Cardiovascular Hybrid OR Suite

Cardiovascular Hybrid OR Suite

Mount Elizabeth Novena Hospital is proud to introduce its cardiovascular Hybrid OR Suite. It has the first in Asia, Philips Allura Xper FD20 Flexmove Xray imaging system in combination with a real OR table, which provides significant advantages in the treatment of patients requiring complex cardiovascular procedures that involves both conventional surgery and image-guided intervention. In this respect It is also the first private Hybrid OR Suite in Singapore.

What is a cardiovascular Hybrid OR Suite?

A cardiovascular Hybrid OR Suite is an advanced operating room equipped with a fully functional catheterisation lab that allows for both full surgical procedures and catheter based intervention to be carried out on the same patient and in the same place.

 

Traditionally the catheter-based interventions are done in a cardiac catheterisation suite and the surgical procedures are separately done in an operation theatre. The Hybrid OR Suite therefore provides a place that will allow for the best available combination of the above therapies for treatment of cardiovascular disease. The multi discipline, integrated cardiovascular procedures suite bring together the best of 2 worlds by combining all the advantages of a modern cath lab with an up-to-date cardiovascular surgical operating theatre.

What are the benefits of the cardiovascular Hybrid OR Suite?

The following benefits can be derived from the cardiovascular Hybrid OR Suite and they are:

1. Minimally invasive surgery together with catheter-based image-guided intervention in the Hybrid OR Suite will allow for a safe and sterile environment and also allow a fully-integrated heart team comprising of interventional cardiologist, cardiac and vascular surgeons and anaesthetists backed by a full set of supporting staff to achieve better outcome and reduce operative mortality and morbidity and also reduction of major complications. The minimal invasive surgery also eliminates the need for big surgical openings and subsequent scars.
2. Very high risk patients previously deemed unsuitable for surgical or catheter-based intervention especially the elderly patients with more complex heart and valvular diseases can now have these procedures done safely, as in case of complications, a conversion from cathether based intervention to full surgery is possible in the same room.
3. Improved speed of recovery
4. Saves time and money

What type of procedures can be done in the cardiovascular Hybrid OR Suites?

Often, aortic aneurysms are coincidentally diagnosed during a routine check up or a medical examination for some other reason. Once you are suspected with an aneurysm, your doctor will have to determine the location of the aneurysm, how fast it is growing and how serious the condition is.

1. Emergency conversion of a catheterbased coronary intervention to a bypass operation for very high risk patients (e.g. acute myocardial infarction). A Hybrid OR Suite will allow the cardiologist to quickly convert from a catheter-based intervention to an open-heart bypass surgery if the need arises. This is potentially life-saving as time is of the essence especially in a very ill patient as his or her condition can deteriorate rapidly while waiting and being transferred to the operating theatre for an emergency bypass operation. The patient-centric set up in the Hybrid OR Suite eliminates hassles of moving the patient to another operating theatre which may compromise the patient. Such condition includes acute intervention in a heart attack, difficult angioplasty of complex coronary artery disease with potential failure and high risk of complications resulting in compromisation of the cardiac function.
   
2. Hybrid coronary revascularization - minimally invasive coronary bypass surgery combined with catheter-based coronary intervention in complex multi-vessel coronary artery disease. In this situation, the patient with complex multi-vessel disease can undergo a minimal invasive roboticassisted coronary artery bypass surgery with a small incision made on the left side of the chest to allow for bypass of the left anterior descending artery (which is the main life line of the heart) followed by the deployment of coronary stents to the rest of the other remaining blood vessels. This combination will reduce the operation time, improve safety and outcome and also allow for a faster recovery with a shorter stay in the hospital. The usual hospitalisation stay for full open coronary artery bypass surgery can be anything between 7 to 10 days, whereas for this hybrid procedure, within 4 to 5 days, the patient can be discharged from the hospital. They are 7 times more likely to return to work within 1 month insteadof the usual 3 months for a standard coronary bypass surgery.
   
3. Intraoperative coronary graft assessment. Early occlusion can occur after coronary artery bypass grafting. Frequency of immediate graft closure rate is between 5 to 12% and a 1-year closure rate of 20 – 30%. Intraoperative coronary angiography offers the “gold standard” option for immediate graft assessment. The detection of immediate graft closure allows the surgeon to revise the graft immediately.
   
4. Hybrid valve surgery. Transcatheter aortic valve replacement is fast becoming one of the leading cuttingedge technology for the treatment of high risk elderly patient with narrowing of the aortic valve which may preclude them from open-heart valve replacement. The procedure is called TAVI i.e. Transcatheter Aortic Valve Implantation (see later section). This is even more relevant when the patient has concomitant coronary artery disease that requires revascularization which can be done more safely at the same time.
   
5. Hybrid endovascular stenting for aortic aneurysm repair which involves the placement of a covered stent within an enlarged aortic aneurysm sac to exclude the blood flow and to prevent fatal rupture. Endovascular stenting has emerged as an alternative to open repair in patients requiring surgery for thoracic aortic aneurysm, dissections, trauma and other pathology. Endovascular stent grafting improves perioperative mortality and neurological complications.
   
6. Hybrid surgical and catheter atrial fibrillation ablation. Atrial fibrilaltion is an abnormal rhythm condition where the upper chamber of the heart instead of contracting, fibrillates. The potential risk of such an abnormal rhythm is stroke which may be as high as 50% to 70% in the elderly aged group. One of the ways to deal with this is to treat the patient with blood-thinning medications but this potentially may cause bleeding especially in the brain and stomach. The ability to perform a surgical and catheter AF ablation to eliminate the mechanisms causing the abnormal rhythm may potentially result in the ability to prevent patient from going into this abnormal rhythm and therefore prevent stroke. The success rate with this combination therapy is better than both as standalone procedures.
   
7. Endovascular limb salvage. Peripheral arterial disease (PAD) is increasingly being recognised in the Asian population especially associated with long-standing diabetes mellitus, hypertension and high cholesterol. Severe PAD of the lower limbs can lead to calf pain on walking or rest and gangrene needing limb amputation. Combining surgical bypass and endovascular therapy can improve blood supply to the limb resulting in limb salvage yet ensuring safety and outcome.
   
8. Hybrid therapy for congenital heart disease. Difficult and complex congenital heart anatomies can be undertaken combining intervention and surgery into a single therapeutic procedure resulting in reduction of complexity, cardiopulmonary bypass time, risk and improved outcomes.
   
9. Pacemaker and ICD implantation. Pacemaker and implantable cardioverter defibrillator (ICD) can be optimally implanted in the Hybrid OR Suite because of the more sophisticated imaging system that offers superior angulation and imaging capabilities yet maintaining higher sterile standards compared to the normal cath lab.
   

10.  Interdisciplinary use. Neurointervention using the Brain Lab software allow for integration of intra-operative angiography and image-guided surgery (IGS). Image-guided intraoperative angiography can enhance both neurosurgery and spinal surgery.

The cardiovascular Hybrid OR Suite brings together the best of two worlds by combining all the advantages of a modern cath lab with the advanced high definition imaging system and the most up-to-date cardiovascular surgery operation theatre. It is the place where the future of cardiovascular treatment is realised now! http://www.phvc.sg/cardiovascular-hybrid-or-suite.html

Congenital Heart Disease

Congenital Heart Disease

Congenital heart disease refers to a range of heart defects that are present at birth, wherein there is a malformation in one or more structures of the heart or blood vessels.

These defects may involve the interior walls of the heart, the valves inside the heart, and the arteries and veins that carry blood to the heart or the body. Congenital heart defects can affect 8 out of every 1,000 children and causes more deaths in the first year of life than any other birth defects.

Risk Factors

Aortic aneurysm can develop in anyone, but males over 60 years old have a higher risk of developing the condition. Other risk factors include high blood pressure, smoking, family history, high cholesterol, emphysema, and obesity.

Symptoms

Most often, there is no known cause for congenital heart disease.  However, there are some factors that are associated with an increased risk of getting congenital heart disease. Family history plays a part. The risk of having a child with congenital heart disease is higher if a parent has a congenital heart defect; Down syndrome; taking certain medications, such as retinoic acid for acne, or alcohol or drug abuse during pregnancy; maternal viral infection, such as German measles, in the first trimester of pregnancy; and poorly managed blood sugar in women who have diabetes during pregnancy.

Diagnosis

In unborn child, most congenital heart diseases are diagnosed during a routine pregnancy ultrasound. When this happens, a paediatric heart doctor should be present when the baby is delivered.

In adults, congenital heart disease is often diagnosed when your doctor hears an abnormal heart sound when listening to your heart. The doctor may request for further screening such as chest X-ray, electrocardiogram (ECG), echocardiogram or transesophageal echocardiogram (TEE), cardiac catheterization, and MRI.

Treatment

Treatment of congenital heart disease is usually based on the severity of the condition. Some are not serious, can be treated with medication alone, and can heal over time. Others require surgery, catheterisation or transplant to repair the defects. Children and adults with congenital heart disease should be treated and monitored by a heart specialist throughout their lives to prevent complications.

Medications commonly prescribed to people with congenital heart defects include angiotensin-converting enzyme (ACE) inhibitors to block the enzyme in the body that causes blood vessels to constrict, antiarrhythmics to regulate the heart rhythm, antibiotics to prevent endocarditis, anticoagulants to reduce the blood clots, beta-blockers to slow the heartbeat and lower blood pressure, digoxin to improve the squeezing strength of the heart, diuretics to reduce the amount of water and salt in the body, and vasodilators to relax the muscles of the blood vessels.

Heart disease symptoms are common among diabetics. Parkway Heart & Vascular Center's cardiologists possess global expertise in heart disease treatment. http://www.phvc.sg/congenital-heart-disease.html

Diabetic Heart Disease

Diabetic Heart Disease

Diabetic heart disease refers to heart disease that develops in people who have diabetes. Diabetes is a chronic medical condition characterised by high levels of sugar in the blood.

Diabetes causes injury to the arteries, making them more susceptible to damage from hypertension and atherosclerosis. People with diabetes are 2 to 4 times more likely to develop cardiovascular disease than people without diabetes. In diabetics, the linings of the blood vessels may become thicker, making it difficult for blood to pass through the vessels.

Cardiovascular disease is also the leading cause of early death among people with diabetes (65%).

Risk Factors

Smoking, alcohol, unhealthy diet, genetics and a sedentary lifestyle are among the major risk factors of developing diabetes.

Although it is more common in the elderly, serious cardiovascular disease may develop in people with diabetes who are even younger than 30. Both type 1 and type 2 diabetics are at greater risk of developing heart disease. Diabetics are disadvantaged by lower success rate in some heart disease treatments, such as coronary artery bypass grafting and angioplasty.

Symptoms

Since diabetes affects the nerves, some people with diabetes suffer from “silent” heart attacks, or without experiencing any pain. These silent heart attacks are not commonly diagnosed during a routine medical check-up.

When a person already suffered from a silent heart attack, he has a higher risk of having another more serious heart attack. Other symptoms include chest pain, shortness of breath, discomfort or pain in the back, arms, neck or stomach, lightheadedness, sweating, nausea, anxiety, and extreme weakness.

Diagnosis

Just like any other heart disease, diabetic heart disease is diagnosed based on symptoms, medical and family histories, a physical examination and several tests.

No single test can diagnose diabetic heart disease, so your doctor may recommend some of the following tests: blood tests, chest X-ray, electrocardiogram (ECG), echocardiography, stress test and urinalysis.

Treatment

Diabetic heart disease can be controlled by making some necessary lifestyle changes and taking prescribed medications. Exercise and other physical activities can lower your blood pressure, help control your weight and blood sugar level, and reduce stress. Keeping your blood sugar, blood pressure, and blood cholesterol within the recommended level can help prevent blockage of the blood vessels in your arteries.

To help prevent stroke or heart failure, diabetics are advised to strictly follow their treatment plan. A diet that is low in sodium and cholesterol is highly recommended.

A diet of lean meat, low-fat milk, poultry, fish and fruits is recommended. Smoking is one of the major risk factors associated with heart attack and stroke so smokers should quit the habit. Also limit the consumption of alcohol.

Heart disease symptoms are common among diabetics. Parkway Heart & Vascular Center's cardiologists possess global expertise in heart disease treatment. http://www.phvc.sg/diabetic-heart-disease.html

Heart Attack

Heart Attack

Heart attack is one of the leading causes of death in the world. In Singapore, it is the second killer disease after cancer. A heart attack occurs when blood flow to a part of your heart is blocked for a long enough time and the heart muscle is damaged or dies.

Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. If the blood flow is blocked, oxygen is unable to travel to the heart, which will affect its function critically. 

The most common cause of heart attack is atherosclerosis (narrowing of the artery due to build-up of cholesterol). Plaque, a substance made up of cholesterol and other cells, can build up in the coronary artery, and causing it to be blocked or narrowed. A heart attack can occur as a result of plaque buildup. 

However, the trigger for a heart attack is not predictable. Heart attacks may occur:

• When you are resting or asleep
• After a sudden increase in physical activity
• When you are active outside in cold weather
• After sudden, severe emotional or physical stress, including an illness

Symptoms
Chest pain is the most common symptom of a heart attack. You may feel the pain in only one part of your body, or it may move from your chest to your arms, shoulder, neck, teeth, jaw, belly area, or the back. The pain can be severe or mild. It can feel like:

• When you are resting or asleep
• After a sudden increase in physical activity
• When you are active outside in cold weather
• After sudden, severe emotional or physical stress, including an illness

The pain usually lasts longer than 20 minutes. Other symptoms of a heart attack include:

• Anxiety
• Cough
• Fainting
• Light-headedness, dizziness
• Nausea or vomiting
• Palpitations (feeling like your heart is beating too fast or irregularly)
• Shortness of breath
• Sweating, which may be very heavy

Some people (the elderly, people with diabetes, and women) may have little or no chest pain. Or, they may have unusual symptoms (shortness of breath, fatigue, and weakness). A “silent heart attack” is a heart attack with no symptoms.

Symptoms
A doctor or nurse will perform a physical exam and listen to your chest using a stethoscope. The doctor may hear abnormal sounds in your lungs (called crackles), a heart murmur, or other abnormal sounds.

A troponin blood test can show if you have heart tissue damage. 

However, the diagnosis is often based on an electrocardiogram (ECG). Coronary angiography is often done right away once a heart attack is confirmed on ECG. 

This test uses a special dye and x-rays to see how blood flows through your heart. It can help your doctor decide which treatments you need next, such as angioplasty (see below). Other tests to look at your heart that may be done while you are in the hospital include Echocardiography and Exercise stress test.

Treatment
Emergency treatment is needed when a heart attack occurs. You will be hooked up to a heart monitor so the health care team can look at how your heart is beating. The health care team will give you oxygen so that your heart does not have to work as hard and medicine including morphine to ease the pain. These are given via an intravenous line (IV) that will be placed into one of your veins.

Angioplasty is often the first choice of treatment for heart attacks. It should be done within 90 minutes after you get to the hospital, and no later than 12 hours after a heart attack. It is a procedure to open narrowed or blocked blood vessels that supply blood to the heart and is carried out immediately after coronary angiography. Usually a small, metal mesh tube called a coronary stent is placed at the same time This helps prevent the artery from closing up again. 

Alternatively, you may be given drugs to break up the clot. It is best if these drugs are given within three hours of when you first felt the chest pain. This is called thrombolytic therapy.

 

Heart attack is one of the leading causes of death in the world. Parkway Heart & Vascular Centre can diagnose heart attack symptoms before it's too late. http://www.phvc.sg/heart-attack.html

vascular disease

 What are Cardiovascular Diseases?

The World Health Organisation Fact Sheet January 2011 has stated that cardiovascular diseases (CVDs) are the number one cause of death globally. More people die annually from cardiovascular diseases then from any other causes. There is an estimated 17.1 million people who died from cardiovascular diseases in 2004, representing 29% of all global deaths. In other words, one in three deaths was attributable to cardiovascular diseases. Of these deaths, an estimated 7.2 million (42%) was due to coronary artery disease and 5.7 million (34%) was due to stroke.

Many people think that cardiovascular disease is just a heart attack. This is a misconception. The term “cardiovascular diseases” encompasses a group of medical conditions that affect the heart and the blood vessels of the human body including the brain, arms and legs.

In Singapore, by far the most common cardiovascular diseases are coronary heart disease and cerebrovascular disease (stroke). Blockages of the coronary arteries will lead to heart attack and blockages of the blood vessels to the brain will result in stroke. 

In Summary
It is important to note that heart diseases include a whole range of heart conditions. Heart attack and stroke are preventable and it begins with lifestyle changes that include a healthy diet, regular physical exercise, avoiding tobacco smoking and stress management. A healthy diet should include choosing diet that is rich in vegetables, fruits, oat, wheat and bran and avoiding foods that contain high fats, trans fats, cholesterol, sugar (carbohydrates) and salts. Reduction in calories to maintain a healthy body weight is also important. Regular exercise program to burn off the excess calories will have significant benefits. Avoid tobacco smoking and also avoid areas where are other people smoking (i.e “second-hand smoking”).

Cardiovascular risk factors screening programs are widely available in Singapore and you should undergo a cardiovascular screening program. You may use the following checklist as a guide to access if one is in the high risk group.

Medical History 

• Previous history of heart attack
• Established coronary artery disease
• Prior history of recgnition of a heart murmur
• History of syncope (fainting spells)

Family History

• Family history of sudden death, i.e. Family history of premature deaths that are sudden or unecpected before the age of 50 years old due to heart disease in ≥ 1 relative
• Family history of premature coronary artery disease

Coronary Risk Factors

• High blood pressure
• Diabetes mellitus
• Overweight — obesity
• Smoking
• Excessive drinking
• High cholesterol

Symptoms

• Exertional chest pain / discomfort
• Excessive exertional / unexplained breathlessness
  and fatigue associated with exercise
• Unexplained fainting or near-fainting episodes
• Swelling of the legs

Cardiovascular diseases are the #1 cause of death. Parkway Heart & Vascular Centre can diagnose your vascular disease & heart disease symptoms before it's too late. http://www.phvc.sg/heart-diseases.html

Cardio and vascular

Why is Cardiovascular (Heart) 

Risk Screening Important?

The rationale for an active approach to the prevention of cardiovascular diseases is firmly based on five observations (modified from European Guidelines on CVD Prevention in Clinical Practice, 2003, 2007):

1. CVD is the major cause of premature death in most developed countries worldwide.  It is an important source of disability and continues to escalate healthcare cost.
2. The underlying cause in atherosclerosis (cholesterol deposition in the arteries that supply the heart and brain) which develops insidiously over many years and is usually advanced by the time symptoms occur.
3. Heart attack, stroke and death frequently occur suddenly without warning and before medical care is available and many advanced therapeutic interventions are therefore not applicable or at best palliative.
4. CVD relates strongly to lifestyle and modifiable risk factors. Cardiovascular disease begins with lifestyle factors such as smoking, physical inactivity and unhealthy diet. With these factors, the heart and blood vessels supplying the major body organs and limbs are damaged and one develops high-risk disease such as high blood pressure, diabetes, high lipid levels and obesity. Left unchecked, these high-risk diseases result in severe damage to the heart and various organs over time and eventually, will result in death.
5. Cardiovascular risk factor modifications have been unquestionably shown to reduce death and adverse outcomes especially in people with either unrecognised or recognised CVD.

Cardiovascular screening identifies those at risk of future cardiovascular events of the heart and other major body organs. The risk factors are divided into modifiable and on modifiable ones. Modifiable risk factors are reversible and if one takes steps to change the lifestyle or receive medical treatment, one would be at reduced risk of developing cardiovascular disease. In addition, there are screening tests such as blood tests, ECG, stress treadmill test and 2D Echo which can help doctors evaluate your risk factors for cardiovascular disease.

Who Should Undergo Cardiovascular Risk Screening?

1. Upon the patient’s request
2. If during a consultation, the following are detected:

• Obesity especially abdominal (increased waist circumference)
• High blood pressure
• High cholesterol
• Raised blood sugar levels
• A middle-aged smoker

1. Family history of:
2. Upon the patient’s request
3. Medical history of

• Premature death (sudden and unexpected or otherwise) before age 50 years due to heart attack
• Premature heart disease detected before age 50 years
• Major risk factors such as high cholesterol, smoking, diabetes

1.  
   1. Chest pain/discomforts
   2. Excessive exertional/unexplained breathlessness and fatigue associated with exercise
   3. Unexplained fainting or near-fainting episodes
   4. Swelling of legs

1.  Previous heart attack 
2. Established coronary artery disease

Cardio and vascular diseases can lead to premature death if left unchecked. Parkway Heart & Vascular Centre provides risk screening for cardiovascular disease. http://www.phvc.sg/cardiovascular-screening.html

Talent management

Be a Talent Magnet 

Just like any strong consumer brand, a great employer brand can do wonders for your recruitment and retention strategy

A bag by any other name is still a bag - unless it is a Bottega Veneta or Hermes.  In today’s consumerist market, a brand is everything, which explains why many are willing to pay several thousand for a Bottega Veneta or Hermes handbag when they could get a lesser known brand at a fraction of the price.   Similarly, the same brand dynamics crucially works the same way in distinguishing employers of choice from the vast sea of organisations. In this competitive business environment, a company has to clearly communicate its unique selling proposition (USP) as an employer in order to attract and retain the best talent within its ranks.

What’s in a name? 

Employer branding is essentially creating positive perceptions about working at an organisation. Just like branding a product, it is an accentuation of certain culture and personality traits that employees can identify and build a relationship with. The concept of employer branding started in the late 1990s, but it was not until the new millennium that it began to gain more prominence. As people became more and more mobile, the battle for talent consequently intensified and globalised. Companies who were quick to recognise this trend started to pour more focus into the shaping of their image as employers.

Resilience in times of talent shortage  

While some companies look at employer branding from a cost perspective, a well-managed reputation does have its long-term benefits.  One of the greatest advantages is that a favourable employer brand is more resilient when there is a shortage of talent.  For all things equal, talent would be attracted to join an organisation that has a strong employer brand image. 

This gives the company more leverage over its competitors when it comes to “selling” the job vacancy. And in times of abundance of talent, the human resource department has the desirable problem of choosing higher-quality candidates out from the pool.  A good employer reputation also improves the offer-acceptance rate.

Employees as brand ambassadors 

When employees are passionate about the place they work in, they would naturally be eager to spread the good name of their employer, be it its policies, corporate ethics, corporate social responsibility or work environment. Besides reducing the hiring time and advertisement costs through a higher rate of recommendations for employment, the positive word-of-mouth from these brand ambassadors contributes to the overall impression of the organisation among the general public.

In times of a public relations crisis, employees can prove to be an organisation’s greatest friend or foe. Where weak employer brands tend to experience difficulties in containing information leaks to the media, strong employer brands find that their employees would be more inclined to stand by and ride out the storm with the company they believe in.

Fame and Fortune

As a bonus, companies that devoutly build themselves successfully as good employers get to enjoy the fair amount of good publicity that comes with making it into employer indices, such as the  100 Best Companies to Work for or the Top 100 Employers of Choice. Not only do they generate favourable media mentions, such third-party endorsements add credibility to the reputation of the company. In addition, research has shown that great employer brands enjoy higher productivity and churn out better financial results.  One common trait among the great companies is that they value their employees.  CEOs of these great companies recognise that when you take good care of your employees, they will in turn take good care of your customers.

  

Not for the half-hearted

Very often, the biggest hurdle to an employee branding exercise is in following through with its implementation wholeheartedly.  There may be instances where some divisions within the organisation view employer branding as an unneeded expense and effort. 

Therefore an organisation’s senior management must ultimately be the all-important support and drive, so that such an initiative has the right weight and backing to fulfil its intended effect. Employer branding is all about winning the hearts and minds of talent. Therefore, it is vital that companies approach employer branding from a long-term perspective.  Inconsistent efforts will only cast doubts on the employer’s sincerity in creating an employee-friendly corporate culture.  In the worst case scenario, it could even backfire and destroy all past merits.

        

In a nutshell, the basics to effective employer branding is to be sincere, consistent and engaging.  Only then, you are able to become a truly talent magnet.This article is contributed by Mr. Josh Goh, Assistant Director, Corporate Services, GSI Executive Search.

Each and every GSI Executive Search consultant possess broad knowledge & extensive experience.  We're headhunters to match clients' demands with talent management locally & regionally.