Minimally invasive procedures revolutionizing the treatment modality for heart ailments

Dr Balbir Singh, Chairman, Cardiac Sciences, Max Hospital, Saket

With recent advancements made in the field of cardiac sciences, despite the high prevalence in number of patients with some forms of cardiac ailments have been providing a new lease of life. Interventions without the open-heart procedures are not only the most innovative scientific approaches of recent times but are also revolutionizing the treatment outcomes in most complex cases.

The latest advancements are also helpful in determining the functional significance in some tricky situations which otherwise would be seemingly borderline, such advanced procedures not only helps in treating the patients effectively, but also improves their quality of life.

While various heart ailments annually account for at least 50% of the overall comorbidities and even premature deaths in India, it is shocking to know that there is a rise in number of people in the age bracket of 25-40 years being susceptible. In India, it has been estimated that one in every four death is attributed to ignorance of the mild symptoms and is one of the leading causes of mortality among both males and females (between 25-35 years).

With fast, appropriate medical care, survival is possible. Rapid treatment with a defibrillator and cardiopulmonary resuscitation, swift & appropriate medical care, survival is possible. A defibrillator is a device that sends an electric shock to the heart to try to restore its normal rhythm.

Cryoablation of the heart is one such recent advancements which is very effective in cases of heart rhythm disorders. Being a minimally invasive procedure, surgeons make use of a thin flexible tube (balloon catheter) to locate and freeze the heart tissues (in a controlled fashion to temperatures as low as minus 80 degrees) that triggers irregular heartbeat, in order to restore normal heart rhythm. Being a completely safe procedure, the chances to impact the healthy tissues and surrounding structures is nil, and various studies have found this procedure to be significantly more effective than medications.

Recently Dr Balbir Singh and his team became the first in North India to have implanted the world’s smallest pacemaker, Micra AV. The device, the latest in pacemaker technology is yet another revolutionary reform made in this field, is the smallest pacemaker in the world with a battery life of 15 years, weighing a mere 15 grams and has dual chamber capabilities. Till date, it has been implanted only in two other hospitals across India.

Doctors worldwide are claiming that the real-world use of Micra has shown a 63% reduction in major complications compared to traditional pacemakers. In comparison to the traditional pacemakers, the Micra AV is MRI compatible and there are no leads attached. Micra AV involves placing it in the heart via vein in the leg thereby eliminating the need for an incision in the chest and any possibility of infection.

Some other big advantages of the Micra AV implant, over its contemporaries, are that the device has several additional internal atrial sensing algorithms which detect cardiac movement, allowing the device to adjust pacing in the lower ventricles to coordinate with the upper atriums, providing ‘AV synchronous’ pacing therapy to patients. It is completely self-contained within the heart, thereby eliminating any potential medical complications arising from a chest incision and from wires running from a conventional pacemaker into the heart. For most patients, the Micra design has translated into fewer medical complications and fewer post-implant activity restrictions.

Valvular heart complications are another life-threatening complication, where valve replacement remains the last resort. But with recent advancements, catheter-based procedures of Mitra clip can help in repairing the leaking heart valves without surgery. Such cases, if justifyuntreated can lead to enlarged heart, breathlessness and even heart failures. Till now, open heart surgery with repair or replacement of the valve had been the only possible treatment for such patients in India but it is often high risk and may not be beneficial.

The Mitra Clip is a novel catheter based non-surgical repair of the mitral valve inside the heart and is performed in the Cath Lab like angioplasty where special catheters are inserted through the large vein in the groin and the catheter is passed from the right chamber of the heart to the left chamber of the heart by puncturing the partition called interatrial septum. Then under echocardiography and X-ray guidance a clip is put on the leaking mitral valve to decrease the leak which improves the condition of patient. The patient is normally ready to be discharged in 24-48 hours’ time.

With such technology available, there is a dire need to raise awareness among the masses to first of all adapt to a heart healthy lifestyle and not to hesitate or delay any of the symptoms, since timely intervention can not only save lives but also improve the quality of life.

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