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CABG for severe LV Dysfunction
In patients where the muscle of the heart has good potential for recovery, the possibility of a high risk coronary artery bypass grafting (CABG) is perhaps one of the good options. These are typically patients who have suffered a significant heart attack with extensive muscle damage. Today, with advanced techniques of beating heart surgery and other equipment at MIOT, it is possible to perform these surgeries with good results. The assistance of equipment like IABP ( intra-aortic balloon pump), ECMO and other mechanical assist devices, has made these surgeries relatively safe when compared to earlier experiences.
In those patients who have suffered extensive muscle damage, the function of the heart is lower, hence, the need for support in terms of medications, ventilator support or mechanical assist devices. These patients require a much more rigorous monitoring and support, in view of possible hemodynamic instability. They are also more prone to having arrhythmias.
After carefully studying the status of the muscle damage (done by preoperative scans like Thallium scan, PET scan or Cardiac MRI) we are able to segregate patients who could improve significantly from heart failure and in some cases, can recover to near normal function of the heart. At MIOT, the best of diagnostic machines are available to critically assess these patients before surgery is offered to them.
High Risk Mitral valve repairs (for ischemic mitral regurgitation)
In some instances of heart attacks, as a consequence of muscle damage, the mitral valve apparatus gets affected in its function. This results in a leak in the mitral valve causing significant mitral regurgitation. Most of these cases continue to experience heart failure even if revascularization is done, as the mitral valve continues to leak due to structural damage to the ventricular muscle. In order to correct this leak, the mitral valve should be repaired along with the CABG procedure. This procedure can significantly reduce heart failure and improve the overall heart failure and improve the overall function of the heart.
Surgical Ventricular Restoration(SVR) surgery
In some cases of heart attacks, the damage to the muscles of the left ventricle can result in an area of extensive scar which leads to an outpunching of the apex of the ventricle, referred to as ventricular aneurysm. This results in pooling of excess amount of blood in the ventricle, resulting in poor pumping function. In suitable cases, SVR surgery helps to exclude the scar, thereby reducing the volume of blood pooled in the ventricle. This helps in reshaping the ventricle and significantly improves the function of the heart. In most cases, the surgery is combined with CABG to give good long term results and reducing heart failure.