Heart failure is considered as one of the leading causes of death worldwide. In India the mortality rate is as high as 20%. Over the years, etiological risk factors, diagnostic criteria, and classifications have been revised to create guide management needed to alleviate the global health burden caused by heart failure. Pharmacological treatments have progressed over time but are insufficient in reducing mortality. This leads to many patients developing advanced heart failure who might require surgical intervention.
To address the cause, The Times of India in partnership with Novartis launched “Beat Heart Failure”, wherein India’s most valued doctors imparted their proficient views to help understanding the disease, management, and treatment.
Recently a discussion was conducted with cardiothoracic surgeons of the Manipal Hospitals with regards to heart failure and surgical management – – Dr Mohammad Rehan Sayeed -Consultant, Cardiothoracic and Vascular Surgeon, Manipal Hospitals, Yeshwanthpur – Dr Joseph Xavier – Senior Consultant – HOD & Chief of Cardiothoracic & Vascular Surgery, Manipal Hospitals, Sarjapur – Dr Devananda N. S. – Chairman, Cardiothoracic Vascular Surgery, Manipal Hospitals, Bangalore https://fb.me/e/15bNv9nep 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 a heart attack. Heart failure is a term used when the heart is unable to pump blood as well as it should due to the gradual weakening of its muscles. On the contrary, a heart attack is the sudden stoppage of the blood supply of the heart. There may be multiple reasons for heart failure, such as hypertension and diabetes. Heart failure symptoms may 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 failures and chronic failures have different medical management, we need to see why heart is failing. Depending on the cause we direct a treatment. Many of them just recover with acute management, so we may not really need surgical intervention immediately, but when medical management is not working, then we need to support them with some heart support devices like extra corporeal support to see the response. If still it doesn’t recover, the next step is permanent surgical procedure, either heart transplant or a device.
Coming in early, getting treated early and getting the right treatment early always is of benefit and value to the patient, said Dr Sayyed. India being the diabetic capital of the world, there is very significant cause of cardiomyopathy or damage to the heart muscle. Come in early, gives doctors the scope of repairing the issue. But come in late with a lot of complications adds up to providing a lot of support, prolonged hospitalization and all of that increases the chances of morbidity and the risk of mortality.
When a heart failure patient’s heart is beyond repair and cause-directed treatment is not feasible, he is usually directed by a cardiologist to a cardiothoracic surgeon. Surgical interventions are available depending on the extent of the damage to the heart, and the treatment done accordingly. Between a transplant and medical management, the doctors prefer extended medical management. Patients are put into cardiac resynchronization therapy if the contraction of the heart is not synchronized, which can be investigated using echocardiography (ECG), and they fall into particular criteria, said Dr Devananda.
When a patient comes to a surgeon the cause of the heart damage becomes immaterial. It’s the extent of the damage that is concerning. The heart has four chambers, and the bottom two chambers are known as ventricles. If one ventricle is damaged, management may be a ventricular assist device (VAD) or a transplant. In case of a biventricular failure (failure of both ventricles), it’ll be a transplant, explained by Dr.Joseph Xavier.
If a patient who comes with massive heart attack and is struggling, they can be put on temporary devices. There are temporary assist devices called ECMO devices. They act as a substitute heart. The devices consist of a pump that pushes the blood and gives the heart time to recover. Along with the devices, the cause of the heart damage also gets addressed.
All patients who have assist devices are eligible for a heart transplant. A heart transplant is replacing the damaged heart with a healthy heart. The quality of life with the transplant is definitely superior to a quality of life with a VAD in place. And it is hugely cost-effective operation too, said Dr Sayeed. There is a substantial rise in heart transplants across the country due to more awareness among people. In the last two years, more than 200 transplants occurred each year across India. A heart transplant is more effective, and the patient gets cured of heart failure. They can resume their normal life provided they take immuno-suppressants. The only disadvantage with a heart transplant is a worldwide shortage of organs.
Dr. Sayeed explained that surgeries have advanced quite considerably, and minimally invasive surgeries, non-bone cutting surgeries are being done successfully. If patients consult their doctors early, they have options of total endoscopic procedure or a robotic procedure to. These procedures are safe, carry an extremely low risk and much better long-term outcomes than a lot of the precarious procedures.
To watch the complete session, click here 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 right lifestyle modifications. To know more about how to manage heart failure, visit https://www.toibeatheartfailure.com/blog Disclaimer: The views and opinions expressed in the article by the panellists/experts are based on their independent professional judgement and are disseminated in public interest. These views should not be considered as a substitute for professional advice of a registered medical practitioner. The purpose of this article is not to promote any medical procedures or medication and/or recommend a certain doctor. For any specific health issues, please consult your registered medical practitioner.” PWR PWR
