Heart Surgery 2008 Kushagra Katariya, MD, FACS CEO, Artemis Health Institute

“ To operate on the human heart is akin to stabbing the patient in the chest and watching him die a rapid death” Christian Theodor Billroth, Vienna, 1872

Heart Surgery Current trend started in 1950s Heart Lung Machine Currently one of the commonest surgeries performed More than 2 million bypass surgeries (2007) More than 0.5 million valve surgeries More than 2.5 lakh pediatric cardiac surgeries

Current trend started in 1950s

Heart Lung Machine

Currently one of the commonest surgeries performed

More than 2 million bypass surgeries (2007)

More than 0.5 million valve surgeries

More than 2.5 lakh pediatric cardiac surgeries

Heart Surgery Coronary artery bypass grafting Valve surgery (repair or replacement) Arrhythmia surgery (correction of rhythm) Congenital abnormality correction Heart failure surgery Heart transplant Ventricular Assist Devices Aneurysm surgery Tumours of the heart

Coronary artery bypass grafting

Valve surgery (repair or replacement)

Arrhythmia surgery (correction of rhythm)

Congenital abnormality correction

Heart failure surgery

Heart transplant

Ventricular Assist Devices

Aneurysm surgery

Tumours of the heart

Coronary artery disease

CABG

Heart Failure Facts U.S. prevalence 4.8 million 550,000 new cases CHF each year Survival outlook <5 years 287,000 deaths per year $23.2 billion spent on CHF in 2002 Source: American Heart Association

U.S. prevalence 4.8 million

550,000 new cases CHF each year

Survival outlook <5 years

287,000 deaths per year

$23.2 billion spent on CHF in 2002

Treatment of Heart Failure Medical treatment: Diuretics, ACE inhibitors, Angiotensin Receptor Blockers, Digoxin, B-blockers, IV inotrope Surgical treatments: Heart Transplatantation Ventricular assist Devices Others (Mitral Valve repair, high risk CABG, Ventricular aneurysm resection etc.)

Medical treatment:

Diuretics, ACE inhibitors, Angiotensin Receptor Blockers, Digoxin, B-blockers, IV inotrope

Surgical treatments:

Heart Transplatantation

Ventricular assist Devices

Others (Mitral Valve repair, high risk CABG, Ventricular aneurysm resection etc.)

Abiocor Total Artificial Heart

Abiocor Total Artificial Heart

Jarvik-2000 LVAD

Atrial Fibrillation Most common cardiac arrhythmia 3 million Americans affected Incidence increases with age 4% of the population over 60 years Doubles risk of death Seven times higher risk of stroke Heart failure Palpitation and discomfort

Most common cardiac arrhythmia

3 million Americans affected

Incidence increases with age

4% of the population over 60 years

Doubles risk of death

Seven times higher risk of stroke

Heart failure

Palpitation and discomfort

Treatment goals in AF Regain normal (sinus) rhythm Antiarrhythmics: Amiodarone, Procainamide Control heart rate Betablockers, Digoxin Reduce risk of blood clot and thus, stroke Coumadin, Aspirin Improve heart function

Regain normal (sinus) rhythm

Antiarrhythmics: Amiodarone, Procainamide

Control heart rate

Betablockers, Digoxin

Reduce risk of blood clot and thus, stroke

Coumadin, Aspirin

Improve heart function

Indications for Surgery Failure of Medical therapy to control rhythm or rate Intolerance of medication Contraindication to anticoagulants Continuing symptoms despite full medical therapy Stroke / other embolic phenomena Failure of Medical therapy to control rhythm or rate Intolerance of medication Contraindication to anticoagulants Continuing symptoms despite full medical therapy Stroke / other embolic phenomena

Failure of Medical therapy to control rhythm or rate

Intolerance of medication

Contraindication to anticoagulants

Continuing symptoms despite full medical therapy

Stroke / other embolic phenomena Failure of Medical therapy to control rhythm or rate

Intolerance of medication

Contraindication to anticoagulants

Continuing symptoms despite full medical therapy

Stroke / other embolic phenomena

Types of AF Paroxysmal Terminates spontaneously in < 7 days, usually within 24 hours Persistent Fails to terminate in 7 days, converted by therapy. May terminate spontaneously (>7 days) Chronic > 1 year duration of persistent AF, failed / unattempted cardioversion Lone Paroxysmal, Persistent or Chronic AF in patients without structural heart disease. (Usually < 60 yrs age group)

Paroxysmal

Terminates spontaneously in < 7 days, usually within 24 hours

Persistent

Fails to terminate in 7 days, converted by therapy.

May terminate spontaneously (>7 days)

Chronic

> 1 year duration of persistent AF, failed / unattempted cardioversion

Lone

Paroxysmal, Persistent or Chronic AF in patients without structural heart disease. (Usually < 60 yrs age group)

Paroxysmal AF

Paroxysmal AF Electrically Isolate Pulmonary Veins Microwave Radiofrequencey Cryo Cautery Cut & Sew HIFU Excise Left Atrial Appendage

Electrically Isolate Pulmonary Veins

Microwave

Radiofrequencey

Cryo

Cautery

Cut & Sew

HIFU

Excise Left Atrial Appendage

Pulmonary Vein Isolation

Thank you