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CHOOSING BETWEEN STENT OR SURGERY

Choosing between Stent or Surgery



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Beating Heart bypass Surgery is blessing for elderly

Beating Heart bypass Surgery is blessing for elderly



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Rare Surgery Perfomed on Patiala

Rare Surgery Perfomed on Patiala



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Press Confrenece on Rare Surgery

Press Confrenece on Rare Surgery



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Right Surgery for Right Heart

Right Surgery for Right Heart



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Rare Surgery for right sided Heart

Rare Surgery for right sided Heart



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Addressing The Media

Addressing The Media



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New Technique for Heart Bypass




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Minimally Invasive Cardiac Surgery of Heart Diseases




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Small Incision Surgery of Heart




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New Technique for Heart Bypass Surgery




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Beating heart Bypass surgery boon for Elderly

Beating heart Bypass surgery boon for Elderly



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KARACHI COUPLE HAD LOST HOPE BUT LITTLE ALI WILL LIVE

Karachi couple had lost hope but little ali will live



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MAX HOSPITAL, MOHALI GIVES A NEW LIFE TO A BLUE BABY

Max Hospital, Mohali gives a new life to a Blue Baby



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City doctor gets US STS membership

City doctor gets US STS membership



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Minimal Invasive Cardiac Surgery




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Coronary artery problem gets a modern treatment

Coronary artery problem gets a modern treatment



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RARE HEART SURGERY IN PVT. HOSPITAL

High risk by birth defect surgery performed in almost in-operable case



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LIFE SAVING BYPASS SURGERY OF B'DESH NATIONAL

Life saving bypass surgery of B'desh National



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Doc gets US society memership

Doc gets US society memership



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NEW TECHNIQUE BLESSING FOR DIABETICS WITH HEART DISEASE

New technique blessing for diabetics with heart disease



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Doctors discuss advancements in Heart treatments

Doctors discuss advancements in Heart treatments



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HE RETURNED BACK DISCOURAGED FROM MECCA

He returned back discouraged from Mecca



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Dr Sarwal gets International membership

Dr Sarwal gets International membership



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High Risk Bypass Surgery gets easier

High Risk Bypass Surgery gets easier



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HOW OFF-PUMP BYPASS SURGERY OFFLOADS MORTALITY

How Off-Pump bypass surgery offloads mortality



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RARE SURGERY SAVES BOY'S LIFE

Rare surgery saves Boy's life



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Kashmiri Boy gets a new lease of life at Max hospital

Kashmiri Boy gets a new lease of life at Max hospital



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SURGERY CURES MAN OF BLUE BABY SYNDROME

Surgery cures man of blue baby syndrome



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Kashmiri Boy gets a new lease of life at Max hospital1

Kashmiri Boy gets a new lease of life at Max hospital1



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Max gives new lease of life to Kashmiri boy

Max gives new lease of life to Kashmiri boy



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SUCCESSFUL OPERATION OF BLUE BABY PATIENT

Successful operation of blue baby patient



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'OPCAB' TECHNIQUE HELPS PATIENTS RECOVER FASTER POST SURGERY

Opcab technique helps patients recover faster post surgery



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Max Hospital Introduces new Techniuqe For High-Risk Bypass Surgery With Calcified Aorta

Max Hospital Introduces new Techniuqe For High-Risk Bypass Surgery With Calcified Aorta



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SUNDAY HEALTH

Sunday health



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KEEP UP WITH EXERCISE FOR A HEALTHY HEART

Five ways to benifit from Coronary Artery Bypass Surgery



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Coverage on latest techniques

Coverage on latest techniques



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RARE VASCULAR SURGERY GIVES NEWS LIFE TO INFANT

Rare vascular surgery gives news life to infant



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HEART AILMENT..... IS THE OPTION STENT OR SURGERY

Heart ailment....is the option stent or surgery



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Max Hospital saved life of 31 year old boy

Max Hospital saved life of 31 year old boy



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Max introduces new technique for CABG

Max introduces new technique for CABG



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RARE SURGERY AT ALCHEMIST SAVES LIFE OF TETROLOGY OF FALLOT PATIENT

Rare surgery at alchemist saves life of tetrology of fallot patient



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IF FINGER AND TONGUE TURNS BLUE , BE ALERT

If finger and tongue turns blue , be alert



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New Device for bad calcified aorta in CABG

New Device for bad calcified aorta in CABG



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New Technique evolved for high risk bypass Surgery

New Technique evolved for high risk bypass Surgery



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MANJEET FINDS NEW LIFE IN PANCHKULA

Manjeet finds new life in panchkula



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RISE IN DISEASE OF THE RICH

Rise in disease of the rich



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New technique for CABG more safe

New technique for CABG more safe



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New Technique for high risk bypass surgery with calcified Aorta

New Technique for high risk bypass surgery with calcified Aorta



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MENDING BADLY DAMAGED HEARTS

The treatment of badly damaged heart after multiple heart attacks is a very challenging situation as far as the Coronary Artery Disease is concerned. With each heart attack, some cardiac muscle cells go dead and cannot be revived. So, more the number of heart attacks, more the damage if no intervention is done during the crucial period. If the number of cells going dead is large, it leads to a scar formation and then ultimately thinning of the heart muscles, which do not participate in the pumping of blood. Heart function goes down, which is called EF or ejection fraction. The size of the heart precisely of the left chamber i.e. left ventricle increases and it loses its geometrical, spiral shape necessary for adequate pumping of the blood. This leads to repeated heart failures and accumulation of fluid in the lungs leading to breathlessness and loss of active working routine. Dr Virendar Sarwal This is why it is a famous quote “Time is muscle”. If someone is suffering from heart disease or Coronary Artery Disease, he should get the required treatment as soon as possible without much wait and should aim at saving the heart muscle from dying. Once the terminal or end stage heart disease sets in, very few options are left as far as treatment is concerned. The commonly done bypass surgery becomes very high risk as heart muscles have lost their reserve and may behave erratically. Due to stress of surgery, the heart may not sustain normal blood pressure and perfusion to other organs of the body and may require high drug support after surgery. So the success chances go down. For this reason, these patients are generally categorized into high-risk end stage heart disease, and are offered only heart transplant as modality of treatment. Heart transplant itself is a rare surgery because of non-availability of donor hearts and is also very expensive to maintain throughout life to avoid graft rejection. In our country, the facilities for heart transplant are very few and even in western countries, there is a huge waiting list for these patients. Many of them cannot make it and die waiting for the donor hearts. Also, heart transplant is a very expensive programme to maintain for the organisations and requires special teams and skills. These patients suffer a lot during the rest of their life, as they suffer from repeated heart failures, repeated hospitalisations and deep dents on their pockets. Also, the quality of life is very low with great restriction on the activities and the exertion levels. This is one group of patients that requires a lot of help and special care and a very minutely chalked out treatment plan. Beating Heart Surgery showed some hope to these patients in terms of reducing the risk towards Bypass surgery. But still, post-operative course is generally very hectic. Intra-Aortic balloon pump is “the device” for these patients which when instituted before during or after bypass surgery helps a lot in giving relief and hastens the progress after surgery. It sustains the human physiology before and during surgery, especially when the stress is highest and there is a lot of swelling in the heart as well as body. It helps in two ways, one it increases the pressure at which the heart muscle is supplied blood in relaxation phase. Secondly, it reduces the load on the heart so that it has to work less. But all said and done, the strength of heart muscle is very important for weaning these patients of the blood pressure maintaining drugs and the intra-aortic balloon pump support. The muscle has to be viable and not dead or scarred before surgery so that when it gets its nutrition back after bypass surgery, it starts working slowly and takes the full load of the heart in maintaining good blood pressure for adequate perfusion of all organs including kidneys, liver, brain, and lungs. Till now, we had some specialised tests available like Dobutamine Stress Echo or stress thallium or resting MUGA (Multigated Acquisition) scan to tell us to some extent whether there is any viable muscle available in a patient who has badly damaged heart with low heart function. But they were not very reliable and dependency of these investigations to decide about bypass surgery was not very accurate. PET-scan (Positron Emission Tomography) was available in western countries, which was very close to assessing the viability accurately in quantifying the risk and to see the benefits of bypass surgery. For last one to two years, we have this investigation available in India also and is basically based on glucose uptake of the heart muscle cells. It predicts fairly accurately how much of the heart muscle is viable which will improve if given blood through bypass surgery. All the more, if combined with the stress thallium, the accuracy further increases. It is very essential to offer these terminally suffering patients a durable and long-term solution or treatment to improve their quality of life and also to save them of repeated hospital admissions and expenses. Also, it saves a lot of resources for the state, as these patients are then pulled out of heart transplant list. In the last two years, we did about 15 such cases, in some of them documented with PET-scan for viability of heart muscle, coupled with beating heart surgery and surprisingly, all of them did very well. They were out of the hospital within 7-9 days of their surgery and heart function at the time of the discharge itself increased to almost double i.e. around 30-35% from 12-20%. This helped them to get back to their active life to a great extent without further hospitalizations. All of them are in constant follow-up and doing very well. So, before we declare these patients unfit for bypass surgery, we should investigate them thoroughly and make a very serious attempt in finding out all the positive signs for viability of heart muscle and then offer them bypass surgery on beating heart. Still the communication to the family about the pros and cons of the procedure and the risks involved should be very clear and all their queries should be answered in great detail so that it becomes a combined effort willingly and in a positive direction. This will help in saving a lot of lives, saving a lot of resources and adding life to years for such patients. As such, all effort should be made not to reach this stage of end stage heart disease by maintaining: 1. Good life style 2. Good dietary control 3. Avoid smoking 4. Avoid excessive drinking 5. Regular exercise 6. Some form of relaxation from routine stress of life 7. Controlling blood sugars in diabetics 8. Adequate control of hypertension 9. Regular routine health check-ups once a year after the age of 35 years And most importantly, if someone is detected to be having coronary artery disease, one should not wait for repeated heart attacks before coming for bypass surgery. Treatment or intervention should be got done as soon as it is indicated because you must remember “TIME IS MUSCLE” — by Dr Virendar Sarwal Wednesday, October 17, 2012 published at www.alatimes.com



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HOPE FOR OCTOGENERIANS

Hope for Octogenerians



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Tissue a better option in Valvular Heart Disease say experts

Tissue a better option in Valvular Heart Disease say experts



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Tissue Valve is better help in elderly

Tissue Valve is better help in elderly



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News today

News today



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Affordable Healthcare only possible with Value Based Medicine.

Affordable healthcare only possible with value based medicine Monday, January 21, 2013 Dr Virendar Sarwal In-charge and Senior Consultant, Dept of Cardiothoracic and Vascular Surgery Max Super Speciality Hospital, Mohali India is a developing country and 80 per cent of the population of our country cannot afford expensive healthcare. The facilities provided by the government are miniscule in front of the giant problem. Shortage of doctors, basic infrastructure, paramedical staff and expensive medicines makes healthcare even more out of reach for a common man. That is the reason we are still struggling with the certain communicable diseases and now added to that is the burden of non-communicable diseases. Dr Virendar Sarwal India is going to be the world capital for heart disease in 2030 as per the WHO report. Diabetes is rampant and there is total lack of awareness about prevention, lifestyle management, hygiene levels, sanitation and the healthy living with the result that we have huge load of patients whether it is communicable or non-communicable disease. Added to it is the shortage of manpower to treat these patients. As per one study, our country has only 20 doctors per 10,000 people as compared to 650/10,000 in US. The budgetary provisions for healthcare are so low that even the primary healthcare cannot be delivered efficiently with the result the rural population is the worst sufferers. That is how there is mushrooming of quacks and invaluable lives are at risk. In such a dismal scenario only alternative to improve upon the services and make each step in healthcare delivery more justified and economical, if we look at an evolving healthcare delivery system all over the world and even in developed countries like US, is Valve Based Medicine. So far, we have been practicing Evidence Based Medicine where in based on the evidence of the disease, we treat it with the costliest way of treatment. It ignores the logic of benefit vs cost ratio whether it is concerned with writing costly medicines or adopting the costliest intervention. The value based medicine concept is different from the evidence based medicine concept in the sense that we are treating human beings and not symptoms. The treatment plan has to be based on the effective control of the disease with respect to the perception of the patient and his family in terms of benefit as compared to the cost involved in it. Let’s say in heart disease a patient having coronary artery disease in two or three vessels can be treated with bypass surgery as well as ballooning and stenting. Now, whereas stents will cost him a big money and will also not be durable so bypass surgery becomes more economical and more durable. What the patient wants here is effective quality of life improvement with an economical and durable procedure. So, of course, bypass surgery is the best answer here. Similarly, a sore throat can be effectively treated with low-end antibiotic treatment and supportive therapy instead of expensive and high-end antibiotics. Value based medicine is a means to compare all healthcare interventions on the same scale and a measure that can be combined with the cost of an intervention to arrive at a cost utility ratio. It provides most effective assessment of the patient perceived worth of an intervention. It also measures quality of life and/or length of life. The irony of healthcare industry is that it is one of the few industries where purchasers or the patients are unable to measure the valve of what they purchase. So, value based medicine allows highest quality care, maximization of healthcare rupee and incorporation of patient based perception of quality of life. The goal of value based medicine is to promote what is best for the most important people in healthcare i.e. patients. It provides transparency backed by scientific opinion, communication by personal attention, no scare or fear by involving empathy, economics and 24×7 availability. Similarly, if we come to procedures, the beating heart surgery is value based medicine. Minimal invasive surgery goes a step further in that direction as it makes the patient up and about early and the patient does not lose productive days of earning and is back to work at the earliest with less stress on the body. Also, in terms of logistics there is less ICU stay, less hospital stay, less use of blood products. Value based medicine also incorporates all the forthcoming evidence which is percolated to the patient level and helps in decision making for the patients. Now, coming to stent vs surgery, two major trials — one in 2009 Syntax trial and the other in November 2012 Freedom trail — have clearly established and concluded that in multi-vessel disease and diabetes, bypass surgery scores over drug coated stents in terms of death, second heart attack and second or repeat intervention. So, all patients with multi-vessel disease should be offered bypass surgery as the first option for durable economical treatment. In this scenario, value based medicine (VBM) stipulates that when it come to coronary artery disease each and every patient should meet the surgeon with his angiography report to reach to a conclusion whether he needs to go for stents or surgery. The other thing, which our country needs to incorporate into VBM is the availability of cost effective medicines, disposables and equipment. Most of the equipments, disposables used in high-end surgeries is still being imported and thereby making huge loss and leading to escalation of prices of these essentials. The government has to encourage use of generic drugs, which should be free and easily available and encourage manufacture of disposables and equipments in our own country. It will do away the huge profit margin taken by the multinational companies when the middlemen and dealers add to the cost. There are very innovative products available in India and effort should be done to produce them at mass level and promote them at all levels. In fact, all hospitals should be told to use them as the first priority. The infrastructural resources for the primary, secondary and tertiary healthcare delivery are very less so a policy needs to be made wherein the government and the private sectors should join hands in making the total available infrastructure at the disposal of all the patient population group. There should not be any differentiation and all available beds should be utilized to the maximum by one and all. It will help in reducing the waiting list and huge queues seen in government hospitals today. All it needs is rationalization of compensation to the private sector. Today also many government agencies are utilizing the private resources for tertiary care by reimbursing them the subsidized cost of treatment. Why can’t it be applied to the primary and secondary care? The public private partnership (PPP) is another good concept of upgrading and bringing secondary and tertiary care in all cities and rural areas. To promote healthcare delivery in rural areas the doctor should be encouraged by arranging for them good housing and transport facility and good schooling for their children. In fact, the concept of rural dispensaries should be abandoned and what we need is a good primary/secondary healthcare centre within a radius of 20 kilometres and that area on daily basis should be covered for OPD service by mobile vans with fixed hours backed by strong ambulance service which most states have already adopted. This will help getting the medical and paramedical manpower stationed at these centres as they will get basic facility and necessities of life for themselves and their family and doctors will be able to deliver better healthcare with better facility in terms of equipment and beds in an upgraded hospital environment. It will also help in running the various preventive healthcare programmes in true earnest. These primary/secondary healthcare centres should be backed by tertiary care centres whether in private or government sectors at treatment cost rationalized by a committee of experts consisting of knowledgeable people from the government and the private sectors. We need to understand that health is the ultimate necessity of life and is very important for the economic growth of this country. If we get developed this concept of value based medicine, it will see us through in building a healthy and capable society which in turn will produce a workforce which will work hard to take this country forward and will make it a world leader.



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For Heart's Sake

Heart is the most important organ of the body. Adding life to heart means adding years to life. To add life to your heart, there is an ageby- age guide, which can help in bringing small changes but with big results. In your 20s Drink water: Coming out of your teens, you may regularly drink soda, sports drinks or big glasses of juice. Switching at least one or two of these drinks a day for water will not only save you money, it may also save your heart. Find a better stress reliever: Now is the time to switch your bad habits to good ones. If you started smoking cigarettes as a way to fit in and look cool in your teens and in your 20s you're doing it to reduce stress, stopping smoking is the number one thing you can do for your heart. People who smoke in their 20s and continue for the rest of their lives die on average 12 to 14 years younger than non-smokers. Learn your family history: Fill in the gaps on your family health tree. Talk to your parents and other relatives to find out what medical conditions run in your family. In your 30s Set post-pregnancy goals These are prime weight-gaining years, especially if you are experiencing pregnancies. Women get into a vicious cycle. They'll have a baby, gain 40 pounds and lose five. They'll have another baby, gain 40 pounds and lose 10, and then by the end of their 30s, they turn around and they've gained 90 pounds. Do what you love Whatever activity makes you feel really good inside, make sure you do it for at least 15 or 20 minutes every day. Know your numbers By now you should be familiar with your "three Bs" - your body mass index, blood pressure and blood cholesterol. In your 40s Weight train For women, the 40s are when your body starts losing a lot of its lean muscle tissue and metabolism slows, making you more likely to gain weight. Nurture your relationships You realise how important relationships become in helping you get through difficult times and in helping encourage you to make healthy choices in your life. If you haven't already done it, now is the time to create and nurture that network of support around you. In your 50s Rethink when you eat The often-repeated advice to eat breakfast like a king, lunch like a prince and dinner like a pauper is especially true as you age into your 50s and beyond. Volunteer your time In your 20s and 30s, there are a lot to be excited about--marriage, babies and career. By the time you reach your 50s, those big life events may be in your past, and you may instead be facing an empty nest, parents who are dying or already gone and the denouement of your career. Volunteering your time for a cause is a great way to bring more positives into your life. Get screened The National Osteoporosis Foundation recommends a bone mineral density test after 50 if you have risk factors such as being menopausal or osteoporosis. Dr Sarwal is a cardiologist)



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Tissue Valves better choice for Valve replacement Dr Sarwal

Tissue Valves better choice for Valve replacement Dr Sarwal



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Tissue Valves better choice for Valve replacement Dr Sarwal1

Tissue Valves better choice for Valve replacement Dr Sarwal1



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News today

News today



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News today

News today



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