Team Approach Treatment Reduces Time, Cost in Serious Cardiac Cases: Expert

By 121 News

Mohali, Sept.27, 2024:- The video assisted thoracoscopic surgeries (VATS) have an advantage of making thoracic surgery minimally invasive without compromising on outcome. VATS was usually performed through multiple ports but in patients with dense adhesions and complex locations many times accurate visibility was hindered making surgery difficult.

Dr. Deepak Puri, senior CTVS surgeon at Max Hospital Mohali said that the advent of uniportal VATS in the last decade has simplified thoracoscopic surgeries with several advantages.

He further said that we have modified the uniportal VATS technique further to facilitate complex thoracic surgeries, thus improving exposure and being less expensive. This technique further improved the direct visibility for surgeons by specially designed retractors and utilizing anterior as well as posterior approach for the surgeon through a single 3 to 4 cm incision which is later used for intercostal drains placement after completion of the procedure. 

He highlighted that this unique technique not only improves exposure for surgeons with direct visualization like an open thoracotomy. At the same time, it is less painful, less costly for patients facilitating complex procedures with reduced hospital stay and early return to normal activity. He further said that one of the most challenging critical situations is acute ischemic heart failure with cardiogenic shock along with multivessel disease not amenable to PCI.

He said that these patients usually arrive at odd hours and are usually loaded with antiplatelet medication. Many have ventricular arrhythmias, even cardiac arrest with ongoing CPR before being shifted to the operation room. Some even have frank pulmonary oedema with cardiac arrest refractory to CPR requiring open cardiac massage and few may even need to be put on cardiopulmonary bypass machine although a quick off pump revascularization reduces the post revascularization complications like difficult weaning from pump, high inotropes, renal failure and low cardiac output in such patients.

We have also done a comparative analysis of management of such critical patients along with case reviews of a few of the most challenging cases to show the comparative improvement in the short- and long-term outcome of such patients in the last decade.

He added that these patients managed by a comprehensive team approach in the last decade showed less conversion to pump, less mechanical complications, less IABP dependence and less inotropic requirement. Moreover, ICU stay, hospital stay, and mortality was significantly reduced. Incidence of recurrent disease needing repeat percutaneous or surgical re-interventions was also drastically reduced because of meticulous team approach.