ADVANCES IN THE ADVANCES IN THE PREVENTION AND PREVENTION AND TREATMENT OF HEARTTREATMENT OF HEARTDISEASESDISEASES

DR.MANOJ .J. PRADHANDR.MANOJ .J. PRADHAN CARDIAC SURGEONCARDIAC SURGEON

ATHENA HEARTCAREATHENA HEARTCARE

1 PERSON DIES EVERY 33 SECONDS1 PERSON DIES EVERY 33 SECONDS

DUE TO A HEART ATTACK IN INDIA!DUE TO A HEART ATTACK IN INDIA!

A FEW STARTLING FACTS ABOUT A FEW STARTLING FACTS ABOUT HEART DISEASE IN INDIAHEART DISEASE IN INDIA

CORONARY ARTERY DISEASE OCCURS CORONARY ARTERY DISEASE OCCURS ABOUT 10 YRS. EARLIER IN INDIANS ABOUT 10 YRS. EARLIER IN INDIANS COMPARED TO WESTERNERSCOMPARED TO WESTERNERS

THE INCIDENCE OF CORONARY ARTERY THE INCIDENCE OF CORONARY ARTERY DISEASE IS AS FOLLOWSDISEASE IS AS FOLLOWS

URBAN URBAN RURAL RURAL

MALES 65/100 MALES 22.8/100MALES 65/100 MALES 22.8/100

FEMALES 45/100 FEMALES 17.2/100FEMALES 45/100 FEMALES 17.2/100

A FEW STARTLING FACTS ABOUT A FEW STARTLING FACTS ABOUT HEART DISEASE IN INDIAHEART DISEASE IN INDIA

THUS IF YOU LIVE IN CITIES AND TOWNS,YOU THUS IF YOU LIVE IN CITIES AND TOWNS,YOU HAVE A THREE TIMES HIGHER CHANCE OF HAVE A THREE TIMES HIGHER CHANCE OF SUFFERING A HEART ATTACK.SUFFERING A HEART ATTACK.

THE W.H.O FIGURES SAY THAT THERE ARE THE W.H.O FIGURES SAY THAT THERE ARE MORE THAN FOUR MILLION HEART PATIENTS MORE THAN FOUR MILLION HEART PATIENTS IN INDIA.IN INDIA.

INDIA HAS THE HIGHEST RATE OF HEART INDIA HAS THE HIGHEST RATE OF HEART ATTACKS IN THE WORLD.ATTACKS IN THE WORLD.

INDIAN STATISTICS ABOUT INDIAN STATISTICS ABOUT CVDCVD

Current projections suggest that by Current projections suggest that by the year 2020,India will have the the year 2020,India will have the largest cardiovascular disease largest cardiovascular disease burden in the worldburden in the world

One–fifth of deaths in India are One–fifth of deaths in India are from coronary vascular disease.By from coronary vascular disease.By the year 2020,it will account for the year 2020,it will account for one- third of all deaths,and many one- third of all deaths,and many of these will be young deaths.of these will be young deaths.

HEART DISEASE IN HEART DISEASE IN WOMENWOMEN

10% of women between 45-10% of women between 45-64yrs. , and 25% of those over 65 64yrs. , and 25% of those over 65 yrs. Are now living with heart yrs. Are now living with heart disease.disease.

Nearly 13% women over 45 yrs. Nearly 13% women over 45 yrs. have had a heart attack! have had a heart attack!

Women who smoke may suffer a Women who smoke may suffer a heart attack 19 years earlier.heart attack 19 years earlier.

HEART DISEASE IN HEART DISEASE IN INDIANSINDIANS

Why are we seeing this sudden Why are we seeing this sudden increase in heart disease?increase in heart disease? NOT AN OVERDIAGNOSIS!NOT AN OVERDIAGNOSIS! Lifestyle changes:more western outlook.Lifestyle changes:more western outlook. But we continue to work a 6 day week.But we continue to work a 6 day week. Result oriented society:in the past,it Result oriented society:in the past,it

was important to do your job well and was important to do your job well and enjoy doing it. Nowadays, the result is enjoy doing it. Nowadays, the result is more important not the means.more important not the means.

HEART DISEASE IN HEART DISEASE IN INDIANSINDIANS

Traditionally we have a higher Traditionally we have a higher carbohydrate intake.carbohydrate intake.

Very little physical exertion due to Very little physical exertion due to lack of space & facilities,lack of an lack of space & facilities,lack of an exercise culture & little interest in exercise culture & little interest in sports.sports.

Higher incidence of obesity , Higher incidence of obesity , diabetes, heart disease.diabetes, heart disease.

Hereditary ?Hereditary ?

A FEW FACTS ABOUT HEART A FEW FACTS ABOUT HEART DISEASEDISEASE

ANGINA IS CHEST PAIN THAT OCCURS ANGINA IS CHEST PAIN THAT OCCURS SECONDARY TO BLOCKAGES IN THE SECONDARY TO BLOCKAGES IN THE CORONARY ARTERIES.CORONARY ARTERIES.

ANGINA OCCURS WHEN THE HEART MUSCLE IS ANGINA OCCURS WHEN THE HEART MUSCLE IS STARVED OF OXYGEN AND ENERGY.STARVED OF OXYGEN AND ENERGY.

VERY SEVERE AND SUDDEN BLOCKAGES IN THE VERY SEVERE AND SUDDEN BLOCKAGES IN THE CORONARY ARTERIES MAY PRODUCE A HEART CORONARY ARTERIES MAY PRODUCE A HEART ATTACK.ATTACK.

TREATMENT OF CORONARY ARTERY DISEASE IS TREATMENT OF CORONARY ARTERY DISEASE IS ALL ABOUT AVOIDING THAT HEART ATTACK!ALL ABOUT AVOIDING THAT HEART ATTACK!

AnginaAngina

Angina is a Angina is a specific type specific type of pain in the of pain in the chest caused chest caused by inadequate by inadequate blood flow blood flow through the through the blood vessels blood vessels (coronary (coronary vessels) of the vessels) of the heart muscle heart muscle (myocardium). (myocardium).

What Is a Heart What Is a Heart Attack?Attack?

A heart attack is a condition

in which damage to an area of heart muscle occurs because of inadequate oxygen supply to the region. Cardiac arrest is a condition in which the heart stops or is otherwise unable to pump enough blood to supply vital organs. Cardiopulmonary arrest is a sudden cessation of both breathing and effective heart function.

Heart attack symptomsHeart attack symptoms

Symptoms of a heart attack may be widely varied, from the classic "elephant on the chest" feeling of crushing pain, to the

nausea and heartburn mistaken for indigestion. In some patients, the symptoms may only be sudden fatigue or an oppressive

feeling of impending death.

Jaw pain and heart Jaw pain and heart attacksattacks

Pain from a heart attack Pain from a heart attack may sometimes radiate may sometimes radiate to the jaw and teeth. to the jaw and teeth. Chest pain is a major Chest pain is a major symptom of heart attack, symptom of heart attack, but otherbut other

symptoms such as symptoms such as weakness, shortness of weakness, shortness of breath, nausea, or breath, nausea, or

vomiting may alsovomiting may also occur.occur.

Pain from a heart attack may sometimes radiate to the jaw and teeth. Chest pain is a major symptom of heart attack, but othersymptoms such as weakness, shortness of breath, nausea, or vomiting may also occur.

Other important facts:Other important facts: Most heart attacks occur Most heart attacks occur

between 4.00am end 10am between 4.00am end 10am due to higher adrenaline due to higher adrenaline amounts released in the body amounts released in the body during early morning hours.during early morning hours.

25% of all heart attacks are 25% of all heart attacks are “silent”- without chest pain.“silent”- without chest pain.

Diabetics are at greater risk Diabetics are at greater risk for “silent” heart attacks.for “silent” heart attacks.

SIGNS OF A HEART SIGNS OF A HEART ATTACKATTACK

CHEST PAIN,BACK PAIN , JAW PAIN.CHEST PAIN,BACK PAIN , JAW PAIN.SWEATING,VOMITINGSWEATING,VOMITINGVAGUE FEELING OF UNEASINESSVAGUE FEELING OF UNEASINESSACIDITY!ACIDITY!GIDDINESS,BREATHLESSNESSGIDDINESS,BREATHLESSNESSUNCONSCIOUSNESSUNCONSCIOUSNESSDEATHDEATH

TREATMENT OF A TREATMENT OF A HEART ATTACKHEART ATTACK

TAKE THE PATIENT TO A HOSPITAL ASAP!TAKE THE PATIENT TO A HOSPITAL ASAP!

GIVE HIM/HER A TABLET OF GIVE HIM/HER A TABLET OF ISORDIL/SORBITRATE TO KEEP UNDER ISORDIL/SORBITRATE TO KEEP UNDER THE TONGUE.THE TONGUE.

IF HE/SHE IS NOT VOMITING , GIVE ONE IF HE/SHE IS NOT VOMITING , GIVE ONE TABLET OF DISPIRIN.TABLET OF DISPIRIN.

INSIST THAT AN ECG BE TAKEN! INSIST THAT AN ECG BE TAKEN!

TREATMENT OF A TREATMENT OF A HEART ATTACKHEART ATTACK

ADMISSION TO AN ICU.ADMISSION TO AN ICU.ADMINISTRATION OF A CLOT BUSTER-ADMINISTRATION OF A CLOT BUSTER-

STREPTOKINASE,UROKINASE.STREPTOKINASE,UROKINASE.IF NOT HELPFUL-ANGIOGRAPHY IF NOT HELPFUL-ANGIOGRAPHY

FOLLOWED BY PRIMARY FOLLOWED BY PRIMARY ANGIOPLASTY.ANGIOPLASTY.

Lives saved per 1000

65 --- within 1 hr

27 --- 2-3 hr

25 --- 4-6 hr

8 --- 7-12 hr

WHAT CAUSES HEART WHAT CAUSES HEART DISEASE?DISEASE?

STRESSSTRESS

DIETDIET

HIGH CHOLESTEROLHIGH CHOLESTEROL

DIABETESDIABETES

HEREDITYHEREDITY

WHAT ARE THE PREVENTABLE WHAT ARE THE PREVENTABLE CAUSES?CAUSES?

LIFESTYLELIFESTYLEOBESITYOBESITYTOBACCO IN ANY FORMTOBACCO IN ANY FORMDIETARY EXCESSDIETARY EXCESSLACK OF EXERCISELACK OF EXERCISEALCOHOLALCOHOL

RISK FACTORS FOR RISK FACTORS FOR YOUNG PATIENTS TO YOUNG PATIENTS TO DEVELOP MIDEVELOP MI

SMOKING –74.8%SMOKING –74.8% HYPERTENSION –18.8%HYPERTENSION –18.8% HYPERCHOLESTEROLAEMIA –18%HYPERCHOLESTEROLAEMIA –18% OBESITY –18%OBESITY –18% DIABETES MELLITUS –16.4%DIABETES MELLITUS –16.4% FAMILY HISTORY OF PREVIOUS MI FAMILY HISTORY OF PREVIOUS MI

–13.2%–13.2%

CARDIOVASCULACARDIOVASCULAR RISK FACTORSR RISK FACTORS

Smoking - The risk of heart disease for smokers is more than twice that of non-smokers.

High Blood Pressure - If you have high blood pressure, it is important to work with your doctor to lower it.

Other Risk Factors High fat/high cholesterol

diet Family history of coronary

artery disease Diabetes Lack of exercise Obesity (being overweight) Stress

LIFESTYLELIFESTYLE

WHAT’S WRONG IN OUR LIVES TODAY?WHAT’S WRONG IN OUR LIVES TODAY?

ABSOLUTELY EVERYTHING’S CHANGED!ABSOLUTELY EVERYTHING’S CHANGED!

TIME IS AT PREMIUM!TIME IS AT PREMIUM!

MONEY AND SUCCESS IS EVERYTHING!MONEY AND SUCCESS IS EVERYTHING!

LIFESTYLELIFESTYLE

EXTENDED WORKING HOURSEXTENDED WORKING HOURS

NO TIME FOR RELAXATIONNO TIME FOR RELAXATION

NO EXERCISENO EXERCISE

STRESS!!!STRESS!!!

STRESSSTRESS

WHAT IS STRESS?WHAT IS STRESS?

IT IS THE FIGHT OR FLIGHT RESPONSE IT IS THE FIGHT OR FLIGHT RESPONSE IN THE HUMAN BODY!IN THE HUMAN BODY!

MOST OF THE TIME WE FIGHT!MOST OF THE TIME WE FIGHT!

THIS CAUSES MENTAL AND PHYSICAL THIS CAUSES MENTAL AND PHYSICAL STRESS.STRESS.

STRESSSTRESS

MENTAL STRESS CAUSES AN MENTAL STRESS CAUSES AN EXTRA LOAD ON THE HEART- EXTRA LOAD ON THE HEART- INCREASE IN HEART RATE AND INCREASE IN HEART RATE AND BLOOD PRESSURE!BLOOD PRESSURE!

PROLONGED& SUSTAINED MENTAL PROLONGED& SUSTAINED MENTAL STRESS CAUSES A HARDENING OF STRESS CAUSES A HARDENING OF ALL ARTERIES IN THE BODY ALL ARTERIES IN THE BODY CAUSING HIGH BLOOD PRESSURE.CAUSING HIGH BLOOD PRESSURE.

EMOTIONS AND YOUR HEARTEMOTIONS AND YOUR HEART

POSITIVE REACTIONS -POSITIVE REACTIONS -HAPPINESS,WINNING,CONTENTMENT.HAPPINESS,WINNING,CONTENTMENT.

NEGATIVE REACTIONS-NEGATIVE REACTIONS- TENSION,ANGER,TENSION,ANGER, FRUSTRATIONS,DEJECTION.FRUSTRATIONS,DEJECTION.

NEGATIVE REACTIONS CAUSE NEGATIVE REACTIONS CAUSE STRESS & HARM THE HEART!STRESS & HARM THE HEART!

BAD EFFECTS OF STRESS!BAD EFFECTS OF STRESS!

HIGH BLOOD PRESSUREHIGH BLOOD PRESSURE DIABETESDIABETES HEART DISEASEHEART DISEASE PERIPHERAL ARTERIAL DISEASEPERIPHERAL ARTERIAL DISEASE STROKESTROKE

How serious is HT? Can it be fatal?

Absolutely. High BP contributes directly or indirectly to about one million deaths each year and accounts for more doctor visits and prescriptions than any other medical problem. If left untreated, high BP causes the walls of the small arteries to thicken (which reduces the flow), and weaken (which increases the chance of rupture). If this continues long enough, the result can be a heart attack, stroke, kidney damage or potentially lifethreatening problems

CHOLESTEROL-SOME CHOLESTEROL-SOME MISCONCEPTIONSMISCONCEPTIONS

YOU DON’T HAVE TO BE FAT/OVERWEIGHT YOU DON’T HAVE TO BE FAT/OVERWEIGHT TO HAVE HIGH CHOLESTEROL!TO HAVE HIGH CHOLESTEROL!

YOUR CHOLESTEROL LEVEL IS NOT ONLY YOUR CHOLESTEROL LEVEL IS NOT ONLY RELATED TO THE AMOUNT OF FATS YOU RELATED TO THE AMOUNT OF FATS YOU EAT!EAT!

CHOLESTEROL IS MADE BY OUR BODY CHOLESTEROL IS MADE BY OUR BODY EVEN IF YOU STOP EATING FATTY EVEN IF YOU STOP EATING FATTY SUBSTANCES.SUBSTANCES.

ALL CHOLESTEROL IN BLOOD IS NOT BAD!ALL CHOLESTEROL IN BLOOD IS NOT BAD!

ADVANCES IN THE PREVENTION ADVANCES IN THE PREVENTION AND TREATMENT OF HEART AND TREATMENT OF HEART DISEASESDISEASES

PRIMARY PREVENTIONPRIMARY PREVENTION STRESS REDUCTIONSTRESS REDUCTION LIFE STYLE MODIFICATIONLIFE STYLE MODIFICATION REGULAR CHECKUPSREGULAR CHECKUPS

SECONDARY PREVENTIONSECONDARY PREVENTION PROPHYLACTIC ASPIRINPROPHYLACTIC ASPIRIN CHOLESTEROL LOWERING DRUGSCHOLESTEROL LOWERING DRUGS

ADVANCES IN THE PREVENTION ADVANCES IN THE PREVENTION AND TREATMENT OF HEART AND TREATMENT OF HEART DISEASESDISEASES

REGULAR CHECK-UPSREGULAR CHECK-UPS

YEARLY EXERCISE ECG ( STRESS YEARLY EXERCISE ECG ( STRESS TEST) FOR ALL ABOVE 35/40 YRS.TEST) FOR ALL ABOVE 35/40 YRS.

YEARLY LIPID PROFILE TESTINGYEARLY LIPID PROFILE TESTING SCREENING FOR DIABETES.SCREENING FOR DIABETES.

DIAGNOSIS OF HEART DIAGNOSIS OF HEART DISEASEDISEASE

ECG, STRESS TEST ECG, STRESS TEST ECHOCARDIOGRAM.ECHOCARDIOGRAM.

ANGIOGRAPHYANGIOGRAPHY

THALLIUM TESTTHALLIUM TEST

TREATMENT OPTIONS FOR TREATMENT OPTIONS FOR CORONARY ARTERY DISEASECORONARY ARTERY DISEASE

TREATMENT OF HEART TREATMENT OF HEART DISEASE-OPTIONSDISEASE-OPTIONS

DRUGSDRUGS

ANGIOPLASTYANGIOPLASTY

ANGIOPLASTY WITH STENTSANGIOPLASTY WITH STENTS

CORONARY BYPASS GRAFTINGCORONARY BYPASS GRAFTING

COST OF TREATMENTCOST OF TREATMENT

HEART ATTACK- Rs. 10000-25000HEART ATTACK- Rs. 10000-25000

ANGIOGRAPHY- Rs. 12000-15000ANGIOGRAPHY- Rs. 12000-15000

ANGIOPLASTY- Rs. 70,000+cost of stent.ANGIOPLASTY- Rs. 70,000+cost of stent.

COST OF A STENT – Rs.60000-1,50,000COST OF A STENT – Rs.60000-1,50,000

BYPASS SURGERY- Rs.1,25,000 – 2,00,000BYPASS SURGERY- Rs.1,25,000 – 2,00,000

* This is the cost of treatment without * This is the cost of treatment without complications in standard institutes in complications in standard institutes in Pune.Pune.

PREVENTION IS ALWAYS PREVENTION IS ALWAYS BETTER (CHEAPER) THAN BETTER (CHEAPER) THAN CURE!CURE!

PREVENTIONPREVENTION

MEDICATIONSMEDICATIONSSTOP TOBACCO IMMEDIATELY, STOP TOBACCO IMMEDIATELY,

COMPLETELY AND PERMANENTLY.COMPLETELY AND PERMANENTLY.CHOOSE YOUR FOOD WISELY- eat less fat CHOOSE YOUR FOOD WISELY- eat less fat

and sugar.Cut down on meat,diary and sugar.Cut down on meat,diary products,cakes, sweets and ghee. You products,cakes, sweets and ghee. You are allowed to eat are allowed to eat poultry,fish,fruits,vegetable and salads.poultry,fish,fruits,vegetable and salads.

CHANGE YOUR COOKING MEDIUM TO OILCHANGE YOUR COOKING MEDIUM TO OILHAVE A BALANCED DIET.HAVE A BALANCED DIET.

PREVENTIONPREVENTION

DIETDIET

BALANCED DIET-BALANCED DIET-

CARBOHYDRATES( WHEAT, RICE)CARBOHYDRATES( WHEAT, RICE)

PROTEINS( PULSES, SOYA, ANIMAL PROTEIN)PROTEINS( PULSES, SOYA, ANIMAL PROTEIN)

FATS – UNSATURATED, SATURATED.FATS – UNSATURATED, SATURATED.

VITAMINS, MINERALSVITAMINS, MINERALS

WATER. WATER.

PREVENTION OF HEART DISEASEPREVENTION OF HEART DISEASE

WATCH YOUR WEIGHT – being over WATCH YOUR WEIGHT – being over weight can lead to high blood weight can lead to high blood pressure,diabetes and heart diseasepressure,diabetes and heart disease

GO EASY ON ALCOHOL.GO EASY ON ALCOHOL. TAKE REGULAR EXERCISES- such as TAKE REGULAR EXERCISES- such as

brisk walking ,running, swimming,and brisk walking ,running, swimming,and cycling.Not only does it improve your cycling.Not only does it improve your circulation and help in weight circulation and help in weight control,but is also protects your heart.control,but is also protects your heart.

EXERCISEEXERCISE

WALKING IS THE BEST AND THE WALKING IS THE BEST AND THE CHEAPEST FORM OF EXERCISE.CHEAPEST FORM OF EXERCISE.

A BRISK UNINTERRUPTED WALK A BRISK UNINTERRUPTED WALK FOR 25-30 MINS DAILY IS FOR 25-30 MINS DAILY IS NECESSARY FOR BENEFICIAL NECESSARY FOR BENEFICIAL EFFECTS ON THE HEART.EFFECTS ON THE HEART.

TAKING YOUR DOG FOR A WALK IS TAKING YOUR DOG FOR A WALK IS GOOD ONLY FOR THE DOG!GOOD ONLY FOR THE DOG!

PREVENTION OF HEART DISEASEPREVENTION OF HEART DISEASE

REDUCE STRESS!REDUCE STRESS!

DO NOT SET UNREALISTIC TARGETS!DO NOT SET UNREALISTIC TARGETS!

DO NOT CARRY YOUR WORK HOME.DO NOT CARRY YOUR WORK HOME.

TAKE YOUR LEAVE , DON’T ENCASH IT! IF TAKE YOUR LEAVE , DON’T ENCASH IT! IF YOU DO , USE THE MONEY TO PAY FOR YOU DO , USE THE MONEY TO PAY FOR YOUR BYPASS!YOUR BYPASS!

YOGA / MEDITATION.YOGA / MEDITATION.

PREVENTIONPREVENTION

REMEMBER! REMEMBER!

YOU HAVE ONLY ONE HEART, AND IT YOU HAVE ONLY ONE HEART, AND IT IS UPTO YOU TO LOOK AFTER IT IS UPTO YOU TO LOOK AFTER IT WELL.WELL.

ALL WORK , NO PLAY , TOBACCO AND ALL WORK , NO PLAY , TOBACCO AND STRESS MAKE “ JACK” AN ILL MAN! STRESS MAKE “ JACK” AN ILL MAN!

DO NOT RUN THROUGH LIFE SO FAST DO NOT RUN THROUGH LIFE SO FAST THAT YOU FORGET NOT ONLY THAT YOU FORGET NOT ONLY WHERE YOU HAVE BEEN , BUT ALSO WHERE YOU HAVE BEEN , BUT ALSO WHERE YOU ARE GOING.WHERE YOU ARE GOING.

PREVENTION

LIFE IS NOT A RACE , BUT A JOURNEY TO BE SAVORED EACH STEP OF THE WAY

TREATMENT OF HEART DISEASETREATMENT OF HEART DISEASE

ANGIOPLASTYANGIOPLASTYNONOPERATIVE METHOD OF NONOPERATIVE METHOD OF

TREATING BLOCKS IN YOUR TREATING BLOCKS IN YOUR ARTERIES.ARTERIES.

NOT EVERYONE CAN HAVE THIS NOT EVERYONE CAN HAVE THIS PROCEDURE.PROCEDURE.

FAILURE RATES ARE HIGH IN SOME FAILURE RATES ARE HIGH IN SOME CASESCASES

LASTS FOR UPTO 3 YRS.LASTS FOR UPTO 3 YRS.

TREATMENT OF HEART DISEASESTREATMENT OF HEART DISEASES

ANGIOPLASTY WITH STENTANGIOPLASTY WITH STENT

NONOPERATIVE METHODNONOPERATIVE METHOD

RESULTS BETTER THAN ANGIOLPASTY RESULTS BETTER THAN ANGIOLPASTY ALONE.ALONE.

CAN LAST UPTO 5-6 YRS.CAN LAST UPTO 5-6 YRS.

SUDDEN BLOCKAGES OF STENT CAN SUDDEN BLOCKAGES OF STENT CAN OCCUR.OCCUR.

EXPENSIVE.EXPENSIVE.

TREATMENT OF HEART DISEASESTREATMENT OF HEART DISEASES

CORONARY ARTERY BYPASS GRAFTINGCORONARY ARTERY BYPASS GRAFTING

CAN BE DONE IN ALL PATIENTS.CAN BE DONE IN ALL PATIENTS.

CAN LAST UPTO 10-15 YRS.CAN LAST UPTO 10-15 YRS.

MOST COST EFFECTIVE PROCEDURE.MOST COST EFFECTIVE PROCEDURE.

RECOVERY FASTER IN PATIENTS DONE RECOVERY FASTER IN PATIENTS DONE ON A BEATING HEART.ON A BEATING HEART.

VEIN GRAFT TO RIGHT CORONARY VEIN GRAFT TO RIGHT CORONARY ARTERYARTERY

VEIN GRAFT TO RIGHT CORONARY VEIN GRAFT TO RIGHT CORONARY ARTERYARTERY

VEIN GRAFT TO RIGHT CORONARY VEIN GRAFT TO RIGHT CORONARY ARTERYARTERY

COMPOSITE MAMMARY GRAFTSCOMPOSITE MAMMARY GRAFTS

THE HEART LUNG MACHINE

NEW TRENDS IN NEW TRENDS IN CORONARY BYPASS CORONARY BYPASS GRAFTINGGRAFTING

NEW TRENDS IN CORONARY ARTERY NEW TRENDS IN CORONARY ARTERY BYPASS GRAFTINGBYPASS GRAFTINGNEW TRENDS IN CORONARY ARTERY NEW TRENDS IN CORONARY ARTERY BYPASS GRAFTINGBYPASS GRAFTING

OCTOPUSOCTOPUSIS IT THE INVENTION IS IT THE INVENTION TO REVOLUTIONIZE TO REVOLUTIONIZE CABG ? CABG ?

OCTOPUSOCTOPUSIS IT THE INVENTION IS IT THE INVENTION TO REVOLUTIONIZE TO REVOLUTIONIZE CABG ? CABG ?

NEW TRENDS IN CORONARY NEW TRENDS IN CORONARY BYPASS GRAFTINGBYPASS GRAFTING

OFF PUMP CABG – BEATING OFF PUMP CABG – BEATING HEART SURGERYHEART SURGERY DOES NOT NEED THE HEART LUNG DOES NOT NEED THE HEART LUNG

MACHINEMACHINE THE HEART CONTINUES TO BEAT THE HEART CONTINUES TO BEAT

WHILE THE ANASTOMOSIS ARE WHILE THE ANASTOMOSIS ARE PERFORMED.PERFORMED.

NEEDS THE USE OF A STABILISER NEEDS THE USE OF A STABILISER TO REDUCE MOTION WHILE TO REDUCE MOTION WHILE SUTURING.SUTURING.

HEART SURGERY IN THE HEART SURGERY IN THE 21ST CENTURY21ST CENTURY

ENDOSCOPIC RADIAL ARTERY HARVESTING

WATCH BAND INCISION FOR RADIAL HARVEST

TOTALLY ENDOSCOPIC CORONARY BYPASS GRAFTING

ROBOTIC CORONARY BYPASS SURGERY

ADVANCES IN THE PREVENTION AND ADVANCES IN THE PREVENTION AND TREATMENT OF HEART DISEASESTREATMENT OF HEART DISEASES

ADVANCES IN THE PREVENTION AND ADVANCES IN THE PREVENTION AND TREATMENT OF HEART DISEASESTREATMENT OF HEART DISEASES

A HAPPY MAN HAS A HAPPY HEART!A HAPPY MAN HAS A HAPPY HEART!