ctvs

DEPARTMENT OF CARDIO THORACIC VASCULAR SURGERY (CTVS)

	Services	Departments

Faculty

Introduction

Infrastructure

Services

Academic Activities

Vision of the Department

Faculty
Dr. Reuben Lamiaki Kynta Assoc. Professor I/c


Dr. Tabang Nyitan Asst. Professor
Senior Perfusionist :
Mr. Mrinal Mandal
Introduction
The Cardiothoracic and Vascular Surgery department of NEIGRIHMS is one of the vibrant Open Heart Centre in North Eastern Region and presently leader in this field in the entire region. The department successfully provide its services in this field and regularly treating new-born to octogenarian group of patients who requires cardiac surgical intervention as a treatment of choice. The department of Cardio-thoracic & Vascular surgery at NEIGRIHMS was established in the year 2005 and headed by Prof. Manuj Kumar Saikia, MCh (AIIMS). The department performed its First Open Heart Surgery in the year 2007. Since then the department has been actively doing all kinds of surgery of the Heart, Aorta, Blood vessels, Lungs and other general thoracic procedures. This is the only Central Government Cardiothoracic Centre in the North East to perform regular open heart surgeries. The department caters to patients not only from the entire North Eastern region but also from other states like West Bengal, Bihar etc. Apart from India it also imparts its services to patients from neighbouring country like Bangladesh and Myanmar. At present, the department has got three experienced Cardio-thoracic Surgeons with one Perfusionist and performs more than 400 cases a year using State-of-the-Art Technology, including Minimally Invasive Technique and works in tandem with other specialized departments like Cardiology, Paediatrics, General Medicine and Radiology for evaluation and planning of each case whenever necessary.
Infrastructure
The Department of Cardiovascular and Thoracic Surgery is one of the Advanced Cardiac Surgical Units in the country. The department has two state-of-the-art advanced Operating Theatres with laminar air flow system exclusively for open heart surgical procedures. Moreover, the general thoracic surgical procedures are performed in a different operating theatre complex. Following are the high end equipment in the theatre complex: 1. Operating Table – multi section operated by hand held remote control 2. The Operating Light fitted with camera and HD DVD recorder 3. Heart Lung Machine – Terumo Roller (Advanced perfusion system -1) 4. Heart Lung Machine – Maquet Roller (HL 20 incorporated with flow and level sensors) 5. Extracorporeal Membrane Oxygenator (ECMO) – Maquet Rota flow system 6. Intra-Aortic Balloon Pump (IABP) – Datascope, system 98 7. Temperature Control Machine (TCM) 8. 6 channel Phillips monitor M – 8 The Intensive Care Unit (CTVS-ICU) in the Department of Cardiovascular and Thoracic Surgery has got 10 totally electrically operated bed unit dedicated to the care of the critically ill postoperative neonatal, paediatric and adult cardiovascular and thoracic patients, along with cardiac medical problems. The care of the patients in the ICU is multidisciplinary. The staff consists of registered nurses who have completed extensive training and have achieved advanced certifications. Each bed is equipped with Advanced ventilator and monitoring system. Unique services include Extracorporeal Membrane Oxygenation (ECMO), providing highest form of life support for patients with severe and abrupt heart and/or lung failure. The Cardiovascular and Thoracic Surgery Ward is 30 bedded which includes 6 bedded Step-down ICU unit. The unit is also staffed by Advance Practice Team and highly skilled nurses.
Services
The department offers services through its experienced experts in treating people with all disorders affecting the heart, aorta, blood vessels, lungs and chest wall. The team of specialists evaluates and ensures an accurate diagnosis and development of the most appropriate treatment plan. Current areas of focused expertise include: • Neonatal Cardiac Surgery • Paediatric and Adult Congenital Cardiac Surgery • Adult Cardiac Surgery • Mitral Valve Repair • Aortic Surgery • Minimally Invasive Cardiac Surgery • Thoracic Surgery, Video Assisted Thoracic Surgery and Thoracic Plastic Surgery • Chronic Thromboembolic Pulmonary Hypertension Surgery Type of heart diseases and conditions treated in the department are: • Aorta-pulmonary window • Aberrant subclavian artery • Aneurysm • Aneurysm of atrial septum • Aneurysm of ventricle • Aneurysm of sinus of Valsalva • Aneurysmal dilatation of right ventricular outflow tract (RVOT) • Anomalies of the systemic venous connection (TAPVC, PAPVC) • Anomalous coronary artery • Aortic dissection • Aortic regurgitation • Aortic subvalvular stenosis • Aortic supravalvular stenosis • Aortic valvular stenosis • Atrial baffle contruction • Atrial septal defect (ASD) • Atrial-ventricular (A-V) canal defect • Bicuspid aortic valve • Coarctation of aorta • Common atrioventricular valve • Cor triatriatum • Coronary artery disease • Double aortic arch • Double outlet right ventricle • Ebstein's anomaly • Hemitruncus arteriosus • Hypertrophic obstructive cardiomyopathy (HOCM) • Hypoplastic pulmonary artery • Hypoplastic right ventricle • Left ventricular outflow obstruction • Malfunctioning valve prosthesis • Mitral regurgitation • Mitral stenosis • Patent ductus arteriosus • Pericardial cyst • Pericardial effusion • Pericarditis • Prosthetic valve endocarditis • Prosthetic valve stenosis • Pseudoaneurysm • Pulmonary artery obstruction/stenosis • Pulmonary atresia • Pulmonary insufficiency • Pulmonary stenosis • Pulmonary thromboembolism • Ruptured sinus of valsalva (RSOV) • Right ventricle-pulmonary outflow tract obstruction • Right ventricular outflow tract (RVOT) obstruction • Single ventricle • Subvalvular pulmonary stenosis • Superior vena cava syndrome • Supravalvular mitral ring • Taussig Bing anomaly • Tetralogy of Fallot • TOF — others • Transposition of the great vessels • Tricuspid atresia • Tricuspid insufficiency • Tricuspid stenosis • Truncus arteriosus • Tumors and masses • Two chamber right ventricle • Vascular ring • Ventricle to pulmonary artery conduit stenosis • Ventricular septal defect (VSD) Type of Neonatal and Paediatric Surgeries performed routinely in the department are: • Aortic valve repair/reconstruction and replacement • Aortic root enlargement • Arterial switch operation • Atrial baffle to reroute systemic venous and pulmonary venous return (Senning Procedure) • Atrioventricular Canal Defects (AV Canal) repair • Atrialized right ventricle placation (Repair of Ebstein’s Anomaly) • Atrial septal defect (ASD) repair, minimally-invasive • Atrial septectomy • Bidirectional Glenn • Blalock Taussig shunt • Central shunt • Closure atrioventricular fistula • Coarctation of the Aorta • Coronary Anomalies repair • Commissurotomy • Conal resection or ventricular septal defect enlargement • Conduit plication • Fontan procedure • Hemitruncus repair • Infundibular resection • Konno procedure • Lateral tunnel • Left ventricular outflow tract (LVOT) aneurysm repair • One and half ventricular repair • Partial Anomalous Pulmonary Venous Return (PAPVR) repair • Patent Ductus Arteriosus (PDA) closure • Primum ASD repair and mitral cleft repair • Pulmonary artery aneurysm repair • Pulmonary artery band • Pulmonary valve/pulmonary artery patch enlargement • Pulmonary valvotomy • Pulmonary valve monocusp repair • Right ventricular outflow tract (RVOT) reconstruction • Sinus venosus ASD repair • Subvalvular Aortic Stenosis Resection • Subclavian flap Aortoplasty • Supravalvular Aortic Stenosis Repair • Systemic to pulmonary artery shunt • Total Anomalous Pulmonary Venous Connection (TAPVC) repair • Tetrology of Fallot (TOF) total correction/intracardiac repair • TOF with LPA/RPA plasty • TOF with monocusp repair • Takeuchi operation • Transannular patch (Monocusp) • Vascular Rings repair • Ventricular Septal Defect repair (VSD closure) • Ventricular to pulmonary artery conduit The Adult cardiac surgical procedures performed routinely in the department: • Ascending aortic aneurysm repair with valved conduit • Ascending aortic and arch of aorta Dissection repair • Abdominal aortic aneurysm repair – Aortobifemoral bypass grafting • Aortic root enlargement • Aortic valve procedures o Aortic Valve Replacement • Prosthetic • Bio prosthetic o Aortic valve repair o Aortic valve thrombus/pannus removal • Atrial tumor excision • Brachial artery repair • Closure atriovenous fistula • Coronary artery bypass graft – Off and on pump CABG • David procedure • ECMO • Evacuation of pericardial effusion / haematoma • Left ventricular aneurysm repair • Maze procedure • Mitral valve procedures o Mitral valve annuloplasty o Mitral valve artificial chordae insertion (neochordae) o Mitral valve commissurotomy o Mitral valve perforation repair o Mitral valve perivalvular leak repair o Mitral valve quad/tri excision and repair o Mitral valve repair, minimally-invasive o Mitral valve replacement o Ligation of left atrial appendage • Pericardial cyst excision • Pericardial window • Pericardiectomy • Pulmonary embolectomy • Pulmonary valve procedures o Pulmonary valve repair and replacement • Superior vena cava (SVC) obstruction repair • Tricuspid valve procedures o Tricuspid valve annuloplasty o Tricuspid valve artificial chordae insertion o Tricuspid valve leaflet repair o Tricuspid valve reconstruction • Vegetation removal (endocarditis) • Ventricular aneurysm repair Vascular surgical condition /operation performed in the department are : • Ascending Aortic Aneurysm Repair (Bentall operation) • Abdominal Aortic Aneurysm Repair (AAA) • Aortoiliac Disease – Aortobifemoral graft • Brachial - Brachial Bypass. • Carotid Artery Disease, Carotid end arteriectomy • Deep Vein Thrombosis • Embolectomy • Peripheral Aneurysm Repair (Popliteal) • Peripheral Arterial Disease Femo-femoro Bypass surgery • Pulmonary Embolism • Thoraco- Abdominal Aneurysm Repair. General Thoracic surgical condition treated in the department are : • Chest Wall Tumors • Chest Wall Deformities (pectus excavatum, pectus carinatum) • Bronchiactesis - Lobectomy • Chylothorax • Chronic Empyema - Decortication • Foreign body removal • Lung Cancer – Pneumonectomy • Mediastinal Tumors (thymomas, myastenia gravis,neurofibroma, excision teratoma ect.) • Small, Indeterminate Lung Nodules - Lobectomy • Tracheal Stenosis repair
Academic Activities
The Department strives to provide the finest surgical patient care, education and research. The department provides residents, nursing staff and technical engineers a wide range of academic exposure to have a better perspective, develop superior skills and an ability to make informed judgment. This level of capability is attained through a program that offers extensive clinical exposure at every level of teaching and training. Clinical and basic research also is taken up to encourage those who are interested in adding this expertise to their academic development. Ongoing education is provided via regular classes, seminars, clinical conferences, journal clubs and Continuing Medical Education (CME) that serves to continuously develop the knowledge and skills of our medical professionals on an ongoing basis.

Conferences Organised:
1. Organized first Live Minimally Invasive Cardiac Surgery Workshop in the 3rd Annual Conference of Assam Cardiovascular Thoracic Surgeons’ Association held at Shillong on 2-3 October 2015. http://www.neigrihms.gov.in/Conferences,%20Seminar,workshop/LIVE%20WORKSHOP%20ON%20MINIMALLY%20INVASIVE%20CARDIAC%20SURGERY.pdf 2. Organized first “Vascular Surgery Workshop cum CME” in Northeast India in alliance with Association of Cardio-Vascular and Thoracic Surgeons of Assam (ACVTSA) on 10-11th November 2017. 3. Organized first Thoracic-Plastic Surgery Conference in Northeast India on 16 September 2019.
Projects in progress:
1. Intramural Research by Dr. J.P. Kalita titled “Role of Urinary and Blood Neutrophil Gelatinase Associated Lipocalin (NGAL) as novel biomarker for an accurate and early detection of Acute Kidney Injury (AKI) in patients undergoing Cardiac Surgery under Cardiopulmonary Bypass” – Completed 2. Intramural research by Dr. Reuben L Kynta titled: “Out of Pocket Expenditure (OOPE) for Super Speciality Surgical Treatment at a public sector tertiary hospital in Northeast India”-Completed 3. Intramural Research by Dr. Reuben L Kynta titled “Profile and Outcomes of patients of low flow low gradient severe mitral stenosis undergoing mitral valve replacement in Northeast India.” – Ongoing 4. Extramural Research by Dr. Reuben L Kynta titled- “Hospital Based Cardiovascular Disease Registry and Patterns of care for Heart failure in North-East Region of India (HBCVDR– NE).”- Ongoing 5. Extramural Research by Dr. Reuben L Kynta titled- “Design fabrication and testing of shock wave assisted needle-free drug delivery system’ in collaboration with Department of Mechanical Engineering, NIT Meghalaya- Ongoing 6. Intramural research by Dr. Reuben L Kynta Maternal and Foetal Outcomes among patients of Valvular Heart Disease: A Prospective Observational study from Meghalaya - Ongoing

Publications:
1. Devi LP, Kumar R, Kalita JP, Khonglah Y, Handique A. Locally Advanced Askin's Tumour in a Child-a Rare Case Report and Review of the Literature. Indian J Surg Oncol. 2015;6(3):288-291. doi:10.1007/s13193-015-0422-z 2. Karim HM, Saikia MK, Mitra JK, Medhi J. Impacted fish bone leading to rapidly growing common carotid artery pseudoaneurysm. Indian Journal of Vascular and Endovascular Surgery. 2015 Jan 1;2(1):35. 3. Chapter: “Lungs, Pleura and Chest Wall” Saikia M, Dutta R, Rathore YS, Chumber S. in Essentials of Surgery (2nd Edition). Dhawan IK, Chumber S, Gupta A editors. New Delhi: Jaypee Brothers Medical Publishers; 2016. 1287-1304 4. Kalita J, Saikia MK, Ahangar A et al. Fast Induction of Myocardial Arrest By Bolus Injection of Adenosine At Aortic Root in Patients With " Sick Heart " Undergoing Cardiac Surgery Enhances Myocardial Protection. International Journal of Scientific Research. 2016. 5. 69-117. 5. Malviya Amit, Jha Pravin, Kalita Jyoti, Saikia MK et al. Idiopathic dilatation of pulmonary artery: A review. Indian Heart Journal. 69. 10.1016/j.ihj.2016.07.009. 6. Kalita Jyoti, Saikia Manuj, Sarma Amitav et al. A rare case of Abnormal Connection of Right Inferior Pulmonary Vein to Right atrium with Intact Interatrial Septum. Scholars Journal of Applied Medical Sciences. 4. 1881-1883. 10.21276/sjams.2016.4.6.3. 7. Jyoti Prasad Kalita, Manuj Kumar Saikia, Md Yunus, Jaya Mishra, Reuben Lamiaki Kynta. Giant Thymoma from Ectopic Thymic Tissue in Children: A Case Report and Review of Literature. International Journal of Anatomy Radiology and Surgery. 2016:Jul- Sep:5(3):4-6 8. Karim Habib, Yunus Md, Saikia MK et al. Incidence and Progression of Cardiac Surgery-associated Acute Kidney Injury and its Relationship with Bypass and Cross Clamp Time. Annals of Cardiac Anaesthesia. 20. 22 - 27. 10.4103/0971-9784.197823. 9. Kalita Jyoti, Saikia Manuj, Yunus Mdet al. A Study On Cardiac Myxoma Of Population In North East India. Journal of Evidence Based Medicine and Healthcare. 3. 2561-2565. 10.18410/jebmh/2016/564. 10. Kalita JP, Alam I, Saikia MK. Magnesium supplementation improve outcome after cardiac surgery (International Journal of Medical and Health Research, Volume 4; Issue 4; April 2018; Page No. 22-25) 11. Alam I, Kalita JP, Saikia MK. Ischemic Mitral Regurgitation Repair: A Novel Technique (International Journal Of Scientific Research, Volume-7 \| Issue-4 \| April-2018 \| ISSN No 2277 - 8179 \| IF : 4.758 \| IC Value : 93.98) 12. Kalita JP, Saikia MK, Alam I. Optimal Electrolyte Management After Cardiac Surgery: A Retrospective Observational Study (Global Journal For Research Analysis, Volume-7, Issue-4, April-2018) 13. Kynta RL, Sun N, Saikia MK. Muscle flaps in pulmonary infections: a case series from Northeast India. Asian Cardiovascular and Thoracic Annals. 2020;28(8):488-494. doi:10.1177/0218492320949074 14. Kynta RL, Rawat S, Lyngdoh BS, Gunasekaran AK, Fanai V, Kapoor M, Joseph HT. Eustachian valve myxoma: a rare cause of Budd–Chiari syndrome. General Thoracic and Cardiovascular Surgery. 2021 Aug;69(8):1243-6. 15. Kynta RL, Rawat S, Mandal M, Saikia MK. Pulmonary Thromboendarterectomy Without Circulatory Arrest. Brazilian Journal of Cardiovascular Surgery. 2022 Feb 4.

Achievements:
1. First in Northeast India Extra Corporeal Membrane Oxygenation (ECMO) machine for artificial human circulatory support introduced and used successfully in complex cardiac surgery. https://timesofindia.indiatimes.com/city/guwahati/northeast-gets-advanced-life-support-system/articleshow/29834573.cms https://theshillongtimes.com/2014/02/01/neigrihms-cardiac-surgery-introduces-cutting-edge-life-saving-tech/ 2. First in Northeast India hybrid cardiac procedure performed for aortic aneurysm on a 50 year old man from Nagaland. https://theshillongtimes.com/2014/07/19/neigrihms-doctors-achieve-another-milestone/ 3. First in Northeast India ‘keyhole’ minimally invasive mitral valve replacement cardiac surgery performed on a 36 year old female from Assam. https://www.business-standard.com/article/pti-stories/neigrihms-doctors-perform-beating-heart-valve-replacement-115060300829_1.html https://health.economictimes.indiatimes.com/news/diagnostics/neigrihms-doctors-successfully-perform-beating-heart-valve-replacement/47529115 4. First in Northeast India pulmonary thromboendarterectomy surgery for chronic thromboembolic pulmonary hypertension performed on a 23 year old male from Assam. 5. First Patient from Gopalganj, Sylhet, Bangladesh operated in the department for Coronary artery Bypass Grafting (CABG) and discharged successfully in 2019. 6. First in Northeast India Thoracic-Plastic Surgery Services started to treat complex pulmonary infectious and cancer complications with thoracic-plastic surgical interventions. 7. First patient from Myanmar treated successfully for bomb blast injury related femoral artery pseudoaneurysm in 2022

Vision and Future Plan
The vision of the Department is to acquire and disseminate advancement of knowledge in the field of cardiac surgery with the aim to improve quality of care in the less developed North East Region of the country. To develop Human Resource in this field by opening Post-Doctoral Course such as MCh in CTVS and Perfusion Technology Course. To make the department as the destination of choice for advanced cardiothoracic surgical procedures. The department is actively pursuing in the field of Minimally Invasive Surgery with Robotics, Hybrid Operation Theater and adequately gearing up to acquire requisite facilities so that Cardiac Transplant will be possible in near future making it an International Destination for Cardiac Care.
Photo Gallery

WORLD HEART DAY CELEBRATIONS 2022	MINIMALLY INVASIVE MITRAL VALVE REPLACEMENT	CTVS EQUIPMENT

CTVS OT	CTVS ICU	ECMO MACHINE

DEPARTMENT OF CARDIO THORACIC VASCULAR SURGERY (CTVS)

Vision and Future Plan