Apollo


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Coronary artery bypass graft surgery (CABG)

Provided by Escorts Heart Institute
Brought to you by Healthbase

Coronary artery bypass graft surgery (CABG) involves sewing one end an artery or vein above a blocked coronary artery and the other end below the blockage, thereby allowing blood an alternative means to get to the heart. The arteries or veins used for the bypass (which are known as “grafts”) are usually obtained from the leg or the chest wall. Bypass surgery may not be possible if the coronary artery is heavily calcified or if the disease is very widespread. CABG can be done with or without connecting the patient to heart-lung machine, depending on the kind of blockages and surgeon’s decision.

Several new surgical approaches are being developed, which can potentially reduce the discomfort and complications associated with traditional bypass surgery. These are collectively referred to as being “minimally invasive.” In general, these approaches focus on performing bypass surgery though a very small chest incision and performing bypass surgery while the heart is still beating (ie, without the need for a heart/lung bypass machine).

OPCAB (Off Pump Coronary Artery Bypass)
The bypass surgery done without connecting the patient to of heart-lung machine or pump is called OPCAB.

MIDCAB (Minimally Invasive Direct Coronary Artery Bypass)
is bypass surgery done through a small cut (incision) in the lower part of the sternum (chest bone) only, rather than full cut across it. This type of surgery, which is possible in selected cases only, is associated with a small scar, lesser pain and faster recovery. Alternatively, this surgery can also be done through a small cut on the left side of the chest.

The location and degree of coronary artery blockages are determined before surgery by using a procedure called heart catheterization, or coronary angiogram. This procedure provides an outline, like a road map, of the arteries of the heart.

Factors favoring bypass surgery
Bypass surgery is often recommended over angioplasty when the left main coronary artery is narrowed by more than 50 percent, when angioplasty does not relieve angina, when many arteries are narrowed, or when the heart’s left ventricular pumping function is substantially impaired. Bypass surgery is also preferred over angioplasty in diabetic patients who have two or three vessels involved.

Benefits
Bypass surgery can very effectively relieve angina and can even prolong life in people with severe coronary heart disease, such as those with three-vessel involvement associated with impaired left ventricular pumping function. However, the success of bypass surgery on symptoms and on survival depends upon several factors, including the pattern and extent of arterial narrowing, the general progression of coronary heart disease over time, and the blood vessels used for bypass. In general, bypass surgery is more likely than angioplasty to provide complete revascularisation.

About 95 percent of people who have narrowing of several arteries have improvement or complete relief of their angina immediately after surgery. About 85 to 90 percent of people remain angina-free at one to three years after surgery, and about 75 percent of people remain angina-free or free of major coronary events at five years after surgery. By 10 years, about one-half of all grafted vessels become narrowed or occluded, and by 15 years, about 85 percent of grafted vessels become narrowed or occluded. These late events usually require a second surgery

Recovery from bypass surgery
It usually takes a while to recover from even routine bypass surgery. However, about 70 to 80 percent of people who have this surgery are eventually able to return to work; this is about the same as the percentage of people who are treated medically and are able to return to work. Factors that appear to have a role in a person’s ability to return to work are the presence or absence of angina after surgery, employment status before surgery and income, the function of the heart’s left ventricle, and age.


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Shoulder Replacement

Provided by Wockhardt Hospital
Brought to you by Healthbase

Shoulder ReplacementSimilar to other joint replacement procedures, shoulder replacement surgery is generally done to address persistent pain that is not controlled by non-surgical therapy. Less commonly, poor shoulder motion may also be a reason for replacement surgery.

The shoulder is a ball-and-socket joint, with the top of the arm bone (humeral head) fitting into a socket known as the glenoid. Muscles and tendons, such as the rotator cuff, help hold the joint in place. Surgery involves replacing the humeral head and the glenoid with artificial components. The humeral head replacement is generally made from a metal alloy, while the glenoid component is made from polyethylene plastic. The new components may be anchored by cement or press-fit into place so that the bone grows in around them.

During surgery, a three- to four-inch incision is made along the space between the arm and the collarbone. The procedure lasts about 90 minutes, and the incision is then closed with staples or stitches. Patients typically stay in the hospital for one to two nights, and full recovery usually takes six to 12 weeks.

 

Rehabilitation

 

Arthritic shoulders are stiff. One of the major goals of total shoulder replacement surgery is to relieve much of this stiffness. However, after surgery scar tissue will tend to recur and limit movement unless motion is started immediately. This early motion is facilitated by the complete surgical release of the tight tissues so that after surgery the patient has only to maintain the range of motion achieved at the operation. Later on, once the shoulder is comfortable and flexible, strengthening exercises and additional activities are started.

A careful, well-planned rehabilitation program is critical to the success of a shoulder replacement. You usually start gentle physical therapy on the first day after the operation. You wear an arm sling during the day for the first several weeks after surgery. You wear the sling at night for 4 to 6 weeks. Most patients are able to perform simple activities such as eating, dressing and grooming within 2 weeks after surgery. Driving a car is not allowed for 6 weeks after surgery.

Here are some “do’s and don’ts” for when you return home:

  • Don’t use the arm to push yourself up in bed or from a chair because this requires forceful contraction of muscles.

  • Do follow the program of home exercises prescribed for you. You may need to do the exercises 4 to 5 times a day for a month or more.

  • Don’t overdo it! If your shoulder pain was severe before the surgery, the experience of pain-free motion may lull you into thinking that you can do more than is prescribed. Early overuse of the shoulder may result in severe limitations in motion.

  • Don’t lift anything heavier than a glass of water for the first 6 weeks after surgery.

  • Do ask for assistance. Your physician may be able to recommend an agency or facility if you do not have home support.

  • Don’t participate in contact sports or do any repetitive heavy lifting after your shoulder replacement.

  • Do avoid placing your arm in any extreme position, such as straight out to the side or behind your body for the first 6 weeks after surgery.
    Many thousands of patients have experienced an improved quality of life after shoulder joint replacement surgery. They experience less pain, improved motion and strength, and better function

Frequently Asked Questions

 

What are the symptoms to detect Shoulder Replacement?

 

Patients with arthritis typically describe a deep ache within the shoulder joint. Initially, the pain feels worse with movement and activity, and eases with rest. As the arthritis progresses, the pain may occur even when you rest. By the time a patient sees a physician for the shoulder pain, he or she often has pain at night. This pain may be severe enough to prevent a good night’s sleep. The patient’s shoulder may make grinding or grating noises when moved. Or the shoulder may catch, grab, clunk or lock up. Over time, the patient may notice loss of motion and/or weakness in the affected shoulder. Simple daily activities like reaching into a cupboard, dressing, toileting and washing the opposite armpit may become increasingly difficult.

 

How do I know if I am ready for shoulder replacement surgery?

 

Patients who have tried the usual treatments for shoulder arthritis, but have not been able to find adequate relief, may be a candidate for shoulder replacement surgery. Patients considering the procedure should understand the potential risks of surgery, and understand that the goal of joint replacement is to alleviate pain. Patients generally find improved motion after surgery, but these improvements are not as consistent as the pain relief following shoulder replacement surgery.

 

How long is the recovery following shoulder replacement surgery?

 

Hospital stays vary from one to three days for most patients. You will be sent home wearing a sling and you should not attempt to use the arm except as specifically instructed by your doctor.

Most physicians will begin some motion immediately following surgery, but this may not be true in every case. Usually within two to three months, patients are able to return to most normal activities and place an emphasis on strengthening the muscles around the shoulder and maintaining range of motion.

 

What are the symptoms of severe arthritis of the shoulder?

 

Common symptoms of shoulder arthritis include:

  • Pain with activities

  • Limited range of motion

  • Stiffness of the shoulder

  • Swelling of the joint

  • Tenderness around the joint

  • A feeling of grinding or catching within the joint

Can rehabilitation be done at home?

 

In general the exercises are best performed by the patient at home. Occasional visits to the surgeon or therapist may be useful to check the progress and to review the program.

 

When can I return to ordinary daily activities?

 

In general, patients are able to perform gentle activities of daily living using the operated arm from two to six weeks after surgery. Walking is strongly encouraged. Driving should wait until the patient can perform the necessary functions comfortably and confidently. Recovery of driving ability may take six weeks if the surgery has been performed on the right shoulder, because of the increased demands on the right shoulder for shifting gears.

With the consent of their surgeon, patients can often return to activities such as swimming, golf and tennis at six months after their surgery.


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Unicondylar Knee Replacement

Provided by Wockhardt Hospital
Brought to you by Healthbase

Most people are aware of the total knee replacement surgery. This involves replacing the unhealthy surface of the entire knee joint with metal and plastic implants. It is a very successful operation with good long term results. However a large percentage of patients have arthritis limited to one part of the joint alone. Replacing the whole joint in these patients is overkill and unnecessary.

Knee ReplacementMany middle aged men and women develop osteoarthritis of the knee. Osteoarthritis of the knee affects the inner half or medial compartment to start with and then proceeds to affect the outer half or lateral compartment.

In this operation only that part of the knee, which is unhealthy, is replaced. The normal surfaces are left alone. This operation has several advantages over total knee replacement surgery.

  • It can be done through a very small incision.

  • It is minimally invasive and hence tissue damage is far less.

  • The patient gets complete pain relief and the implant lasts long

  • The knee feels more natural as ligaments are preserved

  • Range of movement is full and it allows squatting and sitting crosslegged

  • Post operative hospitalization is reduced and return to normal is much faster than total knee replacement surgery.

Dr. Kaushal Malhan is a Joint Replacement and sports surgeon at the Wockhardt hospital. He was the first surgeon in India to do the mobile bearing oxford unicompartmental knee replacement and has been in the forefront in the field of full bending knee replacement surgery.

 

 

 

 

 

 

 

Frequently Asked Questions

 

  • What is unicondylar arthroplaty, or partial knee replacement?
  • What are the advantages unicondylar arthroplasty?
  • How is it different from total knee replacement?
  • You mentioned recovery is faster. What does that mean?
  • What does the surgeon do during a unicondylar arthroplasty?
  • How do I know if I am a candidate for this surgery?
What is unicondylar arthroplaty, or partial knee replacement?Partial knee replaces only the area of the knee that is worn out, sparing patients the more medically complicated and involved total knee replacement surgery.

 

What are the advantages unicondylar arthroplasty?With a partial knee replacement, there is a dramatically shorter recovery time due to less surgical trauma, less scarring and fuller range of motion.

 

How is it different from total knee replacement?

During total knee replacement, surgeons typically make a 7 to 8-inch incision over the knee, patients stay in the hospital for approximately four days, and there is a recovery period of up to three months. During minimally-invasive partial knee surgery, a part of the knee to be replaced through a small, 3-inch incision. There is minimal damage to the muscles and tendons around the knee and the required hospital stay is up to two days. The recovery period is about one month.

 

Total Knee Replacement

 

You mentioned recovery is faster. What does that mean?

Patients often walk unassisted within a week or two of the operation. Even those who have both knees done at once are able to walk without the assistance of a walker or cane fairly quickly.

 

What does the surgeon do during a unicondylar arthroplasty?When a knee replacement is performed, some bone and cartage are removed using precise instruments to create exact surfaces to accommodate a metal and plastic prostheses.

 

How do I know if I am a candidate for this surgery?

Candidates for this surgery are generally younger, more active patients. The partial knee replacement allows for symptoms of pain or discomfort. The procedure allows younger patients to buy time before they need a full knee replacement. The procedure is also effective for older patients if they have disease localized to one half of the joint.

 


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Raffles Hospital

An ISO 9001 institute with US/UK trained specialists. Raffles Hospital in Singapore is a 380-bed tertiary care private hospital offering a full complement of specialist services using the most advanced medical technology. The rooms at Raffles Hospital are outfitted to the standards of five-star hotels, with an array of suites, single, double, four and six-bed rooms for you to choose from.

National Heart Center Singapore

National Heart Center Singapore is a designated national center for cardiovascular medicine in Singapore and sees over 85,000 outpatients yearly. Performed 2,056 Angioplasty procedures, 577 CABG procedures & 304 Pacing procedures in 2005. National Heart Center Singapore is the first heart center outside USA to be JCI (Joint Commission International) accredited.

Thailand

Piyavate Hospital

The Piyavate Hospital medical staff is comprised both American Board and Thai Board Certified Physicians in every specialty field, supported by highly qualified registered nurses, technicians and administrative personnel. Piyavate Hospital is located in Bangkok, Thailand. The hospital provides medical services using modern technology and state-of-the-art equipment, accredited by the International Standards Organization ISO 9001-2000.

Bangkok Hospital Group Medical Center

Bangkok Hospital is one of the biggest hospitals in Thailand providing tertiary healthcare. The Bangkok Hospital Group has world renowned physicians, cutting edge technology and excellent nursing staff provide all of their patients with the utmost level of medical care. The Bangkok Heart Hospital an ISO 9001:2000 accredited hospital has treated more than 40,000 cardiac outpatients and has done more than 1,100 heart surgeries to date.

India

Apollo Hospitals Group

The first Indian hospital to receive the Joint Commission International (JCI) USA accreditation the gold-standard in hospital certifications worldwide. Apollo Hospitals have over 7000 beds in 38 hospitals. Indraprastha Apollo Hospitals in New Delhi, India is spread over 12 acres of land, has a built-up area of 600,000 square feet, and handles close to 200,000 patients a year, of which 10,000 are international patients.

Wockhardt Hospitals Group

Wockhardt hospitals Group has established a chain of super specialty hospitals at Mumbai, Bangalore, Hyderabad, Kolkatta and Nagpur. Wockhardt Hospitals has associated with Harvard Medical International (HMI), USA. As associate hospitals of HMI in India, Wockhardt Hospitals benefit from the extensive learning and experience of Harvard Medical School and its affiliated institutions world-wide and strive to bring to its patients the benefits of global standards in technology and clinical expertise. Wockhardt Hospitals, Mumbai, has become the first super specialty hospital in South Asia to achieve accreditation from Joint Commission International (JCI), USA.

Escorts Heart Institute and Research Center

Escorts Heart Institute and Research Center (EHIRC), an ISO 9001 institute has a total of 164 Critical Care beds to provide intensive care to patients after surgery or angioplasty, emergency admissions or other patients needing highly specialized management. The hospital is backed by the most advanced laboratories performing complete range of investigative tests in the field of Nuclear Medicine, Radiology, Bio-chemistry, Haematology, Transfusion Medicine and Microbiology. Performed over 9756 Angiographies, 2707 Coronary Interventions, 5519 Cardiac (3214 CABG, 563 Valve, 765 Congenital, 977 other) surgeries in 2005.

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