Surgery: Archives

Aortic Stenosis/TAVR/TAVI September 17, 2021

Tavr Procedure & Who Can Opt For It

There has been news of hope in recent years for the treatment of a common heart condition Aortic Stenosis, a procedure called transcatheter aortic valve replacement (TAVR). It was introduced in the mid-2000s since then as many as 400,000 patients across the world have had TAVR. According to the trials published in 2010, it was found that the TAVR procedure drastically reduced the risk of death among the inoperable patients. TAVR has been also found to be effective for patients with high and intermediate risk of serious complications from surgery or death. Whether or not you should undergo the procedure is entirely your doctor’s call, but even then, it is essential you know all that you can about the procedure.

What is TAVR used for?

TAVR is designed to treat Aortic stenosis hence it is important to understand the condition.

Aortic valve stenosis or aortic stenosis occurs due to narrowing of the aortic valve opening. It is one of the most common and serious valves disease problems. Aortic stenosis restricts the blood flow from the left ventricle to the aorta and also affects the pressure within the left atrium of the heart. Some people have stenosis due to a congenital heart defect called a bicuspid semilunar valve. During aging, this condition is developed commonly as calcium or scarring damages the valve and restricts the amount of blood flowing through.

Sometimes the left ventricle wall may show muscular thickening because the ventricle must have worked hard to pump blood through the narrow valve opening into the aorta. Appropriate treatment can help reverse or help slow down the progress of this disease.

Symptoms caused by Aortic Stenosis

Many people may not experience any symptoms until the amount of restricted blood flow becomes greatly reduced. Then the symptoms may include:

• Chest pain

• Difficulty in walking short distances

• Feeling dizzy or light-headed or even fainting

• Rapid, fluttering heartbeat

• Difficulty in sleeping or needing to sleep in the sitting posture

• Swollen ankles or feet

• Decline in energy levels

It may be important that someone suffering from aortic stenosis may not experience any of these symptoms. But if you observe a decline in routine physical activities or significant fatigue, it’s worth a doctor’s visit to check for reduced heart function.

Treatment for aortic stenosis

Your doctor may suggest a couple of tests to confirm or rule out aortic stenosis. Tests also help determine the cause and severity of the condition.

The treatment of aortic stenosis depends upon how severe your condition is. For mild or moderate cases your doctor may keep a check on you. You will have to get regular check-ups and echocardiograms. Your doctor may encourage you to make changes to improve your overall health. It might include:

• Working on weight loss

• Switching to a healthier diet

• Managing your stress

• Quitting smoking

• Exercising, depending on your symptoms

For patients with severe stenosis, treatment options may include surgical semilunar valve replacement (SAVR) or transcatheter semilunar valve replacement (TAVR).

Surgical Aortic valve replacement (SAVR) or transcatheter Aortic valve replacement

Traditional treatment of Aortic stenosis- Open Heart Surgery

Open heart surgery is considered a major operation. During an open-heart SAVR procedure, an incision is formed within the chest to access the heart during which the heart is stopped and blood is bypassed through a heart-lung machine. After which the diseased valve is removed and replaced with a replacement valve. SAVR has been the historical standard treatment for aortic stenosis for years.

For candidates who are suitable SAVR has given good outcomes to those patients. But the major drawback of SAVR is the long recovery period that generally requires five to seven days of hospitalization after surgery and more than six weeks for a full recovery. If the patient has too many medical conditions then it makes them unsuitable for SAVR.

A non-surgical treatment- TAVR

TAVR is a minimally invasive procedure. For severe aortic stenosis patients who cannot withstand open-heart surgery, it is now the first line of therapy. Unlike a SAVR procedure which involves opening the chest to exchange a patient’s semilunar valve with a mechanical or tissue valve, the TAVR approach delivers a collapsible replacement valve via catheter. This process involves inserting a hollow tube (catheter) into your aortic valve through the blood vessels. Once the new valve is placed, the balloon on the catheter’s tip is inflated to park the valve in the desired position. Once it’s done, the catheter is then removed and the new valve now does the job of regulating the blood flow.Patients who go under TAVR recover quicker compared to SAVR patients which allows them to leave the hospital and start cardiac rehabilitation sooner and that can help improve the quality of life. It is performed under sedative medication without giving general anesthesia and in most cases, the procedure takes 90 minutes.

The risks TAVR may present

TAVR has major benefits but it also has certain risks as it is a complicated procedure. The risks may include stroke, heart attack, bleeding, and the need for emergency surgery. The risks are low but there is also potential damage to the electrical system of the heart which may result in the need for the placement of a permanent pacemaker.

Is TAVR right for everyone?

Although it might seem like an obvious choice compared to the stress of open-heart surgery, a detailed review must come first because not everyone needs to undergo a TAVR procedure. All patients with severe aortic stenosis must be carefully evaluated to make the best choice for them. Patients in the high-risk category are usually likely candidates of TAVR. A potential patient must have severe aortic stenosis and a three-leaflet valve versus a two-leaflet valve. Patients who have an infection of the heart or associated aneurysms are also not advised for TAVR.

SAVR remains the preferred method for many patients, the surgical techniques have evolved and the valve technology has proven durability. Both the valves are tissue valves, the SAVR valve may be a fixed stent with an approximate lifetime of 15 years while as per The University of Texas Southwestern Medical Center TAVR valve which expands and contracts also has a lifespan of around 10 to 15 years.

If you think you have aortic stenosis, visit your doctor as soon as possible to minimize risks. Take a family member along with you for support and discuss all the options with your doctor. It is important to be evaluated by a heart team, which includes a clinical cardiologist, interventional cardiologist, and a cardiac surgeon. The team will review all your medical information and will provide you the treatment option that’s best for you along with the risks and benefits of the option.

Cancer September 13, 2021

Treating ovarian cancer through surgery

While the thought of cancer as a whole is daunting, one needs to understand that the disease presents itself in different forms. In essence, cancer is when the cells within a body start to mutate at an unnatural pace & cannot be stopped. While this is the common form, many women suffer from a variation of it called Ovarian Cancer.

Ovarian cancer occurs when cancerous growths begin at the ovaries. The female reproductive system has two ovaries on either side of the uterus. The ovaries are responsible for producing eggs (ova) as well as releasing the hormones estrogen and progesterone.

Ovarian cancer usually goes undetected in the early stages. In most cases, it is detected only when cancer has spread to the pelvis and the abdomen, making it difficult to treat. If the tumors are benign (non-cancerous) in nature, they are confined to the ovaries and do not spread. However, if the tumors are malignant, they spread to the nearby organs and can be fatal.

What are the types of ovarian cancer?

The ovaries are made up of three types of cells. Each of them can develop into a different kind of ovarian cancer. The different types of ovarian cancer are:

Epithelial Tumors: These tumors begin from the cells that cover the outer surface of the ovaries. Over 90% of ovarian cancers are epithelial tumors. These tumors can be benign (non-cancerous), borderline (low malignant potential), or malignant (cancerous).

Ovarian Stromal Tumors: These tumors start from the structural tissue cell that produces the female hormones – estrogen and progesterone. These tumors can be diagnosed at an earlier stage as compared to the other types of ovarian tumors.

Ovarian Germ Cell Tumors: Germ cells are responsible for producing eggs (ova) in women. These tumors begin in the germ cells. Most germ cell tumors are usually benign. This rare type of ovarian cancer tends to occur in younger women.

What are the symptoms of ovarian cancer?

In the early stage, ovarian cancer hardly causes any symptoms, making it difficult to diagnose. Advanced-stage ovarian cancer may cause certain symptoms that may often be mistaken for other common, benign conditions or illnesses.

Some of the most common symptoms of ovarian cancer include bloating/swelling in the abdomen, feeling full quickly while eating, change in bowel habits, pain/discomfort in the pelvic area, frequent urination, and loss of weight.

In case these symptoms are more frequent and don’t go away soon, it is advisable to visit your doctor and rule out the possibilities of ovarian cancer. If you have a family history of ovarian cancer, you may talk to a medical practitioner about the risk of developing the same.

How is ovarian cancer diagnosed?

After analyzing your symptoms, if the doctor suspects ovarian cancer, he/she will conduct a pelvic exam to diagnose the condition. During the pelvic exam, the doctor will insert gloved fingers into the vagina, while simultaneously pressing the abdomen to examine your pelvic organs. The doctor also examines your external genitalia and cervix visually.

The doctor may also suggest imaging tests such as an ultrasound or CT scan to determine the size and the shape of the ovaries. Imaging tests can also show if a mass of tissue is present in the pelvic area, but they cannot confirm if the mass is cancerous. Blood tests may also be conducted to determine the presence of tumor markers that indicate ovarian cancer.

After diagnosing ovarian cancer, the next step would be to stage cancer to finalize the treatment options.

What does ovarian cancer surgery involve?

Surgery is not only one of the main treatment methods for ovarian cancer, but it is also a diagnostic tool to determine ovarian cancer. The goal of the surgery for ovarian cancer is to know how far cancer has spread and removed as much of the tumor as possible. The type of surgery will depend on the stage of cancer and your overall health.

Before the surgery, your doctor may run blood and urine tests a week before to ensure that you are healthy enough to undergo the surgery. Your doctor may also take a chest x-ray and ECG to check your heart rhythm.

Surgery for ovarian epithelial tumors:

The surgery for ovarian epithelial cancer has 2 main goals – staging and debulking.

Staging: This is the first goal of ovarian cancer surgery. Staging is done to see how far cancer has spread from the ovary to the organs. This process involves removing the uterus, along with both the ovaries and fallopian tubes. Some samples of the lymph nodes in the pelvis and abdomen are taken through biopsy. Staging is extremely important as it helps determine the best way to treat the condition.

Debulking: The next goal of the surgery is to remove as much of the tumor as possible. This is known as debulking. This is especially important if cancer has spread across the abdomen. Debulking is done to ensure that no tumor larger than 1 cm is left behind.

Surgery for ovarian stromal tumors:

In most cases, ovarian stromal tumors are confined to just one ovary. So, the affected ovary will be removed through the surgical procedure. If cancer has spread further, the tissues in the surrounding areas may have been removed. The main goal of the surgery for ovarian stromal tumors is to remove cancer.

Surgery for ovarian germ cell tumors:

For most ovarian germ cell tumors, the uterus, both ovaries, and the fallopian tubes are removed. If the cancer is confined to just one ovary and you want to retain the ability to bear children, only the affected ovary and the fallopian tube are removed.

Depending on the type and stage of ovarian cancer, your doctor may choose the type of surgery along with other treatment methods such as chemotherapy. Though the surgery will ensure that the cancerous tumors have been removed, it is important to follow up with your healthcare practitioner on the after-care and the possible side effects of the surgery. You can also incorporate certain lifestyle changes to keep yourself healthy and prevent a relapse.

Contraception September 11, 2021

Planning to get an IUD? Here’s all you need to know

Planning a family is a big decision &, understandably, a few people may want to delay it at any given time. Over the years, this has been possible in large part due to the development of various contraception methods.

Your choice of birth control should depend on several factors including your health, frequency of sexual activity, number of sexual partners, and the desire to have children in the future.

There are different types of contraception:

To prevent sperm from getting the eggs, contraception methods include condoms, diaphragms, cervical caps, and contraceptive sponges.
Measures that keep the women’s ovaries from releasing eggs that can be fertilized include birth control pills, patches, shots, vaginal rings, and emergency contraceptive pills.
Long terms measures for birth control include Intrauterine devices (IUD), intrauterine systems (IUS) that are implanted into the uterus. They can be kept in for several years

IUD is considered effective and safe for most women. They are also a long-lasting option. Let’s learn more about it.

What is an IUD?

An IUD may be a small T-shaped plastic or copper device that’s inserted into the uterus by a doctor or nurse. Copper ions are released inside the uterus prevents pregnancy and protects for anywhere between 3 to 10 years. It is also called a ‘coil’ or ‘copper coil’. Unfortunately, there is a lot of misinformation regarding IUD that makes the patients apprehensive about the insertion.

IUDs aren’t the only form of birth control. An alternative to that is the Intrauterine System or IUS, which prevents pregnancy by releasing hormones in the uterus.

What is the difference between IUD and IUS?

Copper IUDs are made up of plastic frames with copper coil wound around them, IUS is made up of plastic frame which consists hormones. The main difference between IUD and IUS is that IUD releases Copper ions and IUS releases a hormone called progestogen and hormone Levernorgestrel (LNG). But unlike any other contraceptive pills or hormone contraception, the hormones in IUS are local which means they only work around the area of your uterus. This means they are likely to have an impact on your mood or cause any other physical symptoms which usually occur in other hormonal contraception.

A few facts about IUD

It can be placed at any time during your menstrual cycle.
When inserted correctly it can be 99% effective.
It works as soon as it is inserted and lasts for between 3-10 years.
It can be taken out whenever you want by a trained nurse or doctor.
Your periods can be heavier, longer or more painful for 3 to 6 months after inserting in an IUD. Spotting or bleeding in between periods is also possible.

How does it work?

An IUD releases copper ions in the uterus which alters the cervical mucus, hence making it more difficult for sperm to reach the egg and survive. The copper ions released by the IUDs also work as a spermicide. It can also help a fertilized egg from being able to implant itself. Most healthy women can use an IUD. Women who are allergic to copper cannot use copper IUDs. They’re especially suited to women with one partner and at low risk of contracting an STD. IUDs don’t protect against STDs.

Benefits of IUDs

They last for a long time.
Mostly hassle-free, once inserted you or your partner don’t have to think about it.
Safe to use even while you are breastfeeding.
Cost-effective.
There are no hormonal side effects such as acne, headaches, or breast tenderness.
It is not affected by other medicines.
Does not cause obstacles to intercourse.
There is no evidence that an IUD will make you gain/lose weight or increase the risk of cervical cancer, womb cancer, or ovarian cancer.

How is an IUD inserted?

The IUD procedure takes place during a woman’s menstrual cycle (Secretary phase of the menstrual cycle). Before the procedure, a GP or nurse will check inside the vagina to understand the size and position of the womb uterus. Doctors may also test for infections such as STIs and give antibiotic medicines accordingly. After the examinations are done, the doctor will insert the IUD through the cervix and into the uterus. The entire procedure takes around 20-30 minutes to complete.

Is IUD insertion going to be painful?

The IUD insertion procedure depends from person to person. A few women may experience pain during the procedure. Your doctor knows what is best for you & may give an anesthetic or painkiller before they place the IUD. A few women may experience symptoms like cramps or bleeding once it is done. Post fitting, it is advisable to visit a GP after 3-6 weeks to make sure everything is okay.

While an IUD procedure is pretty common, it is always in your best interest to know about issues that may occur after it. Some of these include –

Heavier, painful, or longer periods. This may improve in few months.
Probability of Pelvic Infection
An IUD doesn’t offer protection from STDs.

Most of the above-mentioned side effects are extremely uncommon and if one does feel the need to use an IUD, it is advisable to consult your healthcare professional and find out if the contraceptive method is correct for you.

Heart Attack August 16, 2021

Drug Eluting Stent- An Overview

A coronary artery disease or CAD occurs when there is a build-up in the arteries. In such conditions, it can interrupt the flow of blood to your heart. Plaque causes narrowing or blockage which can result in a greater risk of having a heart attack. Symptoms could include chest pain, discomfort in breathing and shortness of breath.

Cardiovascular diseases are the leading cause of death globally, according to World Health Organisation, it takes an estimate of 17.9 million lives each year. More than four out of five deaths are due to heart attacks or stroke. The most important behavioral risk factors are unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. If you have CAD your doctor might suggest using a stent to treat it. It’s a procedure called Coronary Angioplasty in which the doctor will insert a stent into your coronary arteries. A stent is a small tube made up of metal mesh that is designed to support your artery walls and prevent plaque from blocking your blood flow. It helps the blood flow more freely to your heart. During angioplasty, a thin tube known as a guiding catheter is inserted through the groin or wrist and is then moved towards the site of the blockage. A small balloon at the tip of the balloon catheter is inserted through the guiding catheter near the blocked or narrowed area of the coronary artery. When the balloon mounted with the stent, is inflated, the fatty plaque or blockage is compressed against the artery walls and the diameter of the blood vessel is widened (dilated) to increase blood flow to the heart. Once the plaque is compressed and the artery is opened sufficiently, the balloon catheter is deflated and removed. The stent will remain as a permanent implant in the coronary artery.

Your doctor may use a bare-metal stent(BMS), Drug-eluting stent (DES), or BioResorbable Scaffold (BRS). A drug-eluting stent is the most common type of stent used lately. The new and improved versions of drug-eluting stents are considered safe and effective in most cases. They have ultra-low strut thickness that promotes early vascular healing, the variable strut width, and variable crown design ensure adequate radial strength. However, BRS is a next-generation bioresorbable technology with a low strut thickness of 100 microns which fully resorbs naturally in the artery within 2-3 years, thus restoring the vessel to its true form and nature.

In this blog, you will learn more about Drug-Eluting stents and their benefits.

So what is a Drug-eluting stent?

DES is a standard metallic coronary stent that has a polymer coating and an antiproliferative drug. It allows drug elution into the coronary wall for weeks and months after stent implantation. It releases medication directly into your artery which helps the scar tissues from forming within the stent and narrowing your blood vessels again. That’s how Drug Eluting stents work you might need to take additional medications including blood thinners after the procedure.

Benefits of Drug-Eluting Stent

They can prevent plaque build-up, relieve chest pain, and promote good blood flow to your heart. They may also lower your chances of having a heart attack.

As it’s a less invasive procedure than coronary bypass surgery, which is recommended to people who have more than two narrowed arteries. So most people recover within few days of inserting the stent. A stent helps you get back to your regular schedule faster. In contrast, coronary bypass surgery takes six weeks or more to recover.

With Benefits, Drug-Eluting Stents even have risks:

Like any medical procedure, coronary angioplasty or stenting do involve risks, including:

Bleeding or clotting
Damage to your blood vessel
Infection
Kidney damage caused by the dye
Allergic reaction to the anesthetic, dyes, or other material used
Scarring of your blood vessels
Heart attack and stroke, which is rare

If you form scar tissue after stenting, the doctor may need to repeat the procedure. In case you have chest pain report to your doctor immediately as it could be a sign of serious complication.

There are also few other things you should consider before getting a drug-eluting stent.

For patients with a history of bleeding problems, a drug-eluting stent might not be a good option. Apart from this, you might need to take blood thinners for the rest of your life to prevent your blood from thickening and causing the risk of clots in the stent. Your doctor would give you additional information on what to expect before and after angioplasty.

How to live with a stent?

Having a stent doesn’t mean you have to live differently. But you will have to take extra care of your heart by eating right and healthy. Be active and take your medications. Follow few precautions such as:

Take your blood-thinning medication this would prevent heart attack and stroke. After stenting, you will take aspirin plus another antiplatelet for at least 6 months. If you are at a high risk of bleeding your doctor with shortening the duration of these medicines. Work with your doctor to decide how long you will be needing the medications. The decision depends upon your risk of having a heart attack, risk of bleeding, and your preferences about taking the medicines.
Stent identification card- Your doctor will provide you with a stent identification card that you can show to your health professionals so that they know you have a stent.

Protect your heart health

You can lower your risk of developing blocked arteries or having a heart attack by practicing healthy habits. Common risks for heart disease include high cholesterol, high blood pressure, and being overweight. All of which can be managed with a healthy lifestyle. For example, having a balanced diet and regular exercising can go a long way towards keeping your heart healthy and strong. Smoking would put you at risk. If you are a smoker then now would be a good time to call quits.

If you are diagnosed with CAD, to prevent complications follow your doctor’s instructions and treat it. Drug-eluting stents are a good option for patients with CAD but they are only one part of the solution. You may have to take statins, aspirin, or other medications.

Follow your doctor’s advice and take their prescribed medicines and also follow their recommended lifestyle which will keep your heart healthy.

Knee Replacement August 11, 2021

Why Gold Knee Implant Is A Better Option For Total Knee Replacement

Suffering from severe arthritis of the knees can be a tedious condition with consistent symptoms such as pain in the knees that worsens over time, stiffness, swelling of joints, etc. These persistent symptoms can become a hindrance in one’s day-to-day functioning.

Non-operative treatments like knee joint injections, activity modification, and anti-inflammatory medications can be the first option for most people, but when these have failed to provide adequate relief, Knee replacement surgery can be of help.

Knee replacement, also known as knee arthroplasty or total knee replacement, is a surgical procedure to resurface a knee damaged by arthritis. Metal and plastic parts are used to cap the ends of the bones that form the knee joint, along with the kneecap.

Traditional total knee replacement involves an incision over the knee of about 7-8 inches, and a recovery period of 3-5 days at the hospital.

According to an article by UW Medicine Orthopaedics & Sports Medicine on Total Knee Replacement surgery most reports of surgeons performing knee replacement surgery have been excellent and the results have shown ten-year success rates above 90 percent.

More than 90 percent of total knee replacement patients experience substantial or complete relief of pain once they have recovered from the procedure. The large majority do not require a cane even if there is the one used before the surgery and can walk without a limp.

The major benefit of total knee replacement surgery is the better quality of life. There is a restoration of the ability to carry out activities that they could not do before, due to the pain and stiffness, etc. The pain and the stiffness from the arthritis are relieved by the surgery. It is reported that the distance one can walk will improve well because of the diminished pain.

One major complication that can hinder a total knee replacement surgery is the patient’s allergy to metal components. Some people may experience a reaction to the metal that is used in the artificial knee joint as implants may contain titanium or cobalt-chromium-based alloy. This is where Gold Knee Implants come in.

What are Gold Knee Implants?

For patients who have shown an allergic reaction to metals, the Gold knee replacement procedure can be considered a very good option. The knee implants used for the surgery have a Titanium Niobium Nitride (TiNbN) coating on their surface. This coating gives a golden color to the implant and makes it allergy-proof because of inert material’s coating.

Why one should opt for Gold Knee Implants?

The implant gold knee is one of the best artificial joint. It has a longer life span and does not trigger any allergic reactions. According to an article by Bone and Joint 360 the Golden knee implant is compatible with human tissues, and it is highly recommended for patients that are 60 years of age or below.

Knee implants are normally made of an alloy of chromium and cobalt and sometimes they tend to release metal ions inside your body. Patients who may experience an allergic reaction tend to experience inflammation in the knee joint because of the same. Eventually, complications like infections, loosening of the joint, and persisting knee pain develop.

Benefits of a Gold Knee Implant

Durable implants due to the titanium coating.
The higher life span of the Gold Knee implant as compared to regular knee implants.
Works well with new-age surgical techniques. The outcomes are better when compared to regular implants.

There are various types of implants used other than Gold Knee Implants as well, such as metal on plastic implants, which are the most common type of implants, or ceramic on plastic implants, for people who have a sensitivity to nickel used in metal implants, leading to an allergic reaction or people who are sensitive to nickel used in metal implants.

It is important to evaluate all your options before opting for a total knee replacement surgery, the cost, the biocompatibility, and especially about the type of metal that is used, in case the patient is allergic to a certain metal or alloy.