CHI conducts landmark operation for advanced heart failure

Jun 01, 2014 News

By Sharmain Grainger
Remaining on a steady groundbreaking path in the delivery of cardiac care, the Caribbean Heart Institute (CHI) yesterday performed an inaugural high-end heart surgery to cater to advanced heart failure.

Cardiologist, Dr Mahendra Carpen, attends to Mr Egbert Carter yesterday.

The operation, referred to as Cardiac Resynchronisation Therapy with Defibrillation Implantation, was conducted on one of Guyana’s oldest engineers, 70-year-old Egbert Carter. It represents the first such undertaking to be done on these shores.
Speaking to this publication soon after the near four-hour long procedure, CHI Resident Cardiologist, Dr. Mahendra Carpen, said that the landmark undertaking is in fact an auspicious moment for Guyana.
Dr. Carpen, since 2012, acquired skills to perform the intricate procedure which he has already performed on several occasions in Boston, United States and in Trinidad. “This is the first time that CHI has been able to do this and this is a very, very proud feeling. The whole team is very excited about this because this represents the very high-end of cardiac device therapy for advanced heart failure patients.
“Very, very few places in the Caribbean and even around the world can say that they are capable of doing this,” noted Dr. Carpen.
He said that currently there are, at most, three facilities in the Caribbean that are able to deliver this level of heart therapy although there are many with capabilities to do so. “They often have to fly in cardiologists to do these procedures but we are fortunate that we have the entire team, on ground, capable of doing this; we only have to bring in the Medtronic technician,” said Dr Carpen.
Just for yesterday’s operation, Medtronic Technician, Cynthia Hassett, travelled from Orlando, Florida, to ensure that the requisite defibrillation device was properly inserted and functioning well. Medtronic, Inc. is said to be the world’s fourth largest medical device company.
And according to Dr Carpen, there are a number of patients who are currently in need of the device and by extension the high-end heart therapy, something that will be readily offered upon request.
And given the technical nature of this operation it is classified among the most expensive heart procedures. Moreover, Dr Carpen acknowledged that “not too many persons will be able to immediately afford this but we still have to offer it to patients because if they can afford it they will be able to benefit from it.”
Once this procedure is successful, the Cardiologist said that patients are expected to completely recover and go on to have very normal lives. According to Dr Carpen, the procedure can be conducted on just about any one since “age is certainly not a factor. It depends on the patient. What’s their functional status?”

The proud team at CHI after the operation. From left: Jason Solomon, Eco-cardiographer/Hemodynamic Technician; Karen Pereira-Debidin, Profusionist/Administrator; Cardiologist/Director, Dr Mahendra Carpen; Medtronic Representative, Cynthia Hassett; Co-Manager ICU, Nurse Tessa Smith; Manager CAT Lab, Nurse Corinne Nanton; Co-Manager ICU, Nurse Claudette Holder.

“This patient we operated on today (yesterday) is a very active gentleman; he is physically fit and mentally astonishing, a very bright accomplished gentleman; he is very educated and understood why this device needed to be implanted,” said the Cardiologist of Mr Carter.
He disclosed that after asking all of the necessary questions, Carter and his family decided that they were ready to have the operation done. “We are happy that we were able to coordinate with the device representative to get this done and we were prepared to do it as soon as things were ready…it didn’t matter if it was a Friday, Saturday or Sunday, we were going to do because patients done get sick 8 – 4, Monday to Friday.”
According to Dr Carpen, the patient arrived at CHI around 05:00 hours yesterday and was prepared for preliminary testing. By 10:00 hours he was moved to the laboratory where he was cleaned, draped and sterilised and prepared for the surgical operation which started around 11:00 hours and was completed by 15:00 hours.
“It is a very time consuming procedure because there are several steps; it is very technical,” recalled Dr Carpen as he instinctively detailed the intricate process which when completed enables synchronous contraction of the heart muscles.
“When people have advanced heart failure there is often disorganised contraction of the heart and therefore there is ineffective expulsion of blood supplied to the rest of the body,” explained Dr Carpen.
The entire process which starts with an incision in the left side shoulder in order to locate a vein into which wires are inserted en-route to the heart is done under local anaesthesia and conscious sedation. “We don’t put these patients to sleep, we don’t intubate them, we don’t need any mechanical ventilation, all you need is some medicines to keep patient calm and take the edge off of any pain and that along with the local anaesthesia will give you success,” Dr Carpen asserted.
Carter, who is well known for a number of expert engineering work, among them his input to the refurbished Parade Street, Georgetown, Theatre Guild, and the Berbice River Bridge, is expected to be discharged from CHI as early as today.
“We started with a dream and the dream keeps getting bigger, and I don’t think we will he close to the end anytime soon,” said an optimistic Dr Carpen even as he disclosed that “we have several more things to offer in the very near future and this will pretty much make us second to no place else in the Caribbean.”