Surgical management of heart failure


Heart failure is considered to be one of the leading causes of death around the world. In India, the death rate is up to 20%. Over the years, etiologic risk factors, diagnostic criteria, and classifications have been revised to create a management guide needed to alleviate the global health burden caused by heart failure. Pharmacological treatments have progressed over time but are insufficient to reduce mortality. This leads many patients to develop advanced heart failure which might require surgery.

To tackle the cause, The Times of India, in partnership with Novartis, launched ‘Beat Heart Failure’, in which India’s top physicians shared their knowledgeable perspectives to help understand the problem. disease, its management and treatment.

Recently a discussion was held with cardiothoracic surgeons from hospitals in Manipal regarding heart failure and surgical management –

– Dr Mohammad Rehan Sayeed -Consultant, Cardiothoracic and Vascular Surgeon, Manipal Hospitals, Yeshwanthpur

– Dr Joseph Xavier – Senior Consultant – HOD & Head of Cardiothoracic and Vascular Surgery, Manipal Hospitals, Sarjapur

– Dr Devananda NS – President, Cardiothoracic Vascular Surgery, Manipal Hospitals, Bangalore

The discussion started with Dr Devananda. While explaining the difference between heart failure and heart attack, he mentioned that the term “heart failure” is often confused with heart attack. Heart failure is a term used when the heart is unable to pump blood as well as it should because of the progressive weakening of its muscles. On the contrary, a heart attack is the sudden shutdown of the blood supply to the heart. There can be several reasons for heart failure, such as high blood pressure and diabetes. Symptoms of heart failure can take hours to days (called acute heart failure) or months to years (called chronic heart failure) to develop.

Dr Joseph added to the discussion and said that since acute heart failure and chronic failure have different medical management, we have to see why the heart fails. Depending on the cause, we direct treatment. Many of them just recover with acute management, so we might not really need surgery right away, but when medical management doesn’t work, we have to support them with it. cardiac support devices as additional body support to see the answer. If he’s still not recovering, the next step is permanent surgery, either a heart transplant or a device.

Arriving early, getting treated early, and getting the right treatment early is always beneficial and valuable to the patient, said Dr Sayyed. With India being the diabetes capital of the world, there is a very important cause of cardiomyopathy or damage to the heart muscle. Arrive early, it gives doctors the chance to fix the problem. But arriving late with a lot of complications adds up to providing a lot of support, prolonged hospitalization and all of this increases the chances of morbidity and the risk of death.

When the heart of a patient with heart failure is beyond repair and treatment focused on the cause is not possible, it is usually referred by a cardiologist to a cardiothoracic surgeon. Surgical procedures are available depending on the extent of the damage to the heart and the treatment given accordingly. Between transplant and medical care, doctors favor extended medical care. Patients are given cardiac resynchronization therapy if the heart’s contraction is not synchronized, which can be studied using echocardiography (ECG), and they meet specific criteria, Dr. Devananda.

When a patient sees a surgeon, the cause of the heart damage becomes irrelevant. It is the extent of the damage that is worrying. The heart has four chambers, and the two lower chambers are called ventricles. If a ventricle is damaged, management may be a ventricular assist device (VAD) or a transplant. In the event of biventricular insufficiency (failure of both ventricles), it will be a transplant, explained Dr. Joseph Xavier.

If a patient who comes with a massive heart attack and struggles, they can be put on temporary devices. There are temporary assistive devices called ECMO devices. They act as a surrogate heart. The devices consist of a pump that pushes blood and gives the heart time to recover. In addition to the devices, the cause of heart damage is also treated.

All patients who have assistive devices are eligible for a heart transplant. A heart transplant replaces the damaged heart with a healthy heart. The quality of life with the transplant is significantly higher than the quality of life with a VAD in place. And it is also an extremely profitable operation, said Dr Sayeed. There is a substantial increase in heart transplants across the country due to greater awareness among the people. In the past two years, more than 200 transplants have taken place in India every year. A heart transplant is more effective and the patient is cured of the heart failure. They can resume their normal life if they take immunosuppressants. The only downside to a heart transplant is the global organ shortage.

Dr Sayeed explained that surgeries have advanced considerably and that minimally invasive surgeries, surgeries without bone cutting are being performed successfully. If patients see their doctor early, they have a choice of a total endoscopic procedure or a robotic procedure. These procedures are safe, carry extremely low risk, and have much better long-term results than most precarious procedures.

Remember, heart failure isn’t about stopping. It’s about starting life in a new way. Heart failure can be managed with regular treatment and appropriate lifestyle changes. To learn more about managing heart failure, visit https://www.toibeatheartfailure.com/blog

Disclaimer: “The views and opinions expressed in the article by the panelists / experts are based on their independent professional judgment and are disseminated in the public interest. These views should not be viewed as a substitute for professional advice from a licensed physician. The purpose of this article is not to promote any medical procedures or drugs and / or to recommend a certain doctor. For any specific health concerns, please consult your licensed physician. BCCL, its Affiliates and its group publications assume no responsibility for the accuracy or the consequences of respecting their expert opinions.

Disclaimer: This article was produced on behalf of the Beat Heart Failure team by Mediawire.


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