On January 30, 2018 the team of Vaidam was graced by senior consultant and cardiac surgeon Dr. Sanjeev Malhotra from Max Super Specialty Hospital in Gurgaon.
With an expertise in cardiology and cardiac surgeries expanding over 15 years, Dr. Sanjeev Malhotra has performed over 2000 cardiac procedures (including total arterial bypass, mitral valve repair, minimally invasive cardiac surgeries and thoracic surgeries) relieving patients of their long term cardiac complexities. He holds degrees of MBBS, MS and CTVS from some of the prestigious medical institutions. Life member of the Indian Association of Cardiothoracic Surgeons, during his visit at Vaidam he elaborated on the common cardiac conditions that people around the globe suffer from - the frequency of which has been increasing with each passing day.
Before proceeding with the intricacies of a valve replacement surgery, he deftly drew a rough sketch of the heart and its valves and continued to explain the blood flow through them. Mitral, tricuspid, aortic and pulmonary are the four types of valves that help to stabilize the blood flow in a particular direction. While oxygen rich blood is distributed in the body by the aortic valve, the deoxygenated blood flows to the lungs through the pulmonary valve. Calcification or degeneration of the valves leads to two conditions: stenosis and regurgitation. “This means that either the valves do not open (stenosis) or does not close (regurgitation) properly. Regurgitation results in leaky valves”, said Dr. Malhotra.
Valve repair, valve replacement, valvuloplasty and TAVI are the procedures performed to fix the different conditions pertaining to cardiac valves. “While comparing the two procedures of valve repair and valve replacement, it is best to go for the former. In valve repair, the damages are cleared and recovered whereas in replacement, the mechanical or biological valves are implanted.
Now, biological valves do not have a good life span. Mechanical valve serve as a much better implant but the only problem is that they create a clicking sound that some of the patients are not comfortable with. Moreover older patients have to take blood thinners for life if they are implanted with a mechanical valve so as to ignore blood clots around the implant. In such a scenario we as cardiac surgeons opt more for the procedure of valve repair than a valve replacement. It is safe and affordable as well”, said Dr. Malhotra.
The procedures of valvuloplasty, Bentall’s Surgery and TAVI are performed for aortic valve conditions. According to Dr. Malhotra, valvuloplasty is used to repair an aortic stenosis with the help of balloon catheter whereas TAVI (transcatheter aortic valve implantation) is a minimally invasive process of aortic valve replacement in which the implant is put in place with the help of a catheter.
Bentall’s Surgery is a procedure in which the aortic valve, aortic root and ascending aorta is replaced with the help of a graft after which the coronary arteries are re-implanted into it. It is mostly performed to treat aortic regurgitation, Marfan’s Syndrome (aortic wall weakness) and aneurysm.
When quizzed about on pump and off pump procedure during cardiac surgeries, Dr. Sanjeev Malhotra said, “These are two types of approaches which are administered during a CABG (heart bypass) surgery for coronary artery diseases as well as for valve replacements. During on pump surgery, the heart is stopped and with the help of a heart – lung machine that imitates the function of the heart and lung, continues blood circulation in the body. On the contrary in an off pump surgery the heart is not stopped. But mostly, we prefer the on-pump approach due to safety issues”, said he.
According to Dr. Malhotra, cardiac conditions are rising globally. “It is not limited to age anymore because people as young as in their twenties are also affected by it. The vulnerability towards a heart attack increases amongst hypertensive people. Although a healthy lifestyle can be a savior but a medical history of cardiac problem in the family still stays as a threat. So, it is always advised to be cautious and maintain a diet and exercise regime that would strengthen one’s heart and keep it stable.