Dr. Ahmed Afifi and Dr. Ahmed ElGuindy from HEART Advanced Cardiac Care Clinic Talk Advances in Heart Disease Treatment
In a world where heart disease remains the leading cause of death, the work of this medical fraternity is of incomparable value to the community.
Cairo West was privileged to sit down with two skilled and highly committed doctors who have been key to changing the odds for cardiac patients of all ages and walks of life over the past years, both through the world-renowned Magdi Yacoub Foundation and their own Cairo-based private practice.
How do you juggle a heavy schedule of work with the Magdi Yacoub Heart Foundation, your private surgical cases and regional work?
AG: There is a lot of discipline involved, and what we have learned across the years is that the patient will always come first. Obviously, if there is a clinical emergency; when you have a patient in a critical state, you just drop everything and do what you have to do.
Apart from that, you have to prioritize clinical duties; be it hands-on operating or counseling patients and families, academic and research commitments, and also making time for yourself and your family.
AA: It is difficult enough that you have to keep a tight schedule across different cities. Sound time management is an obvious thing, but there has to be a support system. Around us is a group of amazing individuals who form the team, who continue to look after patients, at the bedside, in various sites and cities day and night.
They are the ones who help you to really focus your attention to where the priority is at the moment. Family support is extremely important. Being blessed with a supportive and understanding family certainly helps.
AG: Time management is also team management, and you really want to make the best use of the hours available in a day. This is where having the right person in the right place pays off and maximizes efficiency.
What can you tell us about the cases you most frequently cover, both through the Foundation and through your private clinic?
AA: Collectively, we treat all patients with heart disease in any age group, starting from newborn babies up to 95-year-old patients. Whether it is in the Aswan Heart Centre or in our private practice here in Cairo.
How would someone know they have heart disease? A child may have difficulty growing, or feeding, or may be very blue. An adult would come with symptoms such as shortness of breath or chest pain. What we do as a team is guide him or her to a certain treatment plan. Some may just require reassurance, some medical treatment, some might need a catheter-based procedure or heart surgery.
AG: We are privileged to be able to work within a multi-disciplinary team, with huge experience across the broad spectrum of heart disease. Heart disease treatment has evolved over the past decades to be very complex, with people progressively becoming more specialized in different areas.
We also have the added advantage of working very closely together, so if you have a patient who can be treated in more than one way, be it surgery, or a minimally invasive approach or a catheter-based procedure, within the team you will always find the options available. We always ensure that we tailor the treatment plan to best suit the patient’s unique condition.
What recent advances are there in techniques involving heart and thoracic surgery?
AA: Catheter-based procedures have evolved dramatically over the past period. We are able to treat various disorders related to coronary vessels that supply the heart, and problems with heart valves via catheter–based procedures through a tiny hole in the groin. This now applies to conditions that were previously not treatable by catheter.
Surgery has also advanced tremendously but in a very different way. Repair of heart valves for example cannot be mimicked by trans-catheter procedures. Somethings we can handle with catheter–based options but sometimes the mid and long-term outcomes are best with open heart surgery.
AG: Although I treat patients by drugs and by catheter, I look at how cardiac surgery has evolved. We used to see cardiac surgeons as very skilled individuals with a lot of art in what they do. For instance, with what Ahmed Afifi does in valve repair, through trying to restore the normal components of the heart without adding foreign material, is very good for patients in the long-term.
AA: Another important advancement is in what we call the peri-operative care; how patients are diagnosed, how their illness is analyzed before the operation, and how they are helped by the intensivists, the anesthetists, and the cardiac perfusion scientists to make a remarkable recovery after the operation.
AG: Patients used to spend a week or ten days in the hospital, and now they can spend less than 48 hours. I would walk into the surgical care unit and see a young child who had undergone quite a complex procedure and just be amazed at how they were walking around in the ICU, the very same night of the surgery.
AA: These advances have to go hand in hand. Nowadays, heart disease interventions are led by catheter. In the past, after aortic valve operations, patients went on a ventilator and spent many days in the ICU.
Have you seen a link between heart health and people’s psychological wellbeing?
AG: There is more than one angle to it. Yes, we fully understand that one’s psychological and emotional state is very critical to wellbeing on the whole and that people who suffer from anxiety, stress and lack of sleep, do in fact have an increased risk of coronary disease in the long term.
In the short term, people who are subjected to intense stress are liable to what we call broken heart syndrome. This actually has a very similar presentation to heart attacks. The patient can have chest pain, or a weakened heart muscle, fortunately, this is often reversible.
It is important to pay attention to his or her psychological condition, well-being and expectations. This is very true in children with congenital heart disease, in particular, where you have to look after the child’s psychological condition.
The new Magdi Yacoub Heart Foundation Global Centre is receiving a lot of publicity, can you please tell us about it?
AG: This is our dream project. I was involved in the establishing of the first Magdi Yacoub hospital in Aswan, back in 2008. When I first walked into the place, which was part of the general hospital then, I was under the impression it was not going to be functioning within five or six years at least. To my absolute surprise, it was Prof. Yacoub who kept pushing and we were actually operating a few months afterwards.
Now, with that background, when we started looking at the new center, five times as big as the current one, includes a bigger number of operating theaters, catheter labs and ICUs. I saw it as a huge challenge, but one that we are perfectly capable of pulling off.
We are moving according to schedule, we are very solid in how we allocate the necessary resources. All credit goes to Prof. Yacoub and the Board of Trustees who have been securing funds at this difficult time we are all going through with the COVID pandemic.
What are the important values that drive the Magdi Yacoub Foundation?
AA: We put patients first, serving our patients is at the very center of it all. Secondly comes the training of young doctors and healthcare individuals. Last but not least is emphasis on scientific research and dissemination of knowledge.
AG: Exactly, I would sum it up by borrowing a quote from Prof. Yacoub, “I only have two masters, patients and science.”
Dr. Ahmed Afifi MD. FRCS(CTh) FACC.
Chief of Cardiac Surgery, Aswan Heart Centre – Magdi Yacoub Foundation
After finishing his training in adult cardiac surgery at St. Mary’s Hospital, Imperial College London, UK, and his pediatric cardiac surgery training at Great Ormond Street Hospital for Sick Children, London, UK; Dr. Ahmed Afifi moved to Aswan in 2010 where he was trained by Prof. Sir Magdi Yacoub. He is currently Head of the Cardiac Surgery Department at Magdi Yacoub Heart Foundation and a member of the Management Committee of the Aswan Heart Centre and has been instrumental in setting up the “Heart Team” approach to patient care and improving outcomes through clinical audit.
A Fellow of the Royal College of Surgeons in the field of Cardiothoracic Surgery, FRCS(CTh) and a Fellow of the American College of Cardiology (FACC), Dr. Ahmed Afifi specializes in complex heart operations for adults and children. He has a special interest in heart valve repair, surgery of the aortic root, and challenging congenital heart disease. Along his career he has continued to mentor surgeons especially in mitral valve repair and the arterial switch operation.
Dr. Ahmed ElGuindy, MD, FRCP, FACC, FSCAI
Chief of Cardiology, Aswan Heart Centre – Magdi Yacoub Foundation
Honorary Senior Lecturer – The National Heart and Lung Institute, Imperial College London
Dr. Ahmed ElGuindy is a visiting Assistant Professor at the School of Sciences and Engineering, The American University in Cairo, he holds a master’s and a doctorate degrees in Cardiovascular Medicine from Cairo University. He is a Fellow of the Royal College of Physicians of the UK, a Fellow of the American College of Cardiology, and a Fellow of the Society for Cardiovascular Angiography and Interventions. He treats various cardiac disorders and specializes in Interventional Cardiology with a special interest in complex coronary interventions, chronic total occlusions, transcatheter aortic valve implantation (TAVI), and intracoronary imaging. He currently runs multiple workshops on complex cardiac interventions in many countries, and is an invited faculty member in many international meetings.
Dr. ElGuindy currently serves as the Clinical Deputy Director of Research at the Magdi Yacoub Foundation and has over 60 publications in international peer-review journals, and is co-author of a textbook on Cardiovascular Medicine. He sits on the Management Committee of the Aswan Heart Centre since 2010, and continues to be heavily involved in strategic planning, clinical governance and quality improvement at the Centre.