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First Case in the World, TAVR + PTCA

First Case in the World, TAVR + PTCA

 First breakthrough Non-Invasive Surgery at Metro Hospitals & Heart Institute, Noida created a world record

 TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) + ANGIOPLASTY WITH STENTING (PTCA) done by

PADMA VIBHUSHAN & DR. B C ROY NATIONAL AWARDEE DR. PURSHOTAM LAL, DIRECTOR – INTERVENTIONAL CARDIOLOGY & CHAIRMAN – METRO GROUP OF HOSPITALS 

v  The open heart surgery, which normally takes 4-5 hours, was successfully done in less than 45 minutes without surgery

v  This was the first breakthrough to perform hybrid procedure on a 76 years old female involving angioplasty with stenting of the major artery along with transcatheter aortic valve replacement (TAVR) by using unique innovative pre-crimped, pre-loaded, pre-packaged ready to use self expandable Aortic Valve.

v  The revolutionary procedure will require less learning curve and will be easy to perform thus making a boon for the elderly patients who are at high risk for open heart surgeries  

30th November, 2016:

Metro Hospitals and Heart Institute, Noida created a world record when a revolutionary non-surgical procedure for heart, Trans Cathether Aortic Valve Replacement (TAVR) was done successfully on a 76 year old patient in less than 45 minutes along with Angioplasty with Stenting of the main artery in the same sitting.

Introduction

Aortic stenosis is the narrowing of the aortic valve of the heart which restricts the blood flow to the whole body. It is one of the most common and most serious valve disease. Patients usually complained breathlessness, chest pain, fainting etc. It mainly affects older people due to scarring and calcium built up and usually starts after the age of 60 but does not shows symptoms until age of 70 or 80. More than one in eight people over the age of 75 may have moderate or severe aortic stenosis. Since we are seeing more and more elderly patients, its condition may become an important public health problem. The mortality rate is almost 50% in the first two years after the symptoms among the untreated patients. In clinical practice atleast 30% of patients with severe symptomatic aortic stenosis do not undergo surgery for replacement aortic valve, owing to advanced age or presence of multiple co-existing conditions. This group of patients who are either unfit for surgery or at high surgical risk, a less invasive treatment like Transatheter Aortic Valve Replacement (TAVR) is a big blessing.

Background

In 1992 while presenting the oration lecture at the annual function of Cardiological Society of India at New Delhi, Dr. Purshotam Lal presented animal studies of Transcatheter Aortic Valve Replacement (TAVR) and made a statement that “one day we will do Aortic Valve Replacement without surgery”. Though Interventional Cardiology made a tremendous progress by that time but everybody was skeptical about the success of this procedure. 12 years after on July 12, 2004 Dr. P. Lal along with his team performed the Transcatheter Aortic Valve Replacement with Core Valve for the first time in the world and published the research paper on the same.  Since then Dr. Lal has been invited by different countries to present the first case of the world of Aortic Valve Replacement with Core Valve. The procedure became so popular around the world that till today about 2 lac cases have been performed in different countries. Currently the Core Valve is being provided by Medtronic and cost about for one procedure 16-20 Lacs which is not possible for a common man to afford. More than 20 different kinds of valves are in clinical use and hopefully the cost will come down due to competition.

Our Case Report

Our patient Mrs. Rama Dhamani, 76 yrs. old female having past history of hypertension since 15 years, hypothyroidism since 10 years, COPD (bad lung), severe osteoarthritis of both knees. She has been complaining severe difficulty in breathing and chest pain and has been hospitalized many times with heart failure. Her Echocardiography showed severe and Calcific Aortic Valve Stenosis. Her Coronary Angiography revealed critical block of its main artery. Neither this patient was fit for surgery nor was the family ready for open heart surgery at any cost. To the extent when we took her in Cath Lab, family told us categorically that we are not ready even for emergency surgery in case you require for some reason on during the procedure. The procedure was done under local Anaesthesia from the groin area like any other angiography procedure. Initially Angioplasty with Stenting of the main artery was performed followed by 26 mm size pre-crimped self expandable valve. Post procedural Angiography and ECHO study showed no leak or tightness in the valve and the patient was sent home after three days. Now the patient has come for three weeks follow-up and is doing well. We are planning for her bilateral knee replacement in the near future which otherwise would not have possible.

Venibri Aortic Valve System has been developed by Colibri Heart Valve System based in Broomfield, Colorado, USA and Venus Medtech at Hangzhou, China.  It is a pre-mounted, pre-crimped and pre-packaged, ready for use self expandable Transcatheter Aortic Valve Replacement (TAVR) device. In this new ready for use system, the valve is extremely strong, durable and made of bio-compatible tissue which enables crimping, loading and packaging of the valve at the time of manufacturing itself. This new system which will involve less learning curve and will take much less time for the procedure and takes only 15 minutes from taking the ready for use catheter loaded with the valve to its deployment.

This particular procedure of combination of innovative pre-crimped self expandable, ready to use valve Replacement along with Angioplasty with Stenting of the main artery makes this the first procedure of its kind in the world.

 “It was difficult and scary time for me as my health was deteriorating each passing day and there was no option but to live with it. I was not fit to have the open heart surgery due to my age and other health problems. But my hopes were rekindled when I learned about the possibility of having the procedure without the surgery and minimal complications involved. I had my health back after having the treatment successfully,” said Mrs. Dhamani after undergoing the non-invasive procedure at Metro hospital.




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Anaesthesiology

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We’ve got the best Anaesthetics and Critical Care experts coupled with latest anesthesia machines ensuring adequate gas mixture delivery to the patient, Anesthetic gas monitors who ensure extreme economy and negligible theatre pollution. The department has long experience of giving successful anaesthesia in various thoracic, vascular and congenital heart disease cases.

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We have well equipped Audiology and Speech Therapy Units, professionally qualified Audiologist and Speech-Therapists to conduct various tests for diagnosis of speech and hearing problems in children and adults. Using multiple range of tests, the Audiology and Speech-Therapist diagnoses degree and type of hearing loss of patient and plan out the needful rehabilitation.

Bariatric & Metabolic Surgery

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Metro Centre for Bariatric & Metabolic (diabetic) Surgeries is an advanced set-up having complete diagnostic and surgical facilities. We provide a relaxing and satisfying experience to every patient and help them achieve their weight-loss goals.

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Our Blood Bank is committed to provide high quality services by assuring the supply of safe and quality blood and its products to the patients. The blood bank adopts most modern technology and equipment. We’ve fully automatic ELISA processor, blood grouping and cross matching and blood component equipments. All the records and standard operative procedures (SOPs) are maintained and followed as per National and International standards.

Cardiology & CTVS

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Department of Cardiology is headed by Padma Vibhushan & Dr. B C Roy National Awardee Dr. Purshotam Lal, a pioneer in Interventional Cardiology consisting of a team of highly qualified and skilled interventional Cardiologists. Under his leadership, the centre has grown into the most specialized centre for angiography and angioplasty.

Dentistry

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Metro Dental And Implant Centre has delivered millions of smiles over the years. The centre offers state-of-the-art dental services both through general out-patient and private OPD.

Dermatology

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The centre provides a holistic, scientific and a technologically advanced approach for all dermatological and cosmetic conditions. Consultations with our experienced dermatologists ensure that the patients get the best advice, be it for skin diseases or cosmetic interventions. Our specialized services include- Pimples / Acne – Pigmentation Treatment, Cosmetic Peels, Non-surgical removal of warts, Laser treatment, as more.

Endocrinology And Diabetes

Best Endocrinology And Diabetes

Department of Endocrinology and Diabetes is a full-fledged facility involved in evaluating and treating patients for diabetes, Obesity, Sexual disorders, Hirsutism, PCOD, Osteoporosis, Adrenal disorders, other endocrine disorders. We offer a wide range of treatment options for endocrine and metabolic diseases. Our specialists are the most experienced one having a long track record of successful treatment of the patients.

ENT & Cochlear Implant

Best ENT & Cochlear Implant

We provide the complete diagnostic and treatment of disease and conditions associated with the ear, nose and throat. We are well experienced in treating everything from a basic disease to doing a complicated surgery involving Otolaryngologists, Audiologists, Speech-language pathologists and other medical professionals. Services include Endoscopic Sinus Surgery, Micro-Surgery of Ear, Cochlear Implant, Rhinoplasty, Head & Neck Surgeries, and more.

Gastroenterology & Gastro Surgery

Best Gastroenterology & Gastro Surgery

Metro Centre for Liver & Digestive Diseases (Gastroenterology & GI Surgery) has combined medical and surgical department. The team of doctors has received super speciality training in their respective field which ensures high quality of care. The combined setup of Gastroenterology and GI Surgery allows quick assessment and treatment of the patient. Our surgical services include the performance of specialized and complex GI surgical procedures for the management of diseases of various parts of the GI tract.

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Clinical Haematology unit headed by very senior clinical haematologist . To support this, Metro Path Labs are well equipped and advanced labs to handle relevant investigations related to blood, lymphnode and spleen disorders like Leukemia, Thalassemia, multiple myeloma, etc. Routine procedures done here are Bone Marrow Aspiration, Bone Marrow Biopsy, Peripheral Smear Study, Reticulocyte count.

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The department aims at healing the person completely - body, mind, spirit, and emotions aimed at optimal health and wellness. This is achieved with the help of specialists and by gaining proper balance in life. Our specialists use all forms of healthcare ranging from conventional medication to alternative therapies, to treat a patient. Our doctors use the combinations of drugs and lifestyle modifications to address any condition.

Homeopathy

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We bring you the convenience of getting quality homeopathic treatment for all your chronic and long standing illnesses. We are committed to provide you the best of the information and constitutional homeopathic treatment. Diseases Treated by Homoeopathy are Infectious Diseases, Viral Diseases, Diseases of Infancy and Childhood & Allergic Disorder.

Internal Medicine

Best Internal Medicine

The Department of Internal Medicine is a full-fledged facility offering comprehensive care for general and preventive medicine for all ages. The Department has the support and back-up of all super-specialities in the hospital providing end to end services varying from diagnosis, prevention, treatment, wellness, preventive health checks, rehabilitation services and management of various medical conditions.

Interventional Radiology

Best Interventional Radiology

A sub-speciality of Radiology is a subspecialty of radiology, providing minimally invasive treatments performed under guidance of x-ray fluoroscopy, ultrasound or computed tomography (CT Scan). In simple terms interventional radiologists “Not Just Diagnose But Treat too” with minimal invasive techniques. The advanced technology in Radiology provides a strong platform for efficient Interventional Radiological Procedures.

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Metro Centre for IVF is at the forefront of delivering quality services in the field of Assisted Reproductive Techniques like IVF-IUI, ICSI, Surrogacy, etc.

Laboratory

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A highly skilled team of medical professionals including physicians, medical technologists, medical technicians, lab assistants, biologists, chemist, microbiologists, geneticists, and other specialists work collaboratively to provide advanced diagnosis and laboratory services. Fully automated Robotic Arm, State-of-the-art BacT / Alert 3D Microbial Detection System etc. are among our top of the line technologies available.

Laparoscopic & General Surgery

Best Laparoscopic & General Surgery

Metro Hospitals and Heart Institute is well equipped with latest technological advancements in general and laparoscopic surgery and the centre is boasted to an advanced centre for general and laparoscopic surgeries.

Nephrology & Renal Transplant

Best Nephrology & Renal Transplant

Our department of nephrology and renal transplant is a well equipped unit with a dedicated team of skilled consultants and paramedical staff which offers patient the advantages of a multidisciplinary approach. Our center deals in treating children and adolescents with congenital and acquired kidney diseases. We accept patients at any stage of kidney disease. The services include Medical Management of Kidney Diseases, Dialysis and Renal Transplant.

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The Department of Neurosciences has extremely talented and very well trained doctors who collaboratively work towards creating new paradigms for knowing the human brain condition and caring for it. Facilities include NCV, EMG, EEG, Video EEG, Botox Therapy for migraine and movement disorders (dystonia), Dedicated Stroke ICU, Neuro Rehabilitation Advanced facilities for Surgical Neurology.

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A balanced diet provides complete balanced nutrition which is essential for a healthy life, enhancing the immunity of the person. The department consisting of expert dieticians provides Diet counseling according to the diagnosis of the patients, Diet counseling for different types of diseases like Diabetes, Liver diseases, Renal diseases, Diet related to pregnancy and lactation, Cardiac diseases, Weight management and many more.

Obstetrics and Gynaecology

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Metro Centre For Obstetrics And Gynaecology is determined to unite their exceptional medical competence, advanced technology and novelty to offer the best treatments to the patients. Our broad spectrum of services include painless deliveries, management of high risk pregnancies/late pregnancies, gynae laparoscopic procedures, gynae onco services, pre and post natal care, amongst others.

Oncology & Onco Surgery

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We strive to create the best in class infrastructure, comprehensive facilities and render care and support by handholding every cancer patient in their journey. The management plan for each cancer is chalked out once the cancer is identified and staged. Treatment plan may include surgery, radiation and/or cancer medicine therapy. The team of Oncology Comprises of expert Medical Oncologists, Surgeons and Radiation Oncologists.

Ophthalmology, Metro Eye Centre

Best Ophthalmology, Metro Eye Centre

The team of highly experienced Ophthalmologists in a modern set-up perform various services like Phacoemulsification (Sutureless Cataract Surgery), YAG laser (for after cataract and glaucoma), Green laser (for diabetic and retinal eye diseases), Automated Perimetry, (For Glaucoma and Neurological visual Field), Applanation Tonometry for Glaucoma, Glaucoma surgery, Squint Surgery, etc. The results of all procedures match the international standards.

Orthopaedics, Joint Replacement & Spine Surgery

Best Orthopaedics, Joint Replacement & Spine Surgery

We offer a wide spectrum of the most up-to-the-minute treatments for all kinds of musculo-skeletal problems and emergencies. The centre specializes in providing services including minimally invasive surgery, cartilage and bone transplantation, spine surgery and limb sparing surgery.

Paediatrics & Neonatology

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Metro Centre for Paediatrics & Neonatology is a top-notch centre for childcare which provides comprehensive paediatric, surgical, and immunization services to children up. We follow a holistic approach to treatment with our Neonatal Intensive Care Unit, Paediatric Intensive Care Unit, Paediatric and Neonatal Emergency, etc.

Physiotherapy

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The services in Physiotherapy & Rehabilitation include Consultation, Diagnostic: examination, S D curve, muscle testing, ADL testing, Manual therapy: active/assisted/passive/resisted/graded resisted exercise etc., physiotherapeutic interventional procedures, (home care) etc., Obstetric, gynecological clinic: antenatal and post natal care, and other management, Geriatric clinic: help in ADL activity, pain free activity, Fitness clinic, Posture correction clinic, Ergonomics clinic, etc.

Plastic, Cosmetic & Reconstructive Surgery

Best Plastic, Cosmetic & Reconstructive Surgery

The department has highly experienced specialists in cosmetic and plastic surgery, state-of -the-art infrastructure ensuring world class medical attention and care. It is an acknowledgement center of excellence providing advanced and intricate treatment. The center also offers the world superior quality cosmetic treatment at costs that are highly affordable, with results comparable to those at the best centers across the globe.

Psychiatry

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With the mission of spreading mental health awareness, we provide a variety of services ranging from awareness programmes to rehabilitations. The services provided are Pharmacotherapy, Electroconvulsive Therapy, Narcoanalysis, Biofeedback, Detoxification and Rehabilitation Programmes, Deaddiction Counseling, Stress Management, Couples/ Marital Counseling and many more.

Psychology

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We have a long experience in addressing the mental health conditions. Our experienced psychologists analyze the reasons behavioral disorder, emotional problem or psychiatric disease, and suggest and implement a valid solution to the problems customized to individual needs. The privacy of the patient is taken seriously during the total course of treatment.

Pulmonology & Sleep Medicine

Best Pulmonology & Sleep Medicine

World-renowned specialists and comprehensive advanced setup helps treat disorders related to the lungs, breathing and sleep with high success rate. The services include treatment of Asthma, COPD, Chronic Respiratory Failure, Sleep Disorders, Interstitial Lung Diseses, Tumours and Cancers of the Lung and Chest, Allergic Disorders, Laparoscopic Assisted Thoracic Surgeries.

Radiology

Best Radiology

A highly skilled team of experience Radiologists and Technicians comprises our Radiology Team. The highly advanced technology combined with high expertise ensures 100% accurate results which helps build right diagnosis. The facilities include: CT Scan (500 Slice), Advanced MRI (1.5 Tesla), 4D Ultrasound, Digital X-Ray, Bone Densitometry, Colour Doppler.

Rheumatology

Best Rheumatology

Highly specialized team is available to deal with diseases of the musculoskeletal system. The services include Treatment of auto immune diseases like Rheumatoid Arthritis, SLE, Ankylosing-spondylosis, gout and other immunological diseases, New Biological Treatments, 24x7 physiotherapy department to deal with musculoskeletal problems and Special emphasis on joint deformity correction

Urology

Best Urology

The Centre for Uro-Sciences boasts of experienced and renowned Urologists having thorough exposure to all urological disorders including complicated conditions. It is has good track record for high success rates. The treatment includes Laser prostatic surgery, Urologic Cancer Surgeries, Laparoscopic Urological Surgeries, Percutaneous Renal Surgery, Urethral Reconstructive Surgery, etc. and the facilities include ESWL (Extra corporeal shock wave Lithotripsy), Uroflowmetry, Uro Radio diagnosis, etc.

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