Featured ArticleIssueSep 21

Innovations in cardiology at Medica Hospitals

How the Kolkata-based hospital is using new technology and techniques to improve patient outcomes

Medica Superspeciality Hospital, Kolkata has invested in the latest technology since it first opened its doors to patients in 2010. The hospital is known for treating complex cases and its thought leaders regularly speak at the cardiology conferences about new research and technology innovations they work with. Some of the thought leaders are Dr Kunal Sarkar, Senior Vice Chairman, Senior Cardiac Surgeon & Head (Medica Institute of Cardiac Sciences); Dr Rabin Chakraborty, Senior Vice Chairman, Medica Group; Dr Dilip Kumar, Director, Cath Lab; Dr Sanjeev Garg, Head, Non- Invasive Cardiology and Dr Anil Kumar Singhi, Senior Consultant, Paediatric Cardiology.

The hospital is the largest chain of private hospitals in Eastern India with hospitals in West Bengal, Jharkhand, Odisha, Bihar, and Assam. The flagship hospital at Kolkata attracts patients from neighbouring countries too. In, 2018-19 the hospital treated 9183 (OP & IP) international patients, mainly from Bangladesh, Myanmar, Nepal, Bhutan and other neighbouring countries, while in 2019-20, the numbers were 7057 (OP & IP) International patients.

Recently, Medica Superspeciality Hospital, Kolkata introduced a new technology for angioplasty treatment by introducing and implanting the latest available indigenous Absorbable Stent / Bio Resorbable Scaffold (BRS). This BRS is the world’s first-ever 100-micron thinstrut scaffold and has received approval from the Drugs Controller General of India (DCGI) and CE Approval in Europe and has been studied in research trials in India and globally, supporting its positive safety and efficacy.

Top Ranked Structural Heart Programes
Medica Superspeciality Hospital is known as a pioneer in structural heart interventions, including transcatheter aortic valve replacement (TAVR), transcatheter mitral valve replacement (TMVR) and transcatheter repair, and left atrial appendage (LAA) occlusion. Several of its doctors are also well known experts in complex percutaneous coronary intervention (PCI), including chronic total occlusion (CTO) procedures. The hospital is the first centre in Eastern India that has managed cardiogenic shock patients with mechanical circulatory support (ECMO). The device subspecialty has the distinction of performing one of the largest conduction system pacing in India.

Dr Kunal Sarkar, Senior Vice Chairman & Head – Medica Institute of Cardiac Sciences

The hospital conducts unique and innovative procedures in the cath lab and its cath lab services run round the clock to provide life-saving procedures like primary angioplasty. Medica also runs active pediatric cardiology and electrophysiology programmes.

Advanced Teaching Programmes
The cardiac team at Medica Superspeciality Hospital is very active and energetic. They frequently conduct active programmes for out station camps at the district level in various parts of Bengal and Eastern Indian like Tripura, Assam, Jharkhand, Bihar.

Dr Dilip Kumar, Director – Cardiac Cath Lab

The hospital also has a reputed DNB Super Speciality training programme in cardiology. They also run various active academic programme through social media like Medica Cardio Talk.

State-of-the-art Technology at Medica Hospital
As cardiac cases become more complex, especially with longer and more involved CTO and structural heart procedures, Medica Superspeciality Hospital looked for cutting-edge systems that could provide both improved image quality and reduce dose for both the cath lab staff and patients.

Dr Sanjeev Garg, Head – Non-Invasive Cardiology

Some of the imaging technologies used are:
• IVUS – Intravenous Ultrasound imaging tool to understand the plaque morphology as well as the stent optimization.
• Rotablation – Fibrocalcific lesion is very hard to open. Rotablation helps to cut the calcification, which helps a smoother delivery of the stent and a proper expansion.
• IVL Therapy – Intravascular lithotripsy is a novel technique based on an established treatment strategy for vascular calcium, in which multiple lithotripsy emitters mounted on a traditional balloon catheter platform deliver localised pulsatile sonic pressure waves to circumferentially modify coronary calcium. This therapy is less time consuming, safer and easier compare to traditional Rotablation therapy.
• FFR – Fractional flow reserve measurement involves determining the ratio between the maximum achievable blood flow in a diseased coronary artery and the theoretical maximum flow in a normal coronary artery.
• CSP – The aim of conduction system pacing (CPS) is to provide physiological ventricular activation by directly stimulating the conduction system. In eastern India, Medica has performed
the highest number of CSP. The hospital has conducted three successful training programme of CRT, where cardiologist from pan India came for training.
• 3D RFA – 3D mapping creates a multidimensional image of the heart’s anatomy. It reduces conventional fluoroscopic radiation. The tip of the catheter sends RF energy to destroy the
abnormal cells in that area.

Leader in Reducing Cardiac Mortality
In recent years, Medica Superspeciality Hospital has spearheaded several initiatives to reduce cardiac mortality. At Medica Superspeciality Hospital Veno-venous (VV ) ECMO has been used for both Covid and non-Covid ARDS which causes extensive lung damage, compromising oxygen delivery to tissues leading to multi-organ failure and even mortality. VV ECMO bypasses the lungs and provides adequate oxygen washes out carbon dioxide, maintains tissue perfusion and prevents organ damage.

Yogesh Joshi, Vice President- Marketing & BD External Hospitals & International Marketing

The team at Medica has experience in using VV ECMO in a patient post LUCS with amniotic fluid embolism that caused acute lung injury. The patient was resuscitated with ECMO and nurses back home.

Veno-arterial (VA) ECMO for low cardiac output due to cardiac dysfunction has been used to support both the lungs and the heart by bypassing both. Here tissues that are devoid of oxygen are provided with adequate oxygen and hemodynamics is maintained, thus, buying time till the recovery of the damaged organ. VA ECMO has been used in Acute coronary syndrome , Acute MI leading to ventricular septal rupture, Cardiogenic shock, myocarditis of various origin, Stuck prosthetic valve, intractable arrhythmias, in massive pulmonary embolism before pulmonary embolectomy, as a bridge to a patient awaiting transplant and in surgeries with impossible airways like tracheal stenosis. VA ECMO as E CPR ( Extracorporeal CPR) plays an important alternative
to traditional CPR due to available resources with a hospital in etiologies of cardiac arrest with reversible causes during a limited period of mechanical cardiorespiratory support. It not only stabilises hemodynamics but also addresses reperfusion injury and prevents immediate death.

Dr Arpan Chakraborty, Senior Consultant – Medica Institute of Cardiac Sciences

The team has initiated VA ECMO as part of E CPR for a patient with a history of DVT who suffered cardiac arrest due to sudden massive pulmonary embolism. He was resuscitated and stabilised on ECMO before taking up for pulmonary embolectomy.

The cardiac team has had a patient of laryngeal CA post-irradiation and laryngectomy with severe Aortic stenosis presenting with syncope, who was stabilised on VA ECMO before undergoing CAG followed by tracheostomy and bioprosthetic aortic valve replacement.

cathlab team

The team also has experience in using VV ECMO with IABP (intra aortic balloon pump) for Acute lung injury with reversible LV dysfunction where use of VA ECMO could be avoided. In last five years, Medica Superspeciality Hospital has administered ECMO in over 300 patients, more than 200 cases of Covid and non Covid ARDS. The team has retrieved patients on ECMO successfully on land and through air transport. The hospital is positioned on the ELSO map as Centre No.738. The hospital has been associated with training programmes of personnel form different part of the country. Medica is integrally associated with the initiation of Government ECMO programmes by the Government of West Bengal and Odisha.

Trans Oesophageal Echocardiography
The hospital has experience in using TEE (trans oesophageal echocardiography) regularly in ORs and ICUs on pre and postoperative patients. TEE serves as eyes and hands for cardiac anesthesiologist and intensivists as it serves in anatomical and functional assessment of the heart: cardiac output, new onset myocardial insufficiency, adequacy of revascularisation surgery, defects in valvular structures, functional adequacy of prosthetic valves, fluid requirement and responsiveness, evidence of pericardial effusion and identification of life-threatening
emergencies like postoperative cardiac tamponade and intraoperative air embolism . TEE also serves in identifying complex structural anatomy of the heart with congenital anomalies and in assessing the adequacy of surgical correction in such hearts.

Dr Rabin Chakraborty, Senior Vice Chairman & Group Head – Cardiology Services

Medica Superspeciality Hospital performs successful complex congenital cardiac surgeries like Norwood procedure, Arterial Switch surgeries, Senning’s procedure; apart from regular surgeries like VSD and ASD closures and palliative surgeries like BD Glenn and BT shunts.

Some of these small patients require ECMO support postoperatively before their hearts become independently functional.

Team’s has a lot of experience in adult cardiac surgeries, like Coronary revascularization, prosthetic valve replacements, Aortic reconstruction procedures, Transesophageal fistula repairs and other vascular repairs, thoracic surgeries like bullectomy ,mediastinal mass removals needs mention.

They have also performed MICS ( Micro Incision Cardiac Surgery) and VATS (video-assisted Thoracic Surgery). Last but not the least, the team also has experience in administration of LVAD ( Left Ventricular Assist Device) and performing successful cardiac transplant.

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