December 30, 2018
Cardiac surgery is the youngest allied surgical branch. Recently many new and important reports about advances in cardiac surgery have been reported. The new minimally invasive cardiac surgeries and ventricular remodeling surgical therapeutics for congenital heart disease, coronary artery diseases, valvular disease, and atrial fibrillation, have been introduced in this review.
According to the recent report and our experience: –
Congenital cardiac surgery
Many complex congenital cardiac surgeries have been introduced in recent past like surgery for TGA, DORV, TAPVC and Truncus arteriosus. The understanding of a single ventricular physiology has lead to newer surgeries like BD Glenn, Fontan, and modified Fontan surgeries. We have not only seen improvement in the surgical techniques, but also in the perioperative and post operative management of neonatal & paediatric cardiac surgeries. In our centre, we are trying to broaden the spectrum of congenital cardiac surgeries for the preterm babies with weight as low as 1 kg.
Minimally invasive cardiac surgery
Recent advances in cardiac surgeries have focused on the need to make surgery less invasive and less painful, reduce hospital stay, and work in order to action quicker return to a productive life.
Amongst the innovations, the incisions on the chest have become much smaller. These may now consist of a cut only on the upper or lower part of the sternum (breast bone), or entering the chest cavity through an incision in between the ribs, thus avoiding cutting any bone at all. Through these techniques the multi-vessel bypass surgery, valve replacements, and repair of certain kinds of holes in the heart are possible. Other techniques are Heart Port Surgery, in which only small incisions are made in between the ribs, through which instruments could be passed for a cardiac surgery. These innovative techniques require advanced surgical skills and exposure. The cardiac anaesthetic skills have also been modified in a way that facilitates these surgeries.
Ventricular remodelling surgeries
The infracted heart is a big challenge for the cardiologists. Usually Myocardial Infarction leads to pump failure, and ultimately leads to end stage heart failure. The coronary artery bypass surgery alone may not help in complete recovery. Recently the new surgical tool has been introduced to manage such problems. These techniques are called ventricular remodelling surgeries. In this surgery the akinetic segments of the heart are segregated, and the size and shape of the LV left ventricle is altered. The LV is reshaped from the dilated cavity to its original size. This is a big surgical challenge. Very few centres – including our own – SDM Narayana Heart Centre, have successfully started this programme.
Heart valve repair
Valve repairs are ideal for any age group. The latest understanding of the static and dynamic anatomy of the valve and annular apparatus has led to many innovative valve repair techniques. Leaflet expansion techniques, annular reduction methods, and creation of the artificial chordae have provided many armaments for the heart valve repair procedures. The repair technique varies depending on the aetiology of the heart valve disease, and it also differs from individual to individual. It is helpful with the paediatric population and women in child bearing age groups. Anticoagulation and its related problems are avoided in this technique as compared to valve replacement surgeries. So far, we have successfully introduced this programme, and many children, and young men and women have been benefitted by it.
Awake cardiac surgery
It is considered in the recent advances as it has introduced the concept of epidural anaesthesia in cardiac surgery. The patients are not intubated and are awake during the entire cardiac surgeries. The lung physiology is well maintained and is suitable in high risk cases.
Hybrid cardiac surgery
The SDM Narayana Heart Centre is one of the centres in India, which has conceptualised and introduced new hybrid cardiac surgical techniques. One amongst them is hybrid ASD closure by a min-thoracotomy or mini-sternotomy. In this surgery, the device is directly introduced inside the right atrium and across the ASD defect. This could be performed even in IVC deficient rims. The device at deficient margins is surgically fixed on a beating heart without using cardiopulmonary bypass.
All these newer techniques have given new hopes to the patients. They not only minimise the pain but also reduce the duration of their stay in the hospital. In addition, several new technologies have evolved to deal with conditions which were previously considered inoperable or not amenable to the surgical treatments. We are proud to introduce these techniques first time in the north Karnataka, and many patients are being benefitted with these techniques.
Dr. Shivaprasad Mukkannavar
Consultant Cardiovascular & Thoracic Surgery
SDM Narayana Heart Centre, Dharwad, Karnataka
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