Лучшие больницы для «Heart Valve Repair» в Ченнаи, Индия

Heart valve disease affects an estimated 5 million people annually worldwide and encompasses a spectrum of pathologies including mitral valve prolapse, degenerative mitral regurgitation (Barlow's disease and fibroelastic deficiency), rheumatic mitral stenosis, bicuspid aortic valve disease, functional tricuspid regurgitation secondary to left-sided heart failure, and infective endocarditis sequelae. When a valve fails to open adequately (stenosis) or close competently (regurgitation/insufficiency), the resultant hemodynamic burden—pressure overload in stenosis, volume overload in regurgitation—progressively impairs myocardial contractility, induces ventricular remodeling, and culminates in symptomatic heart failure, atrial fibrillation, pulmonary hypertension, and increased mortality. Risk stratification prior to intervention employs validated scoring systems including the Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM) score and the EuroSCORE II, alongside comprehensive echocardiographic grading using the American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) guidelines.

• ELIGIBLE CANDIDATES:
• Patients with severe symptomatic degenerative mitral regurgitation (Stage D) due to posterior leaflet prolapse, anterior leaflet prolapse, bileaflet prolapse, or chordal rupture—the most surgically repairable etiology
• Patients with severe asymptomatic mitral regurgitation (Stage C) with preserved LVEF (>60%) and LVESD <40mm when repair durability is highly probable (>95%) at a Heart Valve Center of Excellence
• Patients with rheumatic mitral stenosis with favorable valve morphology (Wilkins score ≤8) who are candidates for open mitral commissurotomy or percutaneous mitral balloon commissurotomy (PMBC/Inoue technique)
• Patients with functional or secondary mitral regurgitation in the setting of heart failure (LVEF 20–50%) being considered for transcatheter edge-to-edge repair (TEER) using the MitraClip or PASCAL device when anatomically suitable (COAPT trial criteria: EROA ≥0.2 cm², optimized GDMT)
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SURGICAL VALVE REPAIR TECHNIQUES (Open Heart Surgery via Cardiopulmonary Bypass):

1. MITRAL VALVE REPAIR (Gold Standard for Degenerative MR):

• Posterior Leaflet Resection (Quadrangular or Triangular Resection): Carpentier's classic technique for P2 segment prolapse; the prolapsing segment is excised and the annulus is reapproximated with sliding annuloplasty to prevent systolic anterior motion (SAM).
• Artificial Chordoplasty (Neo-chordal Replacement): Expanded PTFE (Gore-Tex) sutures are used to reconstruct ruptured or elongated chordae tendineae; the 'loop technique' and 'chordal transfer' are validated methods with high durability; preferred for anterior leaflet and bileaflet prolapse.
• Annuloplasty Ring Implantation: A rigid, semi-rigid, or flexible annuloplasty ring (e.g., Carpentier-Edwards Physio II, St. Jude Medical Tailor ring, Medtronic Simulus) is sutured to the posterior annulus to remodel the dilated annulus and ensure repair durability; considered mandatory to accompany any leaflet repair to prevent recurrent annular dilation.
• Alfieri Edge-to-Edge Stitch: A suture technique creating a double-orifice valve; now more commonly replicated transcatheterly via TEER devices.
• Cleft Closure, Commissuroplasty: For specific congenital or rheumatic etiologies.

2. AORTIC VALVE REPAIR:

PRE-OPERATIVE PHASE (Days –14 to –1):

Step 1 — Remote Consultation & Case Review (2–4 weeks before travel):

Patients share all diagnostic reports (echo reports, cardiac catheterization films, CT/MRI images, ECGs, blood results) with GAF Healthcare's medical coordination team. A senior cardiac surgeon at the selected facility reviews the case and issues a detailed treatment plan including recommended surgical approach (open vs. minimally invasive vs. transcatheter), estimated STS/EuroSCORE II risk, and cost estimate. A video consultation with the operating surgeon is arranged.