Paediatric and Congenital Heart Surgery

Paediatric and Congenital Heart Surgery at Amrita is one of the well-known centers of excellence in the country. The program has to its credit more than 14,000 congenital heart surgeries successfully performed. An average of 2-4 operations are performed for children with congenital heart disease every day, the overall survival rate matching the best in the world. With a dedicated team of doctors, we cater to the needs of patients from all over the country and abroad.
 

• Our Vision: To develop and sustain a program that not only delivers the highest standards of care to all children with heart disease but also has a regional, national and global impact through contextual research and innovations and high quality training.
• Our Mission: Comprehensive Pediatric heart care affordable and accessible to everyone. Maintaining the highest international standards. Contextually relevant research and training manpower for the future.

• Comprehensive multidisciplinary approach, the services integrate the services of other paediatric sub-specialists wherever required, e.g. paediatric cardiologist, neonatologist, electrophysiologist, geneticist, neurologist, nephrologist, gastroenterologist, plastic surgery and so on, all under one roof.
• Comprehensive fetal heart programme with antenatal diagnosis, in house delivery and expedient surgical care.
• State of the art, multidisciplinary post-operative care with involvement of clinical pharmacist, infection control team, specialist nursing, nutritionists and respiratory therapists.
• Medical Social workers and patient educators provide support to patient families, helping them cope with the diagnosis of heart ailments and also actively help them in organising resources for treatment.
• Translators available round the clock to help out-Station and international patients during the treatment period, including arranging stay, specific food and other such support.
• State of the art cardiac imaging technology and a dedicated team of experts for highly advanced cardiac imaging aid in decision making for complex congenital heart surgeries.
   

• India's first and only dedicated CHD-CMRI program was established at Amrita Hospital in 2010.
• 1.5 Tesla GE, 3.0 Tesla GE and 3.0 Tesla Siemen's MRI scanners are used for cardiac imaging.
• 256-slice advanced CT is used for scanning the cardiovascular system.
• Nuclear Medicine scans include myocardial perfusion and viability assessments and lung-perfusion studies.
• 3D- reconstructions, 3D modelling and virtual reality reconstructions to aid in complex congenital heart surgeries.
• Virtual reality Cath meetings to delineate treatment options for complex congenital heart surgeries.
• Dedicated non- cardiac ECMO team for fast and safe delivery of ECMO care for non- cardiac diseases like viral myocarditis, poisoning, ARDS, septic shock, etc.
• Novel technologies including Neoport transport app to track patients during transfer from other remote centres.
• Outreach and community programs including medical camps in Kerala, pan-India and international outreach camps to identify and help financially challenged families to receive cardiac surgical care for their children.
• International collaboration with Children's Heartlink, University of California San Fransisco (UCSF), USA, IJN (National Heart Institute), Malaysia, and International quality improvement collaborative for congenital heart disease (IQIC).

Neonatal cardiac surgery

Congenital heart surgery includes all surgeries that fix or treat heart defects that a child is born with. Amrita has successfully performed more than 6500 arterial switch operations and 1000 TAPVC repairs in neonates:

Arterial switches: It is done in cases of transposition of great arteries where the aorta originates from the wrong ventricle and the baby is blue. Total anomalous pulmonary venous return repair: In case the pulmonary veins open into the wrong side of the heart and the baby is blue

Norwood operation: Done for hypoplastic left heart syndrome where the whole left side of the heart is underdeveloped. One stage repair of arch anomalies with correction of intracardiac defects.

Infant Cardiac Surgery

Most commonly done surgeries in infants are:

• Closure of simpler intra cardiac defects
• Total corrections for Tetralogy, Double Outlet Right Ventricle
• Repair of Endocardial Cushion Defects
• Senning operation
• Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) repairs

• Double switch procedures

  Complex Valve Repairs

• Correction of Ebstein's Anomaly - Ebstein anomaly is an abnormality in the tricuspid valve. The tricuspid valve separates the right atrium (the chamber that receives blood from the body) from the right ventricle (the chamber that pumps blood to the lungs).

• Congenital Mitral Stenosis and Mitral Regurgitation

  Mitral Stenosis - Stiffening of the leaflets and narrowing of the opening of the mitral valve reduces blood flow from the left atrium to the left ventricle.

  Mitral regurgitation - The mitral valve flaps don't close tightly or they bulge backward (mitral valve prolapse) into the left atrium as your heart squeezes (contracts). As a result, the mitral valve leaks blood.

• Aortic and mitral valve repairs- The two most commonly discussed heart valves are the mitral valve and the aortic valve. These two valves are located on the left side of the heart. The mitral valve separates the left upper and left lower chambers of the heart. The aortic valve is located at the top of the left lower chamber of the heart.

• Tricuspid valve repairs including Cone repair for Ebstein anomaly

  
  Complex congenital heart surgeries

  The centre performs high end and rate complex surgeries routinely. These include:

• Norwood operation in neonates
• Complex DORV rerouting using 3D and virtual reality models
• Complex biventricularcomversions of previously palliated univentricular pathway diseases using 3D and vitrual reality models
• Double switch operations
• Rastelli operations
• Advanced mitral and aortic valve repairs for congenital mitral and aortic stenosis and regurgitation. These inculde aortic valve bicuspidization, Ozaki aortic valve repair and Ross operations
• Advanced AV valve repairs in univentricular hearts
• Open heart surgery in Preterm and low birth weight babies

• Combined tracheal surgeries and cardiac surgeries

  
  Operation for Single Ventricle Physiology

  
  The Center performs staged repairs for single ventricle physiology

• PA banding - It is a palliative surgical technique used for the correction of congenital cardiac defects, characterized by pulmonary over-circulation caused by left-to-right shunting of blood. PAB is reserved for palliation in a certain subset of infants with complex congenital heart disease.
• Systemic-pulmonary shunts - It is to inject some blood of systemic circulation into the pulmonary circulation by high pressure through the shunt channels, which will inevitably lead to the corresponding increase of pulmonary circulation blood volume and left ventricular return blood volume.
• Cavopulmonary shunts - The bidirectional cavopulmonary shunt may be defined as an operation that diverts the systemic venous return from the superior vena cava or cavae to both lungs.

• Fontan operation - The Fontan procedure is used in pediatric patients who possess only a single functional ventricle, either due to lack of a heart valve (e.g. tricuspid or mitral atresia), an abnormality of the pumping ability of the heart (e.g. hypoplastic left heart syndrome or hypoplastic right heart syndrome), or a complex congenital heart disease where a bi-ventricular repair is impossible or inadvisable.

  
  Minimally invasive cardiac surgery

  A large majority of congenital heart diseases are now curable with timely surgical intervention. However, not only do patients and their parents undergo tremendous suffering and pain that comes with having a congenital heart disease, but also have to carry a scar and the associated social stigma for the rest of their lives, even though they are fully cured of the disease. We at Amrita have striven to address this concern, and have performed among the largest series of limited posterolateral thoracotomy surgeries to cure simple congenital heart diseases. We have diversified our armamentarium by providing, since 2015, mini-sternotomy and axillary approaches to cardiac surgery in children. We have performed nearly 300 surgeries via the trans axillary approach which is currently considered the most cosmetic way to address simple congenital cardiac lesions. We also offer minimally invasive options for pulmonary valve implantation in patients who have undergone primary TOF repair and have severe pulmonary regurgitation.

  Tracheal surgeries

  Rarely, congenital heart lesions are associated with congenital anomaliesof the upper airways, like tracheal rings, diffuse tracheal stenosis, tacheomalacia and bronchomalacia. Amrita has a comprehensive team approach to deal with these in concomitance with the heart disease. In these situations our teamis buffered by paediatric pulmonologists, ENT, neonatologists and cardiac imaging specialists to help identify and surgically treat these airway problems simultaneously. Surgeries performed include tracheal resection, slide tracheoplasty and aortopexy.

  The preterm cardiac surgical programme

  With every passing year, more and more preterm and low birth weight children with extreme physiological challenges are undergoing open heart surgery at AIMS, with unmatched success rates. The care continuum includes safe transport with tracking using Neoport app, preoperative stabilisation in the neonatal ICU, prompt surgery irrespective of child’s weight, age or complexity of congenital heart disease, and comprehensive team management in the post-operative period. Surgeries performed include VSD closure, TAPVC repair, AP window correction, Arch repair with VSD closure, Arterial switch operation, simultaneous Arch repair with Arterial Switch operation and VSD closure, and Arterial switch operation with VSD closure.Children weighing as low as 1.3 kg and as young as 34 weeks gestational age have undergone open heart surgery successfully and sent home.

  Congenital Defects in Older Children and Adolescents

  The whole spectrum of congenital heart surgery ranging from total corrections to conduit reconstructions is performed. Redo operations for congenital heart defects. Surgeries like replacement of conduits, surgery for endocarditis, staged Fontan surgeries are routinely performed.

State of the art facilities

• Dedicated Operation Rooms
  Facilities for new-born, infant and complex congenital heart surgery. State-of-the-art monitoring systems including dedicated pediatric trans-esophageal echocardiography are available.

• Dedicated State-Of-The-Art Pediatric Cardiac Intensive Care Facility. 

  With supporting monitors and ventilators, Inhalational Nitric Oxide and facilities for LV assist and extra-corporeal support. The pediatric cardiac intensive care unit has 34 beds in total.
  
  Imaging facilities
  
  We have 256 slice CT scanners and 3 Tesla MRI machines which ensure the best imaging needed for complex congenital heart surgeries.

  3D and Virtual Reality lab:
  We are the only centre in the country to have a dedicated 3 D lab and virtual reality centre which is used for planning complex heart surgeries and for academic events like multidisciplinary Cath meetings at local, national and international level.

  Equipment

  
  Heart Lung Machine
  A heart-lung machine is an apparatus that does the work both of the heart and the lungs. The basic function of the machine is to oxygenate the body's venous supply of blood and then to pump it back into the arterial system. Blood returning to the heart is diverted through the machine before returning it to the arterial circulation. These machines are needed for the execution of open heart surgeries.

  ECMO:

  Amrita routinely performs ECMO for non-cardiac indications in coordination with the general pediatric ICU team for conditions like viral myocarditis, ARDS, septic shock etc.

  
  Quality measures

  High-quality, evidence-based care (care that is proven) leads to more lives saved and less time in the hospital. Quality care also means safer care for consumers. This involves constantly and proactively looking at processes to improve safety and, in turn, quality. The department of pediatric CVTS has stringent quality measures, periodic audits and is a part of a large international database which helps deliver care of the highest international standards.
   

Neonatal Cardiac Surgery 

The department has successfully performed more than four hundred and fifty arterial switch operations and eight hundred TAPVC repairs in neonates: 

• Arterial switches: done in cases of transposition of great arteries - where the aorta originates from the wrong ventricle and the baby is blue. 
• Total anomalous pulmonary venous return repair: done in cases where the pulmonary veins open into the wrong side of the heart and the baby is blue. 
• Norwood operation: done for hypoplastic left heart syndrome where the whole left side of the heart is underdeveloped. 
• Systemic pulmonary shunts. 
• One stage repair of arch anomalies with correction of intra-cardiac defects. 

Infant Cardiac Surgery 

• Closure of simpler intra cardiac defects. 
• Total corrections for tetralogy, double outlet right ventricle. 
• Repair of endocardial cushion defects. 
• Senning operation. 
• Anomalous left coronary artery from the pulmonary artery (ALCAPA) repairs. 
• Double switch procedures. 

Complex Valve Repairs 

• Correction of Ebstein's anomaly. 
• Congenital mitral stenosis and mitral regurgitation. 
• Aortic and mitral valve repairs.  

Operation for Single Ventricle Physiology 

The centre performs staged repairs for single ventricle physiology. 

• PA banding. 
• Systemic-pulmonary shunts. 
• Cavopulmonary shunts. 
• Fontan operation. 

Congenital Defects in Older Children and Adolescents 

• The whole spectrum of congenital heart surgery ranging from total corrections to conduit reconstructions is performed. 
• Redo operations for congenital heart defects. 
• Surgeries like replacement of conduits, surgery for endocarditis, staged Fontan surgeries are routinely performed. 

Cosmetic Congenital Heart Surgery 

• Specializes in surgery for congenital heart defects using cosmetically appealing incisions. 
• Over 1500 open-heart procedures performed using limited posterior thoracotomy incisions. 
• Approximately 300 infants and children underwent open-heart procedures through ministernotomy (key-hole) approach. 
• Procedures performed include repairs for tetralogy, closure of septal defects, correction of anomalous venous connections, and endocardial cushion defect corrections. 

Open Heart Procedures Include:

Phone: 0484 – 2851559, 0484-6681559 

Email: [email protected]