Dr GOKHALE CT ASSOCIATES CREATES A MILE STONE IN TRANSPLANTATION SURGERY IN ANDHRA PRADESH AND IN INDIA

                Dr Gokhale and his team did the  first successful lung transplantation in Andhra Pradesh at Yashoda Hospitals, Secunderabad, taking the medical facilities at Hyderabad one more step forward.  There is only one more center in India where such facilities for both lung and heart transplantations are available under one roof.

Cardiothoracic surgery team at Yashoda Hospitals, Secunderabad, headed by Dr A.G.K.Gokhale, Chief cardiothoracic, transplant and minimal access surgeon and Dr G. Subramanyam, Senior consultant Anesthetist, transplanted a lung on  8^th of September, 2012, for a 34 yr old lady from Pune , making her breathe comfortably again after a long time.

This lady with two small children, has been suffering for last two years from a lung condition called Interstitial fibrosis- a condition in which lungs become stiff and oxygen will not go into blood through lungs. She was bedridden depending on oxygen at rest. She was going  all over place in Maharashtra  for possible cure.  Ultimately the treating doctor at Bombay hospital, Mumbai , broke the news to the patient and family that the only option to make her live longer is –Lung Transplantation, as both lungs were damaged.  It was a rude shock for the whole family to learn it and especially when they came to know that lung transplantation is not available anywhere close by. After that they looked all over the country and came to Dr Gokhale at Yashoda Hospitals for this operation about 2 months back.  She was evaluated by Dr Gokhale and  Dr Gangadhar Reddy , pulmonologist  for lung transplantation . After that they had video discussions with lung transplant team at Debakey Heart and Lung center, Houston, Texas and once it was confirmed that there is no other option to save this patient, she was kept on waiting list.  Since then she stayed in a hotel near the hospital premises waiting desperately for a donor to be available.

On the evening of 8^th of September, 2012, a lady patient was declared brain dead  due to massive  bleeding inside the brain, in another corporate (KIMS) hospital , Hyderabad. When her attendants agreed to donate the organs, her lungs were brought in a preservative solution and right lung was transplanted to the patient.

This operation took nearly 14 hours to complete from planning to execution. She was taken off ventilator after 24 hours and when she started talking, those were the happiest moments for the entire team which worked towards this history creation. Apart from Dr Gokhale, surgical team included Dr Viswanath and Dr Dilip Ratti and the Anesthesia team included Dr Subramanyam, Dr Sudhakar, Dr Madhav and Dr Venu. Postoperatively  she was monitored in the intensive care unit by the cardiothoracic surgery and pulmonology teams.

We have two lungs in the chest and they purify blood by giving oxygen from the air we breathe and removing carbon-di-oxide from blood. They can damaged from various reasons like direct and indirect smoking, working in polluted atmosphere, following viral infections and due to a variety of other reasons. As age advances, nearly 10% of people in urban areas develop major lung problems. When they get damaged, patients find it difficult to do the work they were doing  before and slowly get breathless on walking for small distances. Latter they cannot breathe without keeping oxygen and become bedridden. For many of these patients, drugs do not help. The only option for them to live longer and have good quality of life is – Lung transplantation. After transplantation, they can do normal activities and enjoy the life and do what they love. They also have to be on drugs that prevent rejection life-long.  This transplantation  has created a new hope to such patients who otherwise do not have hope to live. This heart team has rich experience in doing complicated heart and lung surgeries for over one and a half decades .

Incidentally in Andhra Pradesh ,Dr A.G.K.Gokhale  and his team did the first successful heart transplant in 2004 and implanted the first left ventricular  assist device (LVAD) in July 2012 and again did the first lung transplant. Dr Gokhale  is one of the only two surgeons in India who performed heart and lung transplants successfully so far.

This complicated surgery was performed on July 10 by a team of doctors headed by Dr AGK Gokhale, Chief Cardiothoracic, Transplant and Minimal Access Heart Surgeon at Yashoda Group of Hospitals.

The patient had a heart valve problem on the left side with an extremely poor heart function. She was suffering from severe narrowing of aortic valve and her pumping chamber on left side was very weak.

The patient had a heart valve problem on the left side with an extremely poor heart function. She was suffering from severe narrowing of aortic valve (valve on left side of the heart) and her pumping chamber on left side was very weak (severe left ventricular dysfunction). The patient developed severe breathing difficulty 10 days back and had to be put on ventilator.

Dr Gokhale performed this rare surgery and replaced the aortic valve and implanted the LVAD. This was done for the first time in Andhra Pradesh. So far, only four such implantations were done in India.

LVAD, used as a ‘bridge to recovery or as a ‘bridge to transplantation,’ is a battery-operated device that helps keep a patient alive when heart can not effectively work on its own. While the damaged heart pumps part of the blood needed for the body, the remaining blood is pumped by the device taking the burden off from the damaged heart. This will buy time to help the heart to recover or till a donor heart is found for heart transplantation.

Speaking on the occasion, Dr Gokhale said, “The patient was on ventilator with breathing difficulty and was suffering from severe left ventricular dysfunction. As her breathing and blood pressure were not improving, her cardiologist, Dr T Sasi kanth performed balloon dilatation of the valve. Despite this, her condition remained critical and she could not be taken off the ventilator. After discussion with the immediate kith and kin of the patient, we decided that she immediately requires a open heart surgery at a very high risk.”

“Without surgery, her chances to survive were meager. A few months back, a new device ‘CentriMag heart assist device’ was approved for use in India. The device will perform the work of left heart chambers giving time for the left ventricle to recover. It was used for this lady after open heart surgery. This operation took six hours. Patient is taken off the ventilator within 24 hours after surgery and she is breathing on her own and recovering well. Depending on the need this device can be left for 30 days to help the heart recover.” he further added.

Source : http://www.expresshealthcare.in

Searches related to : Heart Assist Device in India

• First Heart Assist Device in Andhra Pradesh
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Classical indications for Heart Transplantation are:
1.NYHA class III or IV* heart failure refractory to medical and surgical therapy. Objective data would include a reduced left ventricular ejection fraction ( 2.Inoperable CAD with intractable angina/equivalent symptoms
3.Malignant ventricular arrythmias unresponsive to medical or surgical therapy.

Patients accepted as transplant candidates should have recent right heart catheterization test., Left ventricular ejection fraction and oxygen consumption measurements within 6 months.

All these patients need to undergo rigorous pre-operative assessment to correct any correctable causes for heart damage and for evidence of major infection or tumors in the body. Once they are deemed fit for this surgery, they are put in the waiting list by the center which performs these transplants.

*NYHA Class Symptoms I : No symptoms and no limitation in ordinary physical activity, e.g. shortness of breath when walking, climbing stairs etc.
NYHA Class Symptoms I I: Mild symptoms (mild shortness of breath and/or angina) and slight limitation during ordinary activity.
NYHA Class Symptoms I I I: Marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances (20–100 m). Comfortable only at rest
NYHA Class Symptoms I V: Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients.

Yashoda Hospital recently organised and conducted a live international workshop on minimal access cardiac surgery also called minimally invasive cardiac surgery (MISC) at its academic hall. The aim of the workshop was to discuss the latest advances and improved outcomes of MISC thus taking it to the next level.

Standard procedures for heart surgery can be most invasive as they involve 10″-12″ incisions. An MICS procedure is often performed through a smaller 3″-5″ incision placed between the ribs, or can be done with few small incisions. During the workshop which was conducted on April 14 and 15 the focus was on advantages of MICS which includes minimum hospitalisation, less cost, minimal blood loss, faster recovery, cosmetic advantage, lower infection rate and lesser post surgical complications.

Nearly 150 eminent surgeons from all over India and two renowned international cardiac surgeons attended the workshop as faculty. The international faculty included Dr Hendrik Treede, senior consultant and head of minimally invasive surgery, University Heart Center Hamburg, Germany; and Dr Mahesh Ramachandani, director, minimally invasive cardiac surgery, methodist debakey heart and vascular centre, Houston, Texas, USA.

Dr A G K Gokhale, head of the department, department of minimally invasive cardiac surgery (MICS) Yashoda Hospital, Secunderabad, who presided over the live workshop, facilitated smooth interactions between the audience and the faculty, contributing to the workshop’s success. Three cases of bypass surgery and valve replacements were performed by minimal access approach in this workshop.

Dr Gokhale, drawing attention to the advantages of MICS informed that in an open-chest surgery, the heart and its vessels are exposed through median sternotomy, where the breastbone is sawed open down the mid line and then pulled apart. This is an extremely invasive and traumatic part of a standard heart surgery. In comparison, a minimally invasive procedure uses small incisions to access the heart without stopping the heart or cutting the breastbone and ribcage. A minimally invasive surgery causes lesser trauma and the recovery time is much shorter.

“Additionally, this approach lowers risk of complications such as bleeding and infection. Upon returning home, many patients resume their normal lives in much less time. They require minimal assistance and report needing little or no pain medication. Often, they begin cardiac rehabilitation sooner and consistently maintain their regimen. In as little as two weeks, patients have resumed day-to-day activities and even returned to their jobs,” Dr Gokhale added.

Dr G S Rao, managing director, Yashoda Group of Hospitals said, “Yashoda Heart Institute has earned the reputation of being a leader in heart care performing approximately 10,000 procedures annually. We have made great strides in cardiology and cardiothoracic surgery and thousands of cardiac procedures and surgeries were performed with precision and success. This live workshop will not only highlight the advantages but will also talk about taking this procedure to its next logical level.” ]]> http://blog.drgokhale.com/yashoda-hospital-conducts-live-workshop-on-minimal-access-cardiac-surgery/feed/ 0 http://blog.drgokhale.com/oldest-man-in-india-to-undergo-heart-transplantation/ http://blog.drgokhale.com/oldest-man-in-india-to-undergo-heart-transplantation/#comments Sat, 03 Mar 2012 01:44:11 +0000 admin http://blog.drgokhale.com/?p=24 Today a 69 year old man is walking out with a 24 old year old heart, writing a new record in the history of Heart Transplantation in India and creating hope for many patients with damaged hearts.. This patient was suffering from a heart disease- restrictive cardio-myopathy for the last 10 years. He had a defibrillator cum pacemaker put in USA. Despite the medication and pacemaker his condition continued to worsen to the extent that he stopped moving out of the house except for admissions in the hospital for swelling of feet and breathing difficulty. With these he opted for heart transplantation. On 16th of February, the relations of a 24year old victim of road accident came forward for donating organs. His heart was used to replace the damaged heart of the 69 year old man. Despite the age , patient recovered fast and is being discharged 9 days after surgery. In the world, oldest person to undergo Heart Transplantation was a 71 year old person in Australia.

In the world, Heart Transplantation is a well established procedure to treat patients with end-stage heart failure. As per ISHLT(International Society for Heart and Lung Transplantation) data, over one lakh heart transplants were done so far in the world. Every year in USA alone, more than 3500 heart transplants are done. 10 year survival following heart transplantation is around 60%. However in India, pickup of this procedure has been slow. Since the first heart transplant done in India in 1994, only a little over 100 heart transplants are done in India in a handful of centers.

Lack of awareness among the public and professionals is the main reason. In the last few years, thanks to the media, this problem is being tackled. The incidence of patients in India with end-stage heart failure needing heart transplantation is 100,000.

A.G.K. Ghokale, consultant cardiothoracic and transplant surgeon at Global Hospitals, asked physicians and practicing doctors to deliver cost-effective medial treatment to heart patients.
Addressing the continuing Medical Education workshop, sponsored by Heart Failure Society of India and NTR University of Health Sciences, at KMC, here on Saturday, he said five to six potential and proven drugs were available for treating heart ailments which were also low-priced.
However, the drug industry was pushing a host of formulations which confused the doctors. The Heart Failure Society of India wanted to create awareness among practicing physicians, medical students, professionals and patients about standard treatment procedures available for treating heart diseases. Bypass surgery or transplants were the last resort and before reaching that stage, many options were available to provide quality life to patients. Adequate dosage of drugs was also important for full result, he said.
He said the society, which was started five years ago, conducted workshops at various colleges on a regional basis and at the State and national levels. This year, the annual conference of the society would be conducted in Chennai in December.
He said that heart transplant facility was available in India and it cost Rs. 7 to 8 lakh. He said the incidence of heart problems was 8 to 9 per cent in urban areas and 6 to 7 per cent in rural areas.
Registrar of Health University Dr. Venugopal said the university was planning to introduce a postgraduate course (MD) in Emergency Medicine considering its importance. Also, the university undertook a comprehensive programme to enhance teaching standards and lay emphasis on clinical training rather than classroom teaching. The university enrolled 30 visiting professors and introduced fellowships. It planned to start skill labs in all medical colleges. Advanced methods like stimulation and e-learning would be introduced.
S.A. Sattar, former Director of Medical Education, who delivered the keynote address asked doctors to be realistic and practical in treating patients. He said an artificial pump to supplement the performance of a diseased heart could be thought of before going for heart transplant.
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•  ‘Five to six potential and proven low-priced drugs available for treating heart ailments’
•  Heart transplant facility is available in India and it costs Rs. 7 to 8 lakh: A.G.K. Gokhale

Now-a-days Heart diseases especially Ischemic heart disease cripples and kills tens of thousands of people all over India every year. It has now assumed epidemic proportions. Heart diseases in our region grew by 300% in the last 30 years and are still growing by 2-3% every year, one million people under the age of 40 will die from this disease and 60% of heart patients in the world are likely to be in India.

In this connection, FAPCCI in association with HMA is organizing a Seminar on “Live 100 Years and Beyond” on January 27, 2011 at 5.00 p.m. at Surana Udyog Auditorium, Federation House.

The main idea of the programme is  “How to Live Healthy and Happy” and to make people aware of the heart diseases. Dr. AGK Gokhale, Heart Transplant and Cardiothoracic Surgeon, Global Hospitals will address on  “Healthy and Happy Life”. On this occasion, FAPCCI will be felicitating Sri Boudhanathan, I.A.S., (Retd.)  and Sri Gelli Narayana Chetty, I.A.S., who lived for 100 years and beyond, who will also speak on “How to Live 100 Years and Beyond”.

Dr. AGK Gokhale is the first surgeon in Andhra Pradesh who has successfully done heart transplantation. Dr Gokhale, a noted name among the medical fraternity in general and cardiothoracic surgeons the world over in particular, has had the distinction of performing India’s first heart-kidney combined transplant and Andhra Pradesh’s first heart transplant, besides more than 5000 open heart surgeries- adult as well as pediatric.

We are inviting Sri D.L.Ravindra Reddy, Hon’ble Minister for Medical Education, APVVP & Hospital Services, Health, Family Welfare, Arogyasree, Health Insurance, 104, 108 and Medical Infrastructure, Government of Andhra Pradesh as Chief Guest and Dr. P.V. Ramesh, IAS, Principal Secretary to Government (Health) as Guest of Honor.

All the members are requested to attend the function and make it a grand success.
B.V. Rama Kumar  – Joint Secretary – 9246800355