Manipal Hospital Millers Road Organized a Novel Indo-African Cardiac Workshop

Bengaluru: In a first-of-its-kind in Bengaluru, a 2-day Indo-African workshop organized by Manipal Hospital Miller’s Road in association with Hridaya Vigyan Trust, explicitly engaged Interventional Cardiologists from the African continent in complex coronary procedures, on 14 and 15 October 2022 respectively.

Dr. Davinder Singh Chadha, Senior Consultant – Interventional Cardiology, Manipal Hospital Old Airport Road & Millers Road, directed the workshop and performed percutaneous coronary interventions (PCI) in complex coronary lesions such as Chronic Total Occlusion, Left Main Stenosis, Calcific Coronary Stenosis, etc.

The main highlight of the workshop was to showcase various tools and techniques that are used by cardiologists at Manipal Hospitals for complex PCI and guide cardiologists from the African region in the same.

During the workshop, PCI was done using plaque modification tools such as Rotational Atherectomy, intravascular lithotripsy, and scoring balloons under the guidance of intravascular imaging using sound-based (IVUS – intravascular ultrasound) and light-based (OCT – optical coherence tomography) imaging tools.

All patients were implanted with drug-eluting stents while one patient received a bioabsorbable stent. Interventional Cardiologists Dr. Kieran Mwazo – Coast General Teaching & Referral Hospital, Mombasa, Kenya, Dr. Mohsen Gaballa – M.P. Shah Hospital, Kenya, Dr. Hasham – Aga Khan University Hospital, Kenya, and Dr. Amha Weldehana – King Faizal Hospital, Rwanda came over to participate in the workshop in Bangalore.

The guided workshop entailed a total of 12 complex coronary cases after detailed pre-procedure planning in order to choose the best possible approach.

Dr. Davinder Singh Chadha, Senior Consultant – Interventional Cardiology, Manipal Hospital Old Airport Road & Millers Road, on talking about this novel approach, says, ”This workshop was essentially designed to showcase the complex technologies that we use to our African colleagues and simultaneously train them so that it can provide optimum results and improve patient care in their regions. I do these workshops every month from different parts of the country. This was the first time I engaged doctors outside of the country. At Manipal Hospitals, we have all kinds of tools that are required to produce optimal results available under one roof, which can be used in a given medical clinical situation and bring the maximum benefit to the patient.”

On the first day, there were cases of Chronic Total Occlusion (CTO), a high-risk procedure where completely occluded coronary arteries are opened using special tools.

Dr. Sunil Dwivedi, Consultant – Cardiology, Manipal Hospital Millers Road explained that the chances of rupture of the coronary vessel are very high while performing this PCI and all precautions need to be taken to prevent the same. Left Main Angioplasty involves PCI of the coronary segment which supplies the largest muscle mass and the patients undergoing this procedure are susceptible to sudden cardiac death while the procedure is being done.

Explaining this Dr. Girish Godbole, Consultant – Cardiology, Manipal Hospital Millers Road mentioned that these angioplasties are done always using imaging tools (IVUS, OCT) to ascertain the accurate size of the left main coronary artery as the same is not possible using angiography. Further post-stent implantation intravascular imaging demonstrates whether the stent is well expanded and apposed to the vessel wall; the sole criteria for good long-term results. Calcium deposition is frequently noted in the coronary arteries of Indians making stent implantation very difficult. Dr. Charit Bhograj, Consultant – Cardiology Manipal Hospital Millers Road while performing PCI of one such case highlighted the usage of intravascular lithotripsy (IVL) balloon. IVL using high-pressure acoustic waves cracks the calcium without damaging the surrounding vessel wall. This ensures restoration of vessel compliance leading to optimal stent expansion. Dr Praveen Kumar, Consultant – Cardiology, Manipal Hospital Millers Road performed PCI on a patient who had undergone coronary artery bypass surgery (CABG) in the past. The native coronary artery was stented using the left internal mammary artery as a conduit. This procedure is done rarely in cardiology practice and requires experience and additional tools. Most of the complex coronary procedures were performed using either radial or femoral arteries. The access site in patients undergoing PCI through the femoral artery was closed with a suture-based closure device to facilitate early ambulation and prevent groin complications.

Manipal hospitals have been a pioneer in using these techniques on a daily routine to treat patients coming from all over the world. With the help of this guided workshop, cardiologists from African nations will be able to use these procedures extensively and provide their patients with better care.