mitral valve to allow the valve to fully close and stop leaking. The surgeon may tighten or reinforce the ring around a valve, called the annulus, by placing an artificial ring called an annuloplasty ring.
By repairing the native valve rather than replacing it with a mechanical/ bioprosthetic valve, a patient can avoid long-term use of anticoagulants and problems, such as degeneration and infection. Surgeons usually recommend mitral valve repair instead of replacement, when possible.
Repair rates are usually >90% at 10 years
- The native valve is preserved
- No anticoagulation is required lifelong.
- Improved lifestyle.
- Better preservation of heart function.
- Lower risk of complications like stroke and endocarditis.
Residual MR and recurrence of mitral regurgitation are rare complications
HOCM denotes the thickening of the septum, or wall, separating the left and right ventricles. This may obstruct blood flow from the left ventricle to the body's main artery, the aorta.
The procedure known as a septal myectomy thins out the wall that separates the left and right sides of the heart which reduces the obstruction of blood flow out of the heart. This also corrects the mitral valve regurgitation associated with this condition.
Septal myectomy does not cure HOCM, it will reduce symptoms of fatigue, shortness of breath, and chest discomfort.
Valve-sparing aortic root replacement replaces the same portion of your aorta that is directly attached to your heart (aortic root) while preserving your native aortic valve whereas the Bentall procedure involves replacing a portion of the aorta and the aortic valve of the heart due to an aortic aneurysm.
- The native valve is preserved.
- No anticoagulation is required.
90% freedom for reintervention at 10 years.
Marfan syndrome is a genetic disorder that affects the connective tissue. Marfan syndrome most commonly affects the heart, eyes, blood vessels, and skeleton.
Marfan syndrome is a chronic disorder. Life-threatening problems are aortic aneurysms and dissections.
It is possible to validate a probable diagnosis of Marfan syndrome by genetic testing. When family members are genetically tested for this disease, the results can be used to identify those family members who have the mutation from those who do not. This is very useful information for the family. To avoid aortic dissections, family members who carry the gene might be evaluated for aortic disease, monitored for it, and treated before complications.
This procedure is an advanced minimally invasive technique for multi-vessel coronary bypass (CABG) through a small thoracotomy.
No
- The presence and severity of heart failure
- The severity and location of the coronary artery blockages.
- Sternal complications are completely avoided
- Minimize postoperative pain
- The smaller incisions result in less tissue damage and nerve disruption
- Reduce infection rate
- Faster recovery
Yes, it is safe but cannot be done in all patients.
Yes, it is safe.
95% to 100%
- Reduced pain
- Faster recovery time
- Smaller incisions
- Reduced risk of infection
- Reduced blood loss and transfusions
- Shorter hospital stay
2-3 weeks
- Large tumors are not able to be removed
- Conversion to VATS may occasionally be necessary
International Collaborations
- Hypertrophic Cardiomyopathy Center, Lahey Hospital & Medical Center, Burlington, Massachusetts
Achievements
- Asia’s first Heart and Kidney Transplant performed in 2017
- India’s first center of Excellence for Aortic Disease and Marfan’s Syndrome Inaugurated by Sri.O.Rajagopal (MLA, Kerala) in 2016 November
- Winner of BMJ Award 2014 in the category of Quality improvement in healthcare
- Indian first center to have a comprehensive Norwood program
- Major centre for Mitral Valve Repair Program
- Comprehensive centre for Pulmonary endarterectomy
- 24/7 coverage for Aortic dissection
- Only Robotic Thoracic surgery unit in Kerala which uses the Da Vinci Xi robot, performed the first Robotic thoracic procedure in Kerala in March 2016.
- Highest VATS numbers in Kerala
- Only center to be selected in India for pediatric heart valve repair under the TSFRE grant
- Centre in India doing maximum minimally invasive pediatric cardiac surgery
- 1 center in India with a New Technique for Conduit harvesting –The technique known as Endoscopic Vein Harvesting (2cm Incision)/ Endoscopic Radial artery harvesting.
Diagnostic Tests and Procedures
- Coronary Artery Bypass Grafting
- Valve Surgery: Repair/Replacement
- Ascending aorta + Aortic arch replacement
- Minimally Invasive Cardiac Surgery
- Congenital Cardiac Surgery
- Heart Transplantation
- Minimally invasive cardiac surgery
- Thoracic Tumours
- Open and Endovascular Procedures
- ECMO
- Video-assisted thoracoscopic surgery
- Robotic Thoracic Surgery
Outreach Programs
- Dr Brijesh P.K. is available at Amritakripa Speciality Clinic, Vallimadukunnu, Calicut, every Second Saturday
Treatments
Adult Cardiac Surgery
Surgery for Coronary Artery Disease
The Department of Cardiovascular and Thoracic Surgery at Amrita is well equipped for holistic management of coronary artery disease including life-threatening mechanical complications of myocardial infarction (heart attack). Special features of this program include emphasis on off-pump CABG (surgery is performed while the heart continues to pump blood by itself without the need for a heart-lung machine) and total arterial revascularization. 99% of CABG was done using the OPCAB method. Conduits are harvested endoscopically which increases patient comfort.
Our surgeons perform:
- CABG along with carotid endarterectomy (surgery to remove plaque in carotid arteries to help prevent a stroke)
- Correction of ischemic mitral regurgitation and DOR procedure (surgical method to restore a dilated left ventricle to its normal, elliptical geometry)
- Coronary Endarterectomy for diffuse CAD
Surgery for Heart Valve Disease
Valve repair or replacement provides a solution for problems related to heart valves that have either become too narrow and hardened (stenotic) and fail to open fully, or are leaky and unable to close completely (incompetent).
Mitral Valve Repair Program
Amrita has a well-integrated mitral valve repair program in which a leaking valve is repaired by a combination of techniques like annuloplasty, quadrangular/wedge resection, supporting the leaflets with artificial (Gore-Tex) cords etc.
Advantages of Mitral Valve Repair
Mitral valve repair provides:
- Better long-term survival
- Better preservation of heart function
- Less complications, lower risk of bleeding, stroke and infection (endocarditis) after surgery
- No need for long-term use of blood thinners (anticoagulants)
Diseases of the Aorta
The Center for Aortic Diseases at Amrita is one of the first initiatives in the country to provide patients with comprehensive and total aortic solutions by a core team of cardiothoracic surgeons, cardiologists and radiologists trained to offer surgical, endovascular or hybrid therapeutic options. Aortic surgical procedures performed:
- Valve sparing Aortic root replacement (David’s procedure)
- Bentall De Bono Procedure
- Supra-coronary ascending aortic replacement
- Aortic arch replacement
- Elephant trunk procedure
- Frozen trunk procedure
- Thoracoabdominal aneurysm repair
- TEVAR, EVAR
- Hybrid aortic procedures
Aortic dissection
Aortic dissection is a life-threatening condition caused by a tear in the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation (dissection) of the layers of the aortic wall. As a result, a new, false channel forms in the wall. The arterial wall deteriorates due to excessive blood pressure, which is the main cause of aortic dissections. Patients experience sharp, abrupt pain, usually across the chest but also between the shoulder blades in the back. Imaging tests were done to confirm the diagnosis such as CT angiography, magnetic resonance angiography, or transesophageal echocardiography. Patients typically take blood pressure medications, and surgeons do surgery to repair the tear or cover it with stent grafts.
Valve Replacement Surgeries
Two kinds of valves are used for valve replacement.
Mechanical valves:
- Made from durable metals, carbon, ceramics and plastics.
- Major advantage is durability
- Blood thinners must be taken for the rest of the patient’s life.
Biological valves:
- Made from animal tissue, either an actual pig valve or a bovine pericardial-engineered valve
- Not as durable and may need to be replaced.
- Patients with biological valves will need to take blood thinners in the short term
At Amrita, all complex single, double, and triple valve replacements are performed with excellent results.
Hypertrophic Cardiomyopathy (HCM)
Hypertrophic cardiomyopathy (HCM) is a genetic disease condition in which the heart muscle (myocardium) becomes abnormally thick (hypertrophied) and mitral valves start leaking.
Amrita Hospital has a comprehensive program, the first of its kind in the country, which starts with screening patients, early diagnosis and almost curative surgical treatment (extended septal myectomy) for HCM.
Heart Transplant and Ventricular Assist Devices
Amrita has a highly skilled and experienced multidisciplinary team of heart transplant specialists with which one can be sure that if one receives a heart transplant at Amrita, they will get the most innovative and refined care this country has to offer.
Our team is also exceptionally experienced and certified to implant ventricular implants like THORATEC HEART MATE 2 and BERLIN HEART (which will act as bridge therapy for transplant candidates and destination therapy for non-transplant candidates.
Minimally Invasive Cardiac Surgery (MICS)
Coronary Artery Bypass Surgery and valve repair/replacement surgeries are also done via small incisions (keyhole) in suitably selected patients. Smaller incisions facilitate faster recovery along earlier return to a normal life.
Extracorporeal Membrane Oxygenation (ECMO)
Extra-corporeal Membrane Oxygenation (ECMO) is an advanced form of life support used to treat infants, children, and adults in whom the heart or lungs or both are not functioning. ECMO is achieved by draining venous blood through a closed circuit, removing carbon dioxide and adding oxygen using an artificial lung, and pumping the blood to the circulation (by artificial pumps) via a vein (venovenous ECMO) or an artery (venoarterial ECMO).
Pulmonary Thromboendarterectomy
Pulmonary thromboendarterectomy is a surgical procedure done for the removal of blood clots in the arteries of the lung and restoration of the lung and right heart function. Amrita is one of the few specialized centers in India equipped with the expertise to perform this complex procedure. We continue to update ourselves with cutting-edge technology in our effort to make it available to our patients in the most affordable way.
Thoracic Surgery
Lung Cancer
Comprehensive lung cancer management at Amrita epitomizes the ‘multidisciplinary approach ‘wherein the treatment protocols are individualized for each patient by a team of doctors which includes the thoracic surgeon, pulmonologist, radiation oncologist, medical oncologist, oncopathologist and radiologist.
The surgical expertise offered for lung cancer includes:
- Minimally invasive surgical procedures like mediastinoscopy and thoracoscopy which aid in early diagnosis of cancer.
- Therapeutic procedures like lobectomy (removal of the affected parts of the lung) and pneumonectomy (removal of one entire lung) using conventional open and minimally invasive techniques (VATS).
- Segmentectomy and sleeve resection
- Intraoperative planning for radiotherapy using surgical clip markers, brachytherapy wires and CT-guided wire localization techniques for solitary pulmonary nodules.
- Postoperative adjuvant radiotherapy or chemotherapy
Chest Wall Tumor Excision and Reconstruction
- Our unit specializes in chest wall tumor and sternal tumor excision and reconstruction of the defects caused thereby with various prosthetic materials like Prolene mesh, vicryl mesh and Polymethylmethacrylate (PMMA) implants to provide good cosmesis.
- We are the only center in Kerala specializing in managing sternal infections, especially post coronary bypass sternal osteomyelitis with VAC therapy and muscular flaps.
Mediastinal Tumor Excision
Our unit in Amrita specialises in:
- Keyhole surgery to remove mediastinal tumors like thymoma, retrosternal goiter, lymphoma, duplication cyst, pericardial cyst, neurogenic tumors and germ cell tumors through keyhole (1-2 cm) incisions in the chest using high-definition state-of-the-art endoscopes.
- Retrosternal goiter management which needs the sternum (breastbone) to be cut for approach.
Bullectomy, Pleurodesis, and Lung Volume Reduction Surgery (LVRS)
Bullectomy and pleurodesis is done as a minimally invasive keyhole procedure in which the surgeon uses video-assisted thoracoscopic techniques and lung endostaplers to remove the affected ballooned-out area of the lung and causing the lung to permanently stick to the chest wall and thus prevent recurrence.
Decortication
Tuberculosis and other infections of the lungs can cause fluid accumulation in the chest cavity (pleural effusion) which can further become infected to form pus (empyema). We perform the surgical procedure called decortication both by open surgery or minimally invasive techniques wherein the pleural peel is removed and the lung expands to its normal size and regains full functional capacity with good immediate and long-term relief to the patients.
Thoracic Sympathectomy (Left Cardiac Sympathetic Denervation)
At Amrita, thoracic sympathectomy via the keyhole technique offers a curative solution to problems like sympathetic activity such as increased sweating in the palms and feet (hyperhidrosis), and life-threatening arrhythmias of the heart.
Thymectomy
Thymectomy is a surgical procedure to remove the thymus gland, located behind the breastbone, when it is enlarged, contains benign or malignant tumors, or is associated with autoimmune conditions such as myasthenia gravis or pure red cell aplasia. Both open and keyhole techniques can be performed and remission rates for myasthenia gravis can be as high as 60%, comparable to Western standards
Mediastinoscopy
Mediastinoscopy is a minimally invasive surgical procedure where the surgeons use a specialized instrument called the mediastinoscope which uses a miniature camera to visualize the structures in the center of the chest cavity (mediastinum) and even take appropriate biopsies from lymph nodes or tumors.
- Vital for early detection of lung cancer in smokers and for keyhole diagnosis of various chest diseases.
- Latest Lerut Distending Mediastinoscope used for performing routine mediastinoscopy in thoracic patients as an OP procedure which minimizes the pain and allows speedy discharge from the hospital.
Robotic Thoracic Surgery/Minimally Invasive Thoracic Surgery (Keyhole Chest Surgery)
Da Vinci Xi System
Robotic-assisted lung surgery can be performed using da Vinci technology. The da Vinci system makes it possible to perform surgery through a few small incisions about the size of your fingertip. The da Vinci® Xi surgical robot offers 3-D HD imaging and magnification, scalable motion, and 7 degrees of freedom in the manipulation of surgical “wrists” enabling unparalleled surgical accuracy.
Karl Storz HD Video-assisted Thoracic Surgery (VATS) unit
Amrita is equipped with the Karl Storz HD VATS unit and the latest innovative Endocameleon camera technology that enables the surgeon to visualize vital structures in the chest cavity from 0 to 120 degrees and perform complex thoracic procedures with more dexterity and less operating time. Compared to traditional open surgery, patients who undergo VATS experience:
- Decreased postoperative pain
- Shorter hospital stays
- More rapid recovery and return to work
- Reduced risk of infection
- Less bleeding
Who are the candidates for Robotic Thoracic Surgery/ VATS?
Thoracic surgery procedures routinely performed at Amrita using VATS include:
- Lobectomy
- Pneumonectomy
- Sleeve resection
- Wedge resection
- Lung/pleural and lymph node biopsy
- Drainage of pleural effusion/empyema
- Mediastinal tumor excision
- Thymectomy
- Left cardiac sympathetic denervation
- Bilateral Sympathectomy
- Decortication
Carotid Interventions
Amrita hospital specializes in doing carotid endarterectomy as an isolated procedure or as a combined procedure with other cardiac operations like coronary artery bypass grafting with stroke rates below 1%. This procedure opens up new avenues in stroke management which are certain to benefit stroke patients.
Contact
Adult Cardiac Surgery and Thoracic Surgery
Phone: 0484 - 6681551, 0484 – 2851551
Email: cvtscoordinator@aims.amrita.edu
Pediatric Cardiac Surgery
Phone: 0484 - 6681559, 0484 – 2851559
Email: cvts@aims.amrita.edu
Doctors
Overview
The Department of Cardiovascular and Thoracic Surgery at Amrita is one of the busiest programs in the country. Over 2000 cardiac surgical operations have been performed annually. A fully functioning heart team will evaluate and decide the choice of treatment for complex heart conditions requiring surgery. The heart team includes 7 surgeons, 10 anesthesiologists, and 9 cardiologists with inputs from other subspecialists.
Diseases Treated
Coronary Artery Disease (CAD):
- Coronary Artery Bypass Grafting (CABG)
- Off-pump CABG (OPCAB)
- Total Arterial Revascularization
- Coronary Endarterectomy
Heart Valve Disease:
- Valve Repair
- Valve Replacement (Mechanical and Biological)
- Mitral Valve Repair Program
Aortic Diseases:
- Valve Sparing Aortic Root Replacement
- Bentall De Bono Procedure
- Aortic Arch Replacement
- Thoracoabdominal Aneurysm Repair
- Aortic Dissection
Hypertrophic Cardiomyopathy (HCM):
- Extended Septal Myectomy
Heart Transplant and Ventricular Assist Devices:
- Heart Transplant
- Ventricular Assist Devices (THORATEC HEART MATE 2, BERLIN HEART)
Minimally Invasive Cardiac Surgery (MICS):
- Minimally Invasive Coronary Artery Bypass Surgery
- Minimally Invasive Valve Repair/Replacement
Extracorporeal Membrane Oxygenation (ECMO):
- Venovenous ECMO
- Venoarterial ECMO
Pulmonary Thromboendarterectomy:
- Removal of Blood Clots in Lung Arteries
Thoracic Surgery:
- Lung Cancer Management
- Chest Wall Tumor Excision and Reconstruction
- Mediastinal Tumor Excision
- Bullectomy, Pleurodesis, and Lung Volume Reduction Surgery (LVRS)
- Decortication
- Thoracic Sympathectomy
- Thymectomy
- Mediastinoscopy
- Robotic Thoracic Surgery/Minimally Invasive Thoracic Surgery
Carotid Interventions:
- Carotid Endarterectomy
Features
- Adult Cardiac Surgery
- Pediatric Cardiac surgery
- Thoracic Surgery
- Minimally Invasive (Video-assisted) Thoracic Surgery
- Robotic Thoracic Surgery
- Centre for Excellences
- Mitral Valve Repair Program
- Centre for Aortic Diseases and Marfan Syndrome
- Centre for Hypertrophic Cardiomyopathy
- Robotic Thoracic Surgery Centre
Academy
Courses offered
- Fully Functional super-specialty training program for MCh degree in CVTS with current approval for two candidates per year.
- 2-year Fellowship in Pediatric Cardiac surgery
- BSc Cardiac Perfusion Technology
- BSc and MSc Physician Assistant in Cardiovascular Surgery
Conferences conducted (annually)
- 1st Amrita Heart Valve Conclave 2015 on Aug 21 and 22- Mitral Valve Repair--Invited faculty: Prof. Manuel Antunes, Coimbra, Portugal, Prof. Taweesak Chotivatanapong, Department of Cardiothoracic Surgery Central Chest Institute of Thailand, Prof. V.Mohan Reddy, Lucille Packard Children's Hospital, Stanford, USA and Prof. Justiaan Swanevelder, University of Cape Town, South Africa
- 2nd Amrita Heart Valve Conclave 2016 on Nov 12- Aortic Valve Repair- Learn from the Master-Invited faculty: Prof. Hans-Joachim Schäfers, Director, Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center in Homburg/Saar, Germany.
- 3rd Amrita Heart Conclave 2017 on Nov 18 and 19- MICS CABG --Invited faculty: Dr. Sathyaki. P. Nambala, Sr. Consultant and Chief of Cardiac Surgery, Apollo Hospitals, Bangalore, Dr. Chirag Doshi, Professor, CVTS, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad and Dr. Rajesh M Ramankutty, Chief Cardio Thoracic Surgeon
Caritas Hospital, Kottayam - 4th Amrita Heart Conclave 2018 on Nov 17 and 18- A workshop on Aortic Root Surgery --Invited faculty: Dr. Prem S. Shekar, Division of Cardiac Surgery & Surgical Director of the Heart and Vascular Center, Brigham and Women’s Hospital (BWH), Boston and Dr. Luigino Nascimben, Anesthesiologist, Division of Anesthesiology & Perioperative and Pain Medicine, Brigham and Women’s Hospital (BWH), Boston
- 5th Amrita Heart Conclave 2019 on Dec 14 and 15- Total Endoscopic Mitral Valve Repair—Invited Faculty: Dr. Patrick Perier, Cardiac Surgeon, Herz und Gefäss Klink (Bad Neustadt/Saale), Germany
- 6th Amrita Heart Conclave 2022 on Oct 22 and 23, 2022 - A workshop on Pulmonary Thromboendarterectomy-Learn from the Master--Invited faculty: Mr. David Jenkins, Consultant Cardiothoracic Surgeon, Royal Papworth Hospital, NHS Foundation Trust, Cambridge, UK
- 7th Amrita Heart Conclave 2023 on Dec 9 and 10, 2023 - A workshop on Aortic Surgery-Learn from the Master--Invited faculty: Dr. Joseph S Coselli, Professor and Executive Vice Chair, Department of Surgery, Baylor College of Medicine, Houston, Texas, United States.
Facilities
- 5 fully equipped state-of-the-art operation theatres
- 48 ICU beds
- 4 IABP Machines
- 1 ECMO Machine
- Maquet Vasoview 7 endoscopic vein harvesting system
- Da Vinci surgical system
- Karl Storz Video-assisted Thoracoscopic (VATS) unit with the latest Endochameleon HD endoscope
- Lerut Distending Mediastinoscope
- State-of-the-art Library with access to all leading journals
Ten Best Procedures Performed
- Heart transplantation
- Ascending aorta +aortic arch replacement
- Mitral valve repair
- Double switch operation
- Pulmonary thromboendarterectomy
- Off-pump CABG
- Arterial switch operation + VSD closure + COA repair
- Completion Fontan
- Norwood operation
- Robotic/Video-assisted thoracoscopic surgery
FAQS
Mitral valve repair is commonly used to treat mitral valve pathology due to mitral regurgitation. In mitral valve repair, the surgeon repairs part of the damaged mitral valve to allow the valve to fully close and stop leaking. The surgeon may tighten or reinforce the ring around a valve, called the annulus, by placing an artificial ring called an annuloplasty ring.
By repairing the native valve rather than replacing it with a mechanical/ bioprosthetic valve, a patient can avoid long-term use of anticoagulants and problems, such as degeneration and infection. Surgeons usually recommend mitral valve repair instead of replacement, when possible.
Repair rates are usually >90% at 10 years
- The native valve is preserved
- No anticoagulation is required lifelong.
- Improved lifestyle.
- Better preservation of heart function.
- Lower risk of complications like stroke and endocarditis.
Residual MR and recurrence of mitral regurgitation are rare complications
HOCM denotes the thickening of the septum, or wall, separating the left and right ventricles. This may obstruct blood flow from the left ventricle to the body's main artery, the aorta.
The procedure known as a septal myectomy thins out the wall that separates the left and right sides of the heart which reduces the obstruction of blood flow out of the heart. This also corrects the mitral valve regurgitation associated with this condition.
Septal myectomy does not cure HOCM, it will reduce symptoms of fatigue, shortness of breath, and chest discomfort.
Valve-sparing aortic root replacement replaces the same portion of your aorta that is directly attached to your heart (aortic root) while preserving your native aortic valve whereas the Bentall procedure involves replacing a portion of the aorta and the aortic valve of the heart due to an aortic aneurysm.
- The native valve is preserved.
- No anticoagulation is required.
90% freedom for reintervention at 10 years.
Marfan syndrome is a genetic disorder that affects the connective tissue. Marfan syndrome most commonly affects the heart, eyes, blood vessels, and skeleton.
Marfan syndrome is a chronic disorder. Life-threatening problems are aortic aneurysms and dissections.
It is possible to validate a probable diagnosis of Marfan syndrome by genetic testing. When family members are genetically tested for this disease, the results can be used to identify those family members who have the mutation from those who do not. This is very useful information for the family. To avoid aortic dissections, family members who carry the gene might be evaluated for aortic disease, monitored for it, and treated before complications.
This procedure is an advanced minimally invasive technique for multi-vessel coronary bypass (CABG) through a small thoracotomy.
No
- The presence and severity of heart failure
- The severity and location of the coronary artery blockages.
- Sternal complications are completely avoided
- Minimize postoperative pain
- The smaller incisions result in less tissue damage and nerve disruption
- Reduce infection rate
- Faster recovery
Yes, it is safe but cannot be done in all patients.
Yes, it is safe.
95% to 100%
- Reduced pain
- Faster recovery time
- Smaller incisions
- Reduced risk of infection
- Reduced blood loss and transfusions
- Shorter hospital stay
2-3 weeks
- Large tumors are not able to be removed
- Conversion to VATS may occasionally be necessary
International Collaborations
- Hypertrophic Cardiomyopathy Center, Lahey Hospital & Medical Center, Burlington, Massachusetts
Achievements
- Asia’s first Heart and Kidney Transplant performed in 2017
- India’s first center of Excellence for Aortic Disease and Marfan’s Syndrome Inaugurated by Sri.O.Rajagopal (MLA, Kerala) in 2016 November
- Winner of BMJ Award 2014 in the category of Quality improvement in healthcare
- Indian first center to have a comprehensive Norwood program
- Major centre for Mitral Valve Repair Program
- Comprehensive centre for Pulmonary endarterectomy
- 24/7 coverage for Aortic dissection
- Only Robotic Thoracic surgery unit in Kerala which uses the Da Vinci Xi robot, performed the first Robotic thoracic procedure in Kerala in March 2016.
- Highest VATS numbers in Kerala
- Only center to be selected in India for pediatric heart valve repair under the TSFRE grant
- Centre in India doing maximum minimally invasive pediatric cardiac surgery
- 1 center in India with a New Technique for Conduit harvesting –The technique known as Endoscopic Vein Harvesting (2cm Incision)/ Endoscopic Radial artery harvesting.
Diagnostic Tests and Procedures
- Coronary Artery Bypass Grafting
- Valve Surgery: Repair/Replacement
- Ascending aorta + Aortic arch replacement
- Minimally Invasive Cardiac Surgery
- Congenital Cardiac Surgery
- Heart Transplantation
- Minimally invasive cardiac surgery
- Thoracic Tumours
- Open and Endovascular Procedures
- ECMO
- Video-assisted thoracoscopic surgery
- Robotic Thoracic Surgery
Outreach Programs
- Dr Brijesh P.K. is available at Amritakripa Speciality Clinic, Vallimadukunnu, Calicut, every Second Saturday
Treatments
Adult Cardiac Surgery
Surgery for Coronary Artery Disease
The Department of Cardiovascular and Thoracic Surgery at Amrita is well equipped for holistic management of coronary artery disease including life-threatening mechanical complications of myocardial infarction (heart attack). Special features of this program include emphasis on off-pump CABG (surgery is performed while the heart continues to pump blood by itself without the need for a heart-lung machine) and total arterial revascularization. 99% of CABG was done using the OPCAB method. Conduits are harvested endoscopically which increases patient comfort.
Our surgeons perform:
- CABG along with carotid endarterectomy (surgery to remove plaque in carotid arteries to help prevent a stroke)
- Correction of ischemic mitral regurgitation and DOR procedure (surgical method to restore a dilated left ventricle to its normal, elliptical geometry)
- Coronary Endarterectomy for diffuse CAD
Surgery for Heart Valve Disease
Valve repair or replacement provides a solution for problems related to heart valves that have either become too narrow and hardened (stenotic) and fail to open fully, or are leaky and unable to close completely (incompetent).
Mitral Valve Repair Program
Amrita has a well-integrated mitral valve repair program in which a leaking valve is repaired by a combination of techniques like annuloplasty, quadrangular/wedge resection, supporting the leaflets with artificial (Gore-Tex) cords etc.
Advantages of Mitral Valve Repair
Mitral valve repair provides:
- Better long-term survival
- Better preservation of heart function
- Less complications, lower risk of bleeding, stroke and infection (endocarditis) after surgery
- No need for long-term use of blood thinners (anticoagulants)
Diseases of the Aorta
The Center for Aortic Diseases at Amrita is one of the first initiatives in the country to provide patients with comprehensive and total aortic solutions by a core team of cardiothoracic surgeons, cardiologists and radiologists trained to offer surgical, endovascular or hybrid therapeutic options. Aortic surgical procedures performed:
- Valve sparing Aortic root replacement (David’s procedure)
- Bentall De Bono Procedure
- Supra-coronary ascending aortic replacement
- Aortic arch replacement
- Elephant trunk procedure
- Frozen trunk procedure
- Thoracoabdominal aneurysm repair
- TEVAR, EVAR
- Hybrid aortic procedures
Aortic dissection
Aortic dissection is a life-threatening condition caused by a tear in the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation (dissection) of the layers of the aortic wall. As a result, a new, false channel forms in the wall. The arterial wall deteriorates due to excessive blood pressure, which is the main cause of aortic dissections. Patients experience sharp, abrupt pain, usually across the chest but also between the shoulder blades in the back. Imaging tests were done to confirm the diagnosis such as CT angiography, magnetic resonance angiography, or transesophageal echocardiography. Patients typically take blood pressure medications, and surgeons do surgery to repair the tear or cover it with stent grafts.
Valve Replacement Surgeries
Two kinds of valves are used for valve replacement.
Mechanical valves:
- Made from durable metals, carbon, ceramics and plastics.
- Major advantage is durability
- Blood thinners must be taken for the rest of the patient’s life.
Biological valves:
- Made from animal tissue, either an actual pig valve or a bovine pericardial-engineered valve
- Not as durable and may need to be replaced.
- Patients with biological valves will need to take blood thinners in the short term
At Amrita, all complex single, double, and triple valve replacements are performed with excellent results.
Hypertrophic Cardiomyopathy (HCM)
Hypertrophic cardiomyopathy (HCM) is a genetic disease condition in which the heart muscle (myocardium) becomes abnormally thick (hypertrophied) and mitral valves start leaking.
Amrita Hospital has a comprehensive program, the first of its kind in the country, which starts with screening patients, early diagnosis and almost curative surgical treatment (extended septal myectomy) for HCM.
Heart Transplant and Ventricular Assist Devices
Amrita has a highly skilled and experienced multidisciplinary team of heart transplant specialists with which one can be sure that if one receives a heart transplant at Amrita, they will get the most innovative and refined care this country has to offer.
Our team is also exceptionally experienced and certified to implant ventricular implants like THORATEC HEART MATE 2 and BERLIN HEART (which will act as bridge therapy for transplant candidates and destination therapy for non-transplant candidates.
Minimally Invasive Cardiac Surgery (MICS)
Coronary Artery Bypass Surgery and valve repair/replacement surgeries are also done via small incisions (keyhole) in suitably selected patients. Smaller incisions facilitate faster recovery along earlier return to a normal life.
Extracorporeal Membrane Oxygenation (ECMO)
Extra-corporeal Membrane Oxygenation (ECMO) is an advanced form of life support used to treat infants, children, and adults in whom the heart or lungs or both are not functioning. ECMO is achieved by draining venous blood through a closed circuit, removing carbon dioxide and adding oxygen using an artificial lung, and pumping the blood to the circulation (by artificial pumps) via a vein (venovenous ECMO) or an artery (venoarterial ECMO).
Pulmonary Thromboendarterectomy
Pulmonary thromboendarterectomy is a surgical procedure done for the removal of blood clots in the arteries of the lung and restoration of the lung and right heart function. Amrita is one of the few specialized centers in India equipped with the expertise to perform this complex procedure. We continue to update ourselves with cutting-edge technology in our effort to make it available to our patients in the most affordable way.
Thoracic Surgery
Lung Cancer
Comprehensive lung cancer management at Amrita epitomizes the ‘multidisciplinary approach ‘wherein the treatment protocols are individualized for each patient by a team of doctors which includes the thoracic surgeon, pulmonologist, radiation oncologist, medical oncologist, oncopathologist and radiologist.
The surgical expertise offered for lung cancer includes:
- Minimally invasive surgical procedures like mediastinoscopy and thoracoscopy which aid in early diagnosis of cancer.
- Therapeutic procedures like lobectomy (removal of the affected parts of the lung) and pneumonectomy (removal of one entire lung) using conventional open and minimally invasive techniques (VATS).
- Segmentectomy and sleeve resection
- Intraoperative planning for radiotherapy using surgical clip markers, brachytherapy wires and CT-guided wire localization techniques for solitary pulmonary nodules.
- Postoperative adjuvant radiotherapy or chemotherapy
Chest Wall Tumor Excision and Reconstruction
- Our unit specializes in chest wall tumor and sternal tumor excision and reconstruction of the defects caused thereby with various prosthetic materials like Prolene mesh, vicryl mesh and Polymethylmethacrylate (PMMA) implants to provide good cosmesis.
- We are the only center in Kerala specializing in managing sternal infections, especially post coronary bypass sternal osteomyelitis with VAC therapy and muscular flaps.
Mediastinal Tumor Excision
Our unit in Amrita specialises in:
- Keyhole surgery to remove mediastinal tumors like thymoma, retrosternal goiter, lymphoma, duplication cyst, pericardial cyst, neurogenic tumors and germ cell tumors through keyhole (1-2 cm) incisions in the chest using high-definition state-of-the-art endoscopes.
- Retrosternal goiter management which needs the sternum (breastbone) to be cut for approach.
Bullectomy, Pleurodesis, and Lung Volume Reduction Surgery (LVRS)
Bullectomy and pleurodesis is done as a minimally invasive keyhole procedure in which the surgeon uses video-assisted thoracoscopic techniques and lung endostaplers to remove the affected ballooned-out area of the lung and causing the lung to permanently stick to the chest wall and thus prevent recurrence.
Decortication
Tuberculosis and other infections of the lungs can cause fluid accumulation in the chest cavity (pleural effusion) which can further become infected to form pus (empyema). We perform the surgical procedure called decortication both by open surgery or minimally invasive techniques wherein the pleural peel is removed and the lung expands to its normal size and regains full functional capacity with good immediate and long-term relief to the patients.
Thoracic Sympathectomy (Left Cardiac Sympathetic Denervation)
At Amrita, thoracic sympathectomy via the keyhole technique offers a curative solution to problems like sympathetic activity such as increased sweating in the palms and feet (hyperhidrosis), and life-threatening arrhythmias of the heart.
Thymectomy
Thymectomy is a surgical procedure to remove the thymus gland, located behind the breastbone, when it is enlarged, contains benign or malignant tumors, or is associated with autoimmune conditions such as myasthenia gravis or pure red cell aplasia. Both open and keyhole techniques can be performed and remission rates for myasthenia gravis can be as high as 60%, comparable to Western standards
Mediastinoscopy
Mediastinoscopy is a minimally invasive surgical procedure where the surgeons use a specialized instrument called the mediastinoscope which uses a miniature camera to visualize the structures in the center of the chest cavity (mediastinum) and even take appropriate biopsies from lymph nodes or tumors.
- Vital for early detection of lung cancer in smokers and for keyhole diagnosis of various chest diseases.
- Latest Lerut Distending Mediastinoscope used for performing routine mediastinoscopy in thoracic patients as an OP procedure which minimizes the pain and allows speedy discharge from the hospital.
Robotic Thoracic Surgery/Minimally Invasive Thoracic Surgery (Keyhole Chest Surgery)
Da Vinci Xi System
Robotic-assisted lung surgery can be performed using da Vinci technology. The da Vinci system makes it possible to perform surgery through a few small incisions about the size of your fingertip. The da Vinci® Xi surgical robot offers 3-D HD imaging and magnification, scalable motion, and 7 degrees of freedom in the manipulation of surgical “wrists” enabling unparalleled surgical accuracy.
Karl Storz HD Video-assisted Thoracic Surgery (VATS) unit
Amrita is equipped with the Karl Storz HD VATS unit and the latest innovative Endocameleon camera technology that enables the surgeon to visualize vital structures in the chest cavity from 0 to 120 degrees and perform complex thoracic procedures with more dexterity and less operating time. Compared to traditional open surgery, patients who undergo VATS experience:
- Decreased postoperative pain
- Shorter hospital stays
- More rapid recovery and return to work
- Reduced risk of infection
- Less bleeding
Who are the candidates for Robotic Thoracic Surgery/ VATS?
Thoracic surgery procedures routinely performed at Amrita using VATS include:
- Lobectomy
- Pneumonectomy
- Sleeve resection
- Wedge resection
- Lung/pleural and lymph node biopsy
- Drainage of pleural effusion/empyema
- Mediastinal tumor excision
- Thymectomy
- Left cardiac sympathetic denervation
- Bilateral Sympathectomy
- Decortication
Carotid Interventions
Amrita hospital specializes in doing carotid endarterectomy as an isolated procedure or as a combined procedure with other cardiac operations like coronary artery bypass grafting with stroke rates below 1%. This procedure opens up new avenues in stroke management which are certain to benefit stroke patients.
Contact
Adult Cardiac Surgery and Thoracic Surgery
Phone: 0484 - 6681551, 0484 – 2851551
Email: cvtscoordinator@aims.amrita.edu
Pediatric Cardiac Surgery
Phone: 0484 - 6681559, 0484 – 2851559
Email: cvts@aims.amrita.edu
Doctors