Cardiac Surgery & Vascular Surgery

Cardiac Surgery & Vascular Surgery

CABG: (OPCAB & CCAB): Coronary artery bypass graft surgery (CABG) is performed in patients who have major blockages in the coronary arteries supplying the heart. In earlier times it was done as on pump CABG (CCAB), with patient’s heart being stopped with the help of heart-lung machine. However, technical advancement and increasing expertise of surgeons has made it possible for the surgery to be done off pump (on beating heart) (OPCAB) without the help of heart-lung machine. It has greatly reduced the incidence of complications associated with the heart-lung machine.

Valvular heart disease is a condition in which patients’ heart valves either get tight and restrict the flow of blood (stenosis) or start leaking blood back from one heart chamber to other (regurgitation). It can be caused due to infection (Rheumatic heart disease), age related process (degeneration), or disease present from birth (congenital). The diseased valve may be repaired using a ring to support a person's own valve, or the entire valve may be removed and replaced by an artificial valve. Artificial valves are of many types but mainly divided into two categories: mechanical or tissue valves.

Combined Procedures: Sometimes coronary artery disease is associated with valvular heart disease, for example mitral regurgitation or aortic stenosis. In these clinical setting a combined procedure is performed which include CABG & repair/ replacement of the affected valve. It can be done as a hybrid procedure with CABG being done as OPCAB followed by valve operation on heart lung machine to minimize the ill effects of CPB.

Minimally invasive Heart Surgeries: In the 21st century the paradigm shift is towards performing heart surgeries in a minimally invasive manner either by reducing the size of the incision or through multiple “button-hole” incisions for better cosmetic results or by avoiding the heart lung machine so as to prevent the deleterious effects of CPB.

Aortic Aneurysm/ dissection: Aorta is the major blood vessel in the body which takes blood from the heart and distributes it to rest of the body through different smaller arteries. Diseases involving the aorta include dilatation (aneurysm), tear in its wall (dissection), or complete tear in the aorta (due to injury). Surgery for the diseases of aorta include repair of the aneurysm and complete replacement of a part of diseased aorta. Most commonly affected part of aorta is the ascending aorta. Replacement of a part of aorta is done with an artificial graft made of poly-tetra-fluoro-ethylene (PTFE) (Bentall’s operation). The surgery on the aorta is technically challenging and requires great deal of surgical expertise and skill.

Congenital heart diseases are the diseases of heart present since birth. They usually manifest early in life, however many of the patients may reach adult age before actually getting to know that they have the disease. The child may be small for his age, may develop bluish discoloration of lips and nose while crying or feeding. Popularly congenital heart diseases are known as ‘Hole in the heart’, which most commonly is an atrial septal defect, ventricular septal defect and Tetrology of Fallot’s. Most of the surgeries involving such defects are done as open heart surgeries, with the help of heart-lung machine.

Peripheral vascular Diseases: Diseases involving blood vessels are common in patients who regularly smoke tobacco, or who have diabetes mellitus or hypertension. Various such diseases are obstruction in aorta, femoral or popliteal arteries. Patients usually present with complaints of pain while walking, numbness of legs or pale discoloration of legs. Surgeries for such diseases include making a bypass channel for blood flow across the obstructed segment using a vein graft from the same patient or an artificial graft made of poly-tetra-fluoro-ethylene (PTFE). These set of surgeries are usually performed with two separate small incisions at the ends of the area to be bypassed. The incisions are small enough to be missed after couple of months after surgery.

Thoracic Surgeries: Disease involving the thorax including decortication, lung resections like segmentectomies, lobectomies, & pneumonectomies for lung cancer & bronchiectasis are routinely performed with less morbidity & mortality apart from various disease involving the mediastinum & diaphragm.


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