While scientists and doctors, and artists, have studied the human heart for a long time, it wasn’t till the late 1800s doctors realised they could “fix a broken heart”. The first heart surgery was performed in 1896, when a German surgeon repaired a stab wound in the heart, and gave the patient a new lease of life.
Previous attempts at surgery of the heart were unsuccessful, with the complications and risks involved in opening the very delicate chest area and accessing a still-beating heart to repair tears or clear blocks almost always came with high mortality rates.
Till very recently, the complicated open heart surgery had a 50-50 chance for the survival of the patient: It’s a story almost every family has heard, it’s a plot point in hundreds of movies and TV serials. But today, this is one case where fiction is, clearly, far behind the truth.
Today, cardiology is far less invasive and involves technology that has made sure that even the rarest of operations can be performed with precision and a large margin of success. And these procedures are performed not in the operation theatre of yore, but the cath labs of the future. And at Apollo Hospital, Chennai, the Cath Lab is where doctors, technicians, and support staff work around the clock to ensure your future is as disease free, and as long and happy, as can ever be.
The Catheterisation Lab: The latest in heart disease management
Catheterisation Laboratories - or Cath Labs - are high end facilities equipped to perform interventional cardiology procedures using catheters - thin, highly specialised wires, that are inserted into arteries in the hand, the leg, or the groin, depending on the problem the procedure seeks to solve. Interventional Cardiology is a set of specialised procedures that are performed using the most refined medical equipment, and minimally invasive procedures to fix structural problems in the heart.
Apollo Hospitals in Chennai are one of the pioneers of Interventional Cardiology, definitely the first large hospital in the south of the country to introduce these technologies. Dr Sengottuvelu, a Senior Interventional Cardiologist at Apollo Hospitals in Chennai, and one of the pioneers of Cathlab techniques in India, says, “It’s almost a pinhole. We insert a catheter through a tiny opening, and perform various complex and complicated procedures that were once massively invasive, like removing blocks, stenting, and these days, even valve replacement.”
Follow Dr. Sengottuvelu on Twitter Tweet to @SGS_AHEL
Cathlab procedures allow doctors to perform critical repair or replacement procedures that were previously denied to certain patients who presented with co-morbid conditions that complicated the success of open surgery. For instance, heart patients who also have kidney or liver failure, diabetes, or are of an advanced age, have co-morbid conditions. In such situations, open surgery could be fatal. Today, due to the skill and expertise of Interventional Cardiologists such as Dr. Sengottuvelu, these patients can also receive life-saving treatment, and live a longer, happier, healthier life.
A Cathlab procedure is usually shorter than open surgery, and does not normally require the patient to receive general anesthesia. This is a further advantage as patients recover from their Cathlab procedure quicker, and are able to return home earlier. A regular procedure in a Cathlab could last anywhere between a few minutes to about an hour at most. However, the success of these procedures depend largely on the technology used and the efficiency of the doctor performing it.
There are only a handful of fully equipped, 24-hour Cathlabs across the country.
Standards of care and medical guidelines require that patients with acute heart attacks, or other heart ailments, should be treated in the shortest possible time frame. “Golden hours, and platinum minutes,” says Dr. Sengottuvelu. This therefore requires that Cathlabs be staffed every minute of every day, not just by technicians but also consultants and nursing staff. Apollo Hospitals in Chennai, is perhaps the only hospital and Cathlab that has senior doctors on call, 24x7.
The Cathlab is a sterile, quiet, safe environment within the cardiology wing of the hospital. It consists of a patient area, and the control and monitoring area. The Cathlab at Apollo is at the cutting edge of combining the latest technology with the most radical new procedures in interventional cardiology. “Whatever is happening in the rest of the world, even for the first time, we bring it here as well. We’re at least three to five years ahead of the rest of the country,” Dr Sengottuvelu explains.
An example of this is Radial Angioplasty, which Apollo first performed as early as 2003. Very soon, the cardiologists at Apollo established radial procedures as the default technique in the hospital’s Cathlabs. “Once we established the practice, we conducted several training courses across the country and today, the procedure is widely followed across the country,” says Dr Sengottuvelu.
Procedures that save lives
1. Percutaneous Coronary Intervention (PCI): A procedure that is used to remove blocks in the arteries and thus cure acute heart attacks. Interventional Cardiologists introduce a specialised catheter through a needle-entry in the hand, access the blocked artery, and “crush” the blocks, restoring blood supply to the heart and preventing muscle damage. This procedure saves lives, and reduces complications and long term mortality for a large section of Indian patients.
2. EVAR/TEVAR: Endovascular Aneurysm Repair (EVAR) is a procedure used to treat aneurysms - which are abnormal enlargement of the blood vessel. These mainly form in the arteries supplying to the abdominal area. If the procedure is performed in the thoracic region, it’s called Thoracic Endovascular Aneurysm Repair (TEVAR). In this procedure, an expandable stent is placed in the aorta using a catheter, without any invasive surgeries.
TAVR: Transcatheter Aortic Valve Replacement (TAVR) is a technique used to replace a critically important valve in the heart. The Aortic valve regulates blood flow into the heart. Over time, it may weaken, or develop stenosis (blocks), and could lead to death. In this procedure, a replacement valve is implanted in place of the existing aortic valve, using a catheter.
Rotablation Angioplasty: This technique is used to remove calcified deposits in the artery. Using a catheter with a tiny ‘drill” like motor is sent into the artery, which then scrapes away the hard, calcified deposits without damaging the artery. Following rotablation, a balloon is sent in with a stent to keep the artery from collapsing.Additionally, the Cathlabs are also used to “look” into the heart, using highly advanced imaging techniques such as Intravascular Ultrasound (IVUS), Optical Coherence Tomography (OCT) and more. These procedures are more advanced, and provide a much clearer, more high-definition images of the heart and the blood vessels, and is slowly replacing the traditional angiogram.
Other techniques, such as Fractional Flow Reserve, allow Dr. Sengottuvelu and his team, to take accurate, and reliable measurements of blood flow into the heart, and the scale and scope of the blocks in the blood vessels.
FFR, together with IVUS and OCT, are highly beneficial as they will tell the doctors if complicated surgery is required, or simple medication is enough to remove the blocks. This translates to cost savings, and better quality of life for patients.
This article has been produced by TNM Marquee in association with Apollo Hospitals.