Heart and circulatory dysfunction, performed by a hybrid procedure

LECCE – Until recently, patients with concomitant heart disease were at high risk of surgery and sometimes non-operatively. Today there are so-called innovative “hybrid” procedures which, with careful preoperative study and a minimally invasive approach, reduce risks and give good results.

This is the case of a 69-year-old working at Città di Lecce, a highly specialized NHS-accredited hospital, where a hybrid procedure, or a combination of different interventions, was performed in the same operation session.

This procedure could have been carried out at the Gvm Care & Research Hospital in Lecce where there is a hybrid operating room, one of the few in Puglia, which allows you to perform – in one session – alternating complex and multidisciplinary interventions in the field of cardiac specialists: a team made up of Cardiac surgeons, hemodynamicists, clinical cardiologists and cardiac anesthesiologists work together to determine the best treatment option for each individual case.

The 69-year-old man had a very complex clinical picture: in addition to a severely obstructed carotid and a significant risk factor for stroke, the patient also had severe aortic stenosis and coronary artery occlusion, resulting in an increased risk of heart disease. An attack.. diffuse atherosclerosis has been associated with this, causing problems with walking.

“Because of the highly penetrating framework, we discussed the case at a multidisciplinary level to determine the procedure that combines curative and non-painful solutions to the problems, and to minimize the risks of the procedures – explains Dr. Giuseppe Santarpino, Co-Chief Operating Officer of the Cardiac Surgery Unit of Lecce City Hospital -. We intervened with a carotid stent. With the patient awakened, a combined heart surgery followed to replace the damaged valve and bypass path.”

Therefore, the multidisciplinary team intervened following a step-by-step program, outlined with the cardiology team. For the first part, a vascular approach was adopted, without surgical cutting; Through the catheter, the blocked blood vessel that carries blood to the brain was reopened, and a stent was then inserted into the carotid artery. The patient was awake, and underwent continuous monitoring to ensure there were no ischemic problems and brain complications. During the same operation session, the patient was then slept under general anesthesia to replace the narrowed valve with a biological prosthesis and perform coronary artery bypass grafting.

“This procedure has proven very effective – says Dr. Santarpino -. The patient was transferred to the intensive care unit after surgery and was breathing independently after a few hours. On the second day after surgery he was transferred to the ward and discharged after three days. There will now be a reduced recovery phase. Thanks to the hybrid procedure, the patient must continue to take drug therapy and antiplatelet agents, must maintain a low cholesterol level and undergo regular check-ups.”

Among the doctors who allowed the operation to be successful were Prof. Giuseppe Speziali, Coordinator of Cardiac Surgery at Gvm Care & Research, Dr. Luigi Specchia, Head of Cardiac Surgery, Dr. Kia Vaziri, Head of Cardiology, Dr. Marcello Melone, Head of Department of Anesthesia and Intensive Care at Cita Hospital De Lecce and Dr. Flavio Fiori, Head of the Departments of Anesthesia and Intensive Care at Anthea Hospital in Bari.

“The presence of the cardiac team is now part of European and international guidelines – comments by Dr. Mirror -. Group discussion among specialists is a concept that has revolutionized the way the patient is managed, and therefore has greater advantages, such as the possibility of complete treatment, from diagnosis to follow-up through treatment, with a course of He is followed by different personalities that all contribute to his health. Several years ago, we met here at Città di Lecce every morning to discuss the most complex cases. All this helps us to make the right decision, that is, to choose and adapt the best strategy for the individual patient.”

Collaboration with the regional hospitals with which Lecce City Hospital works in synergy to respond to the health needs of Salento patients also remains essential.

“The Salento Cardiology Network is a strong point in the region and allows us to provide an effective and quality response. Everything is based on collaboration, on professional exchange but above all on strong participation in the course of treatment to give a quick response to the patient’s clinical problem” says Dr. Michele Akugli, Director of the facility Hospital Complex Cardiology” Cardinal Giovanni Banic then a multidisciplinary team at Lecce City Hospital performed surgery on Tricase and a cardiologist for the 69-year-old patient.

“The will is to provide a unified service to the residents of Salento with regard to heart surgery. The patient must be at the center of our action and so we organize the schedules of local hospitals in order to always have a dedicated team in emergency situations. I would like to emphasize the quality of the healthcare offer we provide here at Puglia: The data shows that, citizens know that they can find excellence even in their own lands without resorting to structures in the north. At the Città di Lecce Hospital, for example, we perform about two-thirds of heart surgery in Salento and the Agenas data confirm the excellent results.”

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