Лучшие больницы для «Robotic Heart Bypass Surgery» в Хайдарабад, Индия

Coronary artery disease (CAD) occurs when atherosclerotic plaque progressively narrows or occludes the epicardial coronary arteries — most critically the left anterior descending (LAD), right coronary artery (RCA), and circumflex (Cx) — reducing oxygen delivery to the myocardium. When stenosis exceeds 70% in a major vessel, or 50% in the left main coronary artery, ischemia becomes hemodynamically significant, manifesting as stable angina, unstable angina, or frank myocardial infarction. Chronic myocardial ischemia progressively impairs left ventricular systolic and diastolic function, ultimately leading to heart failure, ventricular arrhythmias, and a substantially elevated risk of sudden cardiac death.

• IDEAL CANDIDATES:
• Patients with single-vessel or two-vessel CAD, particularly isolated LAD disease, who are not suitable for PCI due to vessel anatomy, lesion complexity (high SYNTAX score), or prior stent failure
• Patients with two-to-three vessel disease where at least one graft (typically LIMA-to-LAD) can be placed robotically, with a hybrid approach using PCI for additional vessels
• Patients with preserved or mildly reduced left ventricular ejection fraction (LVEF ≥ 35%) on echocardiography
• Patients with a low-to-moderate EuroSCORE II or STS Mortality Risk Score who are deemed high-risk for conventional open sternotomy (e.g., porcelain aorta, severe COPD, prior chest surgery)
• +18 more

Technique 1 — Totally Endoscopic Coronary Artery Bypass (TECAB, OFF-PUMP):

This is the most advanced iteration of robotic CABG. Using the da Vinci Xi system, the surgeon performs the entire operation endoscopically — LIMA harvest and coronary anastomosis — on the beating heart, with no cardiopulmonary bypass ('off-pump'). This eliminates bypass-related systemic inflammation, reduces aortic manipulation (lowering stroke risk), and is ideal for single-vessel LAD disease. Anastomosis is secured using a specialized endoscopic stabilizer (e.g., the Octopus Nuvo system) to immobilize the target vessel segment. TECAB off-pump is technically demanding and is performed at only a small number of high-volume centers globally, several of which are in India and the UAE.

TECHNIQUE 2 — TECAB ON-PUMP (Endoscopic, Arrested Heart):

The robotic dissection and anastomosis are performed endoscopically, but the heart is arrested using cardioplegia solution via peripheral cardiopulmonary bypass (femoral cannulation). This allows the surgeon to work in a still, bloodless field, making it suitable for patients with more complex coronary anatomy. It extends the applicability of TECAB to multivessel disease and cases where the coronary target is deep or heavily calcified.

PHASE 1 — PRE-TRAVEL CONSULTATION WITH GAF HEALTHCARE (2–4 weeks before travel): The patient submits existing cardiac investigation reports (coronary angiogram, ECHO, ECG, blood reports) to GAF Healthcare's medical coordination team. A GAF-assigned cardiac surgery specialist reviews the case and issues a formal Opinion Letter confirming robotic candidacy, estimated costs, and recommended hospital. GAF assists with e-Medical Visa application (India) or advance registration with the receiving facility (UAE). Current antiplatelet therapy (aspirin, clopidogrel, ticagrelor) and anticoagulants are reviewed — P2Y12 inhibitors are typically withheld 5–7 days pre-operatively.

PHASE 2 — ARRIVAL & PRE-OPERATIVE WORKUP (Days 1–3 in country): Upon arrival, the patient is admitted or assessed at the partner hospital's dedicated international patient lounge. A full pre-operative workup is completed within 24–48 hours: repeat ECHO, coronary CT or review of angiogram, PFTs, and a complete blood panel. The cardiac surgery team — including the robotic surgeon, cardiac anesthesiologist, and perfusionist — conducts a formal pre-operative consultation and consent process. A dedicated GAF patient coordinator assists with translation, family communication, and administrative formalities.

PHASE 3 — SURGICAL DAY (Day 3 or 4): The patient is taken to the Hybrid/Robotic Operating Suite. Anesthesia induction is followed by placement of a double-lumen endobronchial tube (for single-lung ventilation), a pulmonary artery catheter or PiCCO monitor, and intraoperative TEE probe. The da Vinci robotic system is docked. Operative time for TECAB single-vessel (LIMA-LAD) is approximately 2.5–4 hours; multi-vessel or hybrid procedures may take 4–6 hours. Vasopressors (norepinephrine, vasopressin) and inotropes (milrinone, dobutamine) are titrated in real time by the anesthesia team. On completion, intraoperative graft flow is assessed using transit-time flow measurement (TTFM) to confirm anastomotic patency before closure.