LECCE – Until recently, patients with concomitant heart diseases were considered to be at high risk of surgery and sometimes inoperable. Today there are innovative so-called “hybrid” procedures which, through a meticulous pre-operative study and a minimally invasive approach, reduce the risk and give good results.
This is the case of a 69-year-old operated at Città di Lecce Hospital, a high specialty hospital accredited with the national health service, where a hybrid procedure was performed, or a combination of different interventions in the same operating session.
This procedure was able to be carried out at the Gvm Care & Research hospital in Lecce where there is a hybrid operating room, one of the few in Puglia, which allows you to perform – in a single session – complex and multidisciplinary interventions that alternate in the field The Heart Team specialists are operative: a team made up of cardiac surgeons, hemodynamists, clinical cardiologists, cardio anesthetists who work in synergy to identify the best treatment option for each individual case.
The 69-year-old had a very complex clinical picture: in addition to severely obstructed carotids and a high risk factor for stroke, the patient was also suffering from severe aortic valve stenosis and coronary occlusion, resulting in an increased risk of developing a heart attack. . Diffuse atherosclerosis was associated with this, causing walking problems.
“Given the extremely compromised framework, we discussed the case at a multidisciplinary level to identify a procedure that combines curative and non-palliative resolution of the problems, minimizing the risks of the procedures – explains Dr. Giuseppe Santarpino, co-head of the operational unit of Cardiac Surgery of the City of Lecce Hospital -. We intervened with a carotid stent with the patient awake, followed by a combined cardiac surgery to replace the damaged valve and bypass ”.
The multidisciplinary team therefore intervened following a step-by-step program, outlined together with the Heart Team. For the first part, an endovascular approach was adopted, without surgical cutting; through catheters the blocked vessel that carries blood to the brain was reopened and a stent was then inserted into the carotid artery. The patient was awake, constantly monitored in order to check that there were no ischemic problems and brain complications. During the same operating session, the patient was then fell asleep under general anesthesia to replace the stenotic valve with a biological prosthesis and perform an aortocoronary bypass.
“This procedure has proved extremely effective – says Dr. Santarpino -. The patient was taken to the ICU after surgery and was breathing autonomously after a few hours. On the second postoperative day he was transferred to the ward and discharged three days later. There will now be a reduced convalescence phase thanks to the hybrid procedure. The patient must continue to take the drug therapy, antiplatelet agents, must maintain a low cholesterol level and undergo periodic checks “.
Among the doctors who have allowed the success of the operation are Professor Giuseppe Speziale, coordinator of Cardiac Surgery of Gvm Care & Research, Doctor Luigi Specchia, Head of Cardiac Surgery Department, Doctor Kia Vaziri, Head of Cardiology, Doctor Marcello Melone, head of the Anesthesia and Intensive Care Department, at Città di Lecce Hospital, and Dr. Flavio Fiore, head of the Anesthesia and Intensive Care Departments at Anthea Hospital in Bari.
“The presence of a Heart Team is now part of the European and international guidelines – comments Dr. Mirror -. The collegial discussion between specialists is a concept that has revolutionized the way of managing the patient, who thus enjoys greater advantages, such as the possibility of a complete treatment, from diagnosis to follow up passing through treatment, with a path followed by different figures who all contribute to his health. For several years now, here in Città di Lecce Hospital we have met every morning to discuss the most complex cases. All this helps us to make the right decision, that is to choose and adapt the best strategy for the individual patient “.
The collaboration with the territorial hospitals with which the City of Lecce Hospital works in synergy to respond to the health needs of Salento patients also continues to be fundamental.
“The Salento cardiology network is a strong point of the territory and allows us to provide an efficient and quality response. Everything is based on collaboration, on professional exchange but above all on a strong sharing in the treatment path to give a prompt response to the patient’s clinical problem “says Dr. Michele Accogli, director of the complex cardiology facility of the hospital” Cardinal Giovanni Panic ”Tricase and cardiologist of the 69-year-old patient then operated on by the multidisciplinary team of the City of Lecce Hospital.
“The will is to give a unified service to the population of Salento in relation to cardiac surgery. The patient must be at the center of our work and so we organize the agendas of the local hospitals in order to always have a specialist team for emergencies. And I would like to underline the quality of the healthcare offer we have here in Puglia: the data show it, citizens know they can find excellence even in their territory without turning to structures in the North. At Città di Lecce Hospital, for example, we perform about two thirds of the cardiac surgery in Salento and the Agenas data confirm the excellent results ”concludes Dr. Specchia.