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Nigeria: How Tristate Hospital Performs Surgeries on Beating Hearts

Recently, Tristate Hospital, a multi-specialist health facility in Lekki, Lagos, achieved a double medical breakthrough in minimal invasive heart surgery in Nigeria.

The hospital performed the first “beating heart” surgery described in medical parlance as “Off-Pump” Coronary Artery Bypass Grafting, CABG, aka “cabbage” in Nigeria. Tristate Hospital also carried out the first minimally invasive Mitral Valve Repair Surgery in the country.

Coronary artery bypass grafting (CABG), is a type of open-heart surgical operation that improves blood flow to the heart. It is used to treat coronary artery disease. Traditionally, the heart is stopped during the surgery, and the patient is hooked to a heart-lung machine (on-pump).

In the off-pump CABG the heart is operated while it is still beating and actively pumping blood throughout the body, and no heart-lung machine is required.

The Managing Director/CEO of Tristate Hospital, Lagos, Professor Kamar Adeleke, remarked that Tristate Hospital had successfully carried out four of the delicate off-pump procedure.

Adeleke, an interventional cardiologist and cardiothoracic surgeon said that the off-pump technique is far less common and sophisticated such that out of 100 cardiothoracic surgeons in the country, just 5-10 have the capability to perform it successfully.

On the minimally invasive mitral valve repair, he noted that it is a procedure that aims to repair the mitral valve in the heart with a minimal incision instead of a long one in the chest, offering shorter hospital stays, faster recovery, and less pain, even as he noted that both medical treatments are important as they will reduce medical tourism.

What is off-pump CABG?

An off-pump CABG uses the heart to pump blood, unlike the on-pump option where the heart is stopped and a heart-lung machine is required for the procedure.

Off-pump bypass surgery is a minimally invasive procedure that allows for a shorter hospital stay and faster recovery, reducing the risk of postsurgical complications. Historically, heart surgery involves opening the chest, seating the patient, and making an incision to expose the heart. However, minimally invasive procedures are now being used, which are faster, safer, and more financially feasible.

In Nigeria, off-pump bypass surgery in Nigeria is more cost-effective than non-invasive procedures in the US, India or Europe. The approach offers a more efficient and safer approach to heart surgery.

How it is done

During CABG, with the heart still beating, the surgeon uses the patient’s veins or arteries to “bypass” narrowed areas of the coronary arteries. Oxygen-rich blood is routed around the blockage, creating a new path and restoring blood flow to the heart muscle. You may have more than one bypass done at a time, depending on how many coronary arteries are blocked.

Once recovered, most patients experience good results, with symptoms such as chest pain and shortness of breath reduced or eliminated altogether. In addition, CABG may improve your quality of life and help you resume a more active lifestyle.

Who needs it?

CABG is used to treat people who have severe coronary artery disease. This is the narrowing of the coronary arteries–the blood vessels that supply oxygen and nutrients to the heart muscle.

This condition is caused by a buildup of fatty material called plaque within the walls of the arteries. Over time, that plaque–made up of fat, cholesterol, calcium, and other substances found in the blood–will become very hard. When this happens, the coronary arteries are narrowed or blocked, limiting the supply of oxygen-rich blood to the heart muscle.

Cardioplegia, a procedure where the heart is cooled and blood flow is temporarily stopped, may be necessary for heart operations. The choice depends on the technique, patient, and surgeon’s experience. Cardiothoracic surgeons provide expert advice on the best surgical strategy.

Signs & symptoms of CAD

These include chest pain or discomfort (angina), irregular heartbeat, shortness of breath, blood clots that may cut off blood flow and lead to a heart attack.

Who is a potential candidate for CABG

A doctor will assess a patient’s cardiovascular system, including heart, lungs, and pulse, to determine if CABG is necessary. Factors considered include past heart disease treatment, other conditions, age, and family history. Before CABG is recommended, medications, lifestyle changes, and other procedures may be tried. Medical tests like EKG, chest X-ray, cardiac catheterization, stress test, echocardiogram, and angiogram will be performed to determine artery blockage and heart damage.

What you should know about minimally invasive mitral valve repair

The purpose of an invasive mitral valve repair surgery to repair the mitral valve in the heart. Blood flows from the lungs and enters a pumping chamber of the heart called the left atrium. The blood then flows into the final pumping chamber of the heart called the left ventricle.

The procedure requires general anesthesia and a heart-lung bypass machine, which performs the work of these organs during the procedure. The patient may spend a few days in the hospital and then recover for a few weeks at home.

The mitral valve is located between these two chambers. It makes sure that the blood keeps moving forward through the heart. Blood flows properly when the mitral valve is in good condition. Some blood can flow backward into the left atrium when a defective valve fails to seal properly.

A person may need surgery on their mitral valve if the mitral valve is hardened (calcified). This prevents blood from moving forward through the valve. Also, if the mitral valve is too loose, blood tends to flow backward.

Minimally invasive mitral valve surgery is done through several small cuts. An open mitral valve surgery requires a larger cut. Surgeons operate through one or more small incisions instead of one long incision down the centre of the chest. The minimally invasive approach often offers shorter hospital stays, faster recovery and less pain.

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