INTERNATIONAL PATIENTS

KEY PROCEDURES
Bone Marrow Transplant – BMT
Cochlear Implant

Loss of hearing or congenitally hearing impaired patients can have a simple solution to their problem. At Narayana Health's Bangalore campus, cochlear implants are routinely done for those who have become deaf or hard of hearing due to various reasons. Cochlear Implants transform speech and other sounds into electrical energy that is used to stimulate hearing nerves in the inner ear.

This implant has both internal and external components consisting of an external speech processor, headset (worn behind the ear) and a surgically implanted receiver/stimulator package with an electrode array in the skull. Through a surgery an electronic device is fitted in the ear. It does the function of damaged parts in the inner ear and sends signals to the brain.

How the device works

  • The external sound processor captures, filters and processes sounds.
  • The sound processor translates filtered sounds into digital information which is transmitted to internal part of the implant system
  • The internal implant converts digital information into electrical signals and sends them to tiny delicate curls of electrodesthat are placed inside the cochlea
  • Electrical signals from the electrodes stimulate the hearing nerve. It bypasses damaged cells and allows the brain to perceive sound.

Prospective patients who may need cochlear implant first meet an audiologist and ENT surgeon. A number of preliminary tests are done including audiological evaluation to ascertain the level of hearing loss, speech therapist assessment and trial with hearing aids. Thereafter, the patient is cleared for a cochlear implant.

The surgery lasts about 2 hours and is performed under General Anaesthesia. An electrode array is inserted into the cochlea while the receiver / stimulator is secured in the skull. Typically, patients stay in the hospital for 4 days and within a week they can return to normal routine. But the patient requires 3 more weeks to go through the entire rehabilitation process.

Activation of the implant takes place within 2-3 weeks after the surgery, allowing sufficient time for the incision to heal well. Mapping the implant is done on a routine basis during post-operative rehabilitation. This helps in fine tuning the processor and getting best performance, as patients begin to get used to hearing with the implant.

We provide rehabilitation therapy which is necessary to maximize benefit from the implant. This is called Auditory Verbal therapy (AVT). In AVT the patient is taught how to listen with the implant, how to understand speech and talk. Learning to listen takes time and requires family and speech therapist's support during the initial 3 weeks period.

Kidney Transplant

As an individual's kidneys begin to stop functioning to its optimum capacity, then three options of reversing this problem are followed: hemodialysis, peritoneal dialysis and kidney transplant. Many nephrologists believe that a successful kidney transplant provides a better quality of life because it takes away the issues related to dialysis hence allowing greater freedom. Before arriving at a decision about which treatment is best for you, it will help to talk discuss with other patients who have had a kidney transplant. You also need to consult your doctor, nurse and family members.

A kidney transplant is a procedure performed to replace non-functioning kidneys with a healthy kidney from another living donor maybe related or not.

Liver Transplant

Through a liver transplant surgery a diseased liver is replace with a healthy liver from donor not necessarily related. Many people have had liver transplants and now lead normal lives. One of the most common factors for liver transplant is cirrhosis caused by healthy liver cells being replaced with scar tissues.

INDICATIONS FOR LIVER TRANSPLANT INCLUDE:
  • Hepatitis B
  • Hepatitis C
  • Alcohol induced cirrhosis
  • Autoimmune Hepatitis
  • Liver tumors
Joint/Knee Replacement

Joint Replacement is a surgery that allows total relief from pain and improved quality of life for patient suffering from painful joints. There may be many reasons for requiring a knee replacement but most common cause is arthritis, a debilitating disease. In early stages, medicines, physiotherapy, splints, diathermy, weight reduction can control pain but since this is a degenerative disorder it cannot be cured completely.

In modern total knee replacement surgery, only the worn out cartilage surfaces of the joint are replaced. The operation is basically a resurfacing (or "retread") procedure. On resurfaced area, hip or knee joints made up of specialized alloy metal and ultra high density polyethylene (UHDP) plastic is placed. It can be fixed with or without cement.

One could consider a joint replacement surgery when a person is debilitated due to

a. recurrent pain in joint that requires regular ingestion of pain killers and no pain relief

b. pain limiting social activities and daily routine,

c. instability or fear of falling down while walking.

d. Stiffness with loss of range of motion.

 

Preparing for the surgery

 

The patient is thoroughly evaluated & investigated to check fitness to undergo surgery. Once fit, patient is admitted a day prior to the surgery. Stay at the hospital after surgery is for 5-7 days.

 

A 6 inch incision is made in front of the knee. The knee joint is opened and damaged cartilage and bone are removed. It is replaced with metal surface on thigh bone and UDHP plastic on leg bone. These surfaces are fixed to bone with bone cement. Muscled and ligaments are stitched back. Operation lasts for about 2 hours.

 

Usually spinal or epidural anesthesia is used, which anaesthetizes the lower body. There is no pain during the operation. After surgery, epidural is used as patient controlled analgesia, with remarkable pain relief. Multiple monitors are used for 24-48 hours in recovery.

 

Movements of the joints are started day after surgery with some support. By the time of discharge, the patient is independent to move from bed to toilets and within their room with support of walker / frame. The patient is followed up to one month, three months and then every year to assess the joint function.

 

With prudent use of cement total knee replacement lasts for approximately 15 years. TKR/THR surgery is designed to provide painless joint and unlimited standing, sitting, walking and other activities related to daily living. One needs to do regular exercises, weight reduction and annual review with the surgeon.

 

Walking, climbing up and down stairs, driving, and swimming are possible without pain. A person can play golf and go bicycling. There are joints which allow sitting cross legged but routine squatting, sitting cross legged is discouraged so is jogging.

 

a. Infection: Extreme precaution is taken to avoid this complication. Such as strict OT protocol, patient preparation, OT equipped with modern equipments like laminar air flow, space suits, use of broad spectrum antibiotics. With all aseptic precautions, less than 1% patients develop infection in joints.

 

b. Thrombosis: Clotting of blood in lower limb veins can occur in 5- 6 % of patients. If these occur it can be treated by blood thinning agents and a little longer hospitalization.

 

c. Wear, loosening of joint: Prolonged use can cause loosening and wear and tear of artificial joint. This usually happens over 10-15 years. If it happens, the joint can be changed and patient becomes active once again.

 

Joint Replacement surgery is usually an elective surgery and should be done without waiting for total deterioration.

 

The drastic change this surgery produces in Physical quality life index (PQLI) of patients make it one of the most satisfying procedures.

CABG & Redo Coronary Artery Bypass Grafting

Studies have shown that Indians are genetically three times more prone than Europeans in getting cardiac attacks. Maybe a coincidence but the family’s breadwinner is usually the patient. At NH 60% of surgeries carried out are coronary artery bypass grafting and redo coronary artery by pass grafting.

Having carried out over 13,000 coronary bypass grafting and redo coronary artery bypass grafting operations, the team of experts at NH are most experienced when it comes down to performing CABG, redo CABG's and mainly coronary artery bypass grafting on a beating heart without the assistance of heart lung machine. Our cardiac surgeons usually complete arterial graft using internal mammary artery and radial arteries.

Left Ventricular Assisted Device (LVAD)

Due to a cardiac seizure, the heart becomes weak and can't maintain adequate blood flow to meet an individual’s body requirement. Normally a patient is barely able walk or talk or even lie down flat. Patients who have reached the terminal stages patients are recommended to undergo an LVAD implantation. It is a small battery operated pumping device that runs on rechargeable batteries. The pump is implanted in the thoracic region just below the heart, while the batteries are outside. Once implanted it takes over the entire blood pumping function of the heart and the patient gets a new lease of life with few restrictions. It can be used either as a "Bridge to Transplant" that is to keep the patient well until a heart is available for transplantation or as "Destination therapy" that is as a permanent solution in patients not suitable for transplant. Narayana Institute of Cardiac Sciences in Bangalore (erstwhile Narayana Hrudayalaya) was the first center in India to offer this treatment.

Dors Procedure

Following a myocardial infarction or heart attack, the area of infarction often leaves behind by a nonfunctional scar. This can lead to a dilatation of the heart over a period of time and change its shape from a normal elliptical one to a globular one resulting in reduction of heart function and can lead to heart failure. By an operation called Linear Endoventricular Patch plasty or commonly called Modified Dor's procedure the elliptical shape of the heart is restored, thus restoring its normal pump function. This procedure is done in isolation or along with the routine CABG. This procedure has been pioneered by surgeons at Narayana Health and has become a well accepted one, the world over. In fact this modification is considered to be better than the original Dor's procedure. Surgeons at NH have aced this procedure after performing it on a large number of patients.

Valve Repairs

Operations on valves are one of the most common Cardiac surgeries. Rheumatic heart disease is often cause of valve problems in India and many developing countries. Replacement with artificial valves is a very simple procedure but is associated with its own set of problems some of these life threatening. To avoid such problems Valve repair techniques have been devised. However the valve problems in Rheumatic heart disease are very complex. Surgeons at Narayana Health have mastered the Valve repair techniques and perform very complex repairs on these patients, thus saving many from the problems associated with Valve Replacements. NH is considered a center of excellence for valve repairs and a large number of these are done every year.

The Ross Procedure

The Ross Procedure, also known as Pulmonary valve translocation, was developed by Donald Ross in 1967.This operation uses the patient’s own pulmonary valve and part of the main pulmonary artery as a unit to replace the aortic valve and ascending aorta. A homograft valve is harvested from a cadaver, is then placed in the pulmonary position. The pulmonary valve is identical in shape, size, and in fact stronger than the aortic valve and is therefore an ideal replacement for the diseased aortic valve. Narayana Health has a full fledged functioning homograft heart valve bank for the benefit of the needy patients. NH surgeons have expertise in successful valve replacements using homografts and Ross operations having performed about 100 such procedures with excellent results. These operations are being done only in very few centres in our country. Workshops to teach other cardiac surgeons are regularly conducted. We are also perhaps one of the most experienced surgeons in the World in performing operations like Bental Procedure for Aortic Aneurysm and Aortic Arch replacement surgery for dissecting Aneurysm of Aorta.

NH offers all its patients a comprehensive package that includes diagnosis, treatment and rehabilitation. Following a transparent policy of first briefing the patient’s family is perhaps the contributing factor to total trust.