BEST CARDIAC SURGERY

MINIMAL ACCESS CARDIAC SURGERY is being performed regularly by the team of Dr Avinash Dal at Apollo Health City, Hyderabad, India with good results. We are regularly perfoming the mitral and aortic valve replacements as well as ASD closure and have started about 3 months wilth MICS CAB with  port access only and with beating heart technique.

ENDOVASCULAR ANEURYSM REPAIR [EVAR] has been done many times by this unit before.However, in October 2016, we performed the operation on a patient with Thoraco-abdominal aortic aneurysm (Type IV of Crawford) and we used extensive aortic debranching from both the common iliac arteries. In this way, she was repaired later with a stent graft in the thoracic to abdominal aorta uneventfully.

VATS

VIDEO ASSISTED THORACIC SURGERY

Video assisted thoracic surgery also known as thoracoscopy is utilized to a great extent in the Continental Hospital, Hyderabad by the Dr Avinash Dal unit. The surgery is done, unlike conventional surgery, through insertion of ports instead of a big incision, being done by other surgeons. This gives a good relief from pain as well as it is cosmetically more appealing to the patients. Pain in thoracotomy incision is usually due to the compression of the intercostals nerve, that passes along the ribs, by the retractor instrument that is used to open the chest cavity. In VATS, we use only ports and hence there is no need of any retraction of ribs and hence there is very little chance that the patient may get some neuralgia [pain due to nerve affliction] in this surgery. Due to the absence of pain, patients are able to breath better after surgery than those who undergo conventional surgery and hence their recovery is better in the postoperative period. Also, as the length of the incision is smaller, there is less oozing of blood inside of the chest from these small keyhole puncture points and this is one of the main reasons that the bleeding after surgery is less than in conventional surgery.

Precisely, the VATS scores better over conventional thoracic surgery due to:

• Ø Lesser bleeding
• Ø Lesser pain
• Ø Cosmetic incisions
• Ø Faster recovery

VATS is being used at the Dr Avinash Dal unit of Cardiothoracic and Vascular Surgery at Apollo Health City, Hyderabad for the following indications:

v Diagnostic thoracoscopy with biopsy as well as drainage of pleural effusions

v Wedge resection of lung

v Lobectomy of lung

v Treatment of spontaneous and recurrent pneumothorax and bullectomy

v Bronchopleural fistula

v Pleuropericardial window for recurrent pericardial effusion

v Thymectomy

v Mediastinal nodal biopsy

v Mediastinal cysts

The results are very encouraging.

Giant Thymolipoma of chest about 4.6kg removed in basin

CASE REPORT

Vol 6 | Issue 5 | May 2020 Indian J Case Reports 271

Great saphenous vein cannulation as venous access for cardiopulmonary bypass for minimally invasive cardiac surgery

ABSTRACT

Minimally invasive cardiac surgery has seen the development of new techniques and modifications to achieve the goal. Arterial and venous cannulation is prime initial steps for establishing a good cardiopulmonary bypass to enable the main surgery. Usually, percutaneous cannulation is used but is costly; hence, most surgeons prefer an open surgical approach. Direct femoral venous cannulation is easy; however, if there is a tear in the femoral vein, usually on insertion or removal of the cannula, it can cause troublesome hemorrhage. A simple technique for venous cannulation with direct cannulation of the great saphenous vein has been described and does not require additional hardware and is expeditious. The method is safer, reliable, and repeatable and can be done easily even in emergency situations

 14 January 2020 Initial Review - 15 February 2020 Accepted - 07 May 2020