Title : Role of regenerative therapy in heart failure, acute MI & peripheral vascular disease
Abstract:
PURPOSE : Heart Team Approach has benefited management of Cardiovascular patients for more than a decade now. We adapted Integrated for the Comprehensive management of Cardiovascular and Thoracic surgery patients from 2011 . However the virtues of this approach were tested to the fullest extent during Covid Pandemic when patients presented late and had higher comorbidities as well as complications on arrival .
We present our Experience of adopting the Integrated approach for complete management of such patients during Covid Pandemic .
PATIENTS AND METHODS : Since the onset of First wave of COVID Pandemic in February 2020 we admitted 488 patients after rapid screening for COVID antigen followed by RT PCR . Any patient tested positive was shifted to COVID ward and Cardiovascular Intervention was postponed till 2 weeks after recovery from Covid. Among these 302 underwent Off Pump Coronary artery bypass , 2 ASD closure in severe PAH ,1 atrial myxoma excision in patient with CVA, 67 had VATS , 5 had peripheral arterial bypass, 4 had Endovascular repair , 4 had mediastinal tumour removal by Mini thoracotomy, 2 complicated Giant Bronchogeinc cyst ( one cervico - mediastinal Redo,other infracarinal in post PTCA patient) , Segmental resection for pulmonary Aspergilloma (2) and for pulmonary mucormycosis(2) .Apart from these there was 1 EVAR and 1 EVLT 1, RFA 1 while 36 were referred for PTCA and 66 had minimally invasive procedures/ conservative management.
COVID guidelines were strictly followed along with strict written protocols for Comprehensive management of patients. Prompt other speciality consultation were sought whenever indicated. Meticulous Physiotherapy as well as dietary cover was provided pre operative aas well as postoperative in ICU as well as in Rehabilitation center . All patients were regularly followed up in OPD and homecare was provided whenever indicated. Prompt round the clock Video consultations were provided to facilitate diagnosis and management when rapid transportation to hospital was not possible.
RESULT : The postoperative recovery was smooth and uneventful in all except 5 patients with average length of stay post surgery 3.2 days . Post operative mortality were 2 (1 had respiratory failure in post MI 86 year female with Preoperative LVF, other had Preoperative multiple MI with LVF went into Multiorgan failure ).
CONCLUSION :Although the patients presented late with more comorbidities and complications, Integrated approach was beneficial in Comprehensive management by reducing further morbidity and mortality despite higher Preoperative risk.
Benefits: The audience will learn how efficient Team Approach and meticulous guidelines improves management of patients who present late to hospital with numerous comorbidities during Civid Pandemic .
This will further help the audience in planning management of their patients so that complete cost effective benefits can be effectively passed on during the testing times
