The heart team
The heart team around your procedure
When people imagine a heart procedure, they picture the procedure itself — a bright room, a screen full of shadows, an hour that decides everything.
But nobody recovers in an hour. What carries you home is a chain of people that begins at the admission desk and does not end until you walk out — most of whom you will never learn the names of.
This page is about them.
Before
It begins before the lab
By the time you are wheeled towards the cath lab, a great deal has already happened around you, quietly.
A doctor has been through your file — your reports, your allergies, the medicines that need to pause and the ones that must not. Your kidney values are checked before anyone touches your heart, because the dye that shows us your arteries leaves through your kidneys.
A nurse prepares the wrist or the groin, places a small drip line in your arm, and makes sure you have fasted the right number of hours — and that the medicines you are still allowed have been taken with a sip of water.
And before any of this, someone sits with you and explains what we intend to do, why, and what your other options are. You sign only when your questions have run out.
During
Who is in the room
For a routine angioplasty, count them: seven people — and none of them watching the same thing.
Two cardiologists at the table
A first and second operator work the case together — both scrubbed, both standing on your right. The main screen sits across from them, on your left, so that both are reading the same picture head-on at the same moment, rather than one looking over the other’s shoulder.
A third cardiologist on the imaging
Angioplasty is no longer guided by the outside view alone. A fine catheter images the artery from within — using light in the case of OCT, ultrasound in the case of IVUS — and what it shows decides the size of the stent, where it sits, and whether it has fully opened at the end. Reading those images well is a separate skill, and it cannot be done properly by someone who is simultaneously steering a wire. So a third cardiologist does it, on every angioplasty.
A cardiac anaesthetist
One specialist spends the whole procedure doing nothing except watching your breathing, your blood pressure and your comfort. Not the procedure. You.
A scrub nurse and a cath lab technician
Handling the instruments and the imaging equipment, so that the operators never have to look away from your case to fetch, adjust or reset anything.
A circulating nurse
Moving between the sterile field and the rest of the room for anything the team needs, without breaking sterility.
Comfort
You stay awake, and comfortable
Every angioplasty and every structural procedure here is done under controlled conscious sedation.
You stay sleepy and comfortable — not unconscious. If we speak to you, you can hear us and answer. You may remember little of it afterwards.
The anaesthetist is there for every case, not only the complicated ones.
Judgement
How decisions get made
Decisions during your procedure are not made by one person.
Which narrowing to treat, which stent, whether to continue or to stop — the operators agree it between them, at the table, looking at the same images. A view that one of them cannot explain to the other does not become a plan.
Structural heart
When the case is structural
For a TAVR, a MitraClip, an ASD closure or a balloon mitral valvotomy, the room grows.
During TAVR, a cardiologist joins purely to run temporary pacing while the new valve is placed — for those few seconds, controlling the heart’s rhythm is a full-time job on its own. For mitral and septal work, another performs transoesophageal echo throughout, watching the repair from inside the chest in real time while the operators work.
Every person added takes one thing off somebody else’s attention. That is the only reason to add them.
Backup
If a procedure has to become an operation
For complex angioplasty and for every structural procedure, a cardiac surgeon is available around the clock, with a theatre ready next door.
They are not part of the decisions inside the lab — that work belongs to the operators. They are there for the rare case where a procedure needs to become an operation, so that the answer is minutes rather than an ambulance.
After
Where recovery actually happens
The procedure ends. The watching does not.
You spend the hours after it in a monitored bed or the ICU, your heart rhythm, blood pressure and oxygen on a monitor around the clock, the puncture site checked again and again. If your procedure went through the wrist, the pressure band on it is loosened a little at a time. Through the groin, you lie flat for a few hours first — someone will tell you exactly how long.
The night shift is not a lesser shift. There are doctors whose whole job is that floor while you sleep.
The next morning, the checks repeat — and then the work turns to getting you moving. Sitting, standing, walking. Recovery is not lying still; it is built, deliberately, and it starts before you leave the building.
Before you go home, someone sits with you and goes through every medicine — what it is for, when it is taken, and which ones must never be stopped without asking us. You leave with a plan, not just a prescription.
And because recovery does not end at the hospital door, it has a discipline of its own — cardiac rehabilitation.
Honestly
What a team cannot do
A team does not make a procedure risk-free. Nothing does. Every procedure described on this site carries real risks, and they are set out honestly on each of those pages.
What a team changes is the chance that something is noticed early — a pressure that drifts, a wire sitting slightly wrong, an image that does not look the way it should.
The failures that matter in this work are rarely dramatic. More often something small goes unnoticed while everyone is occupied with something else. That is the specific thing more people in the room are for.
Questions
Common questions
Will I be awake during my angioplasty?
Yes, under conscious sedation. You will be sleepy and comfortable rather than unconscious, and able to answer if we speak to you.
Who actually performs my procedure?
Two cardiologists work your case together, from start to finish, with a third reading the imaging from inside the artery.
How soon will I be up and walking?
It depends on the access point. Through the wrist, you can usually sit up soon after; through the groin, you lie flat for a few hours first. Either way, early movement is part of the plan, and the team will tell you exactly when.
Does having so many people mean my case is complicated?
No. Seven people is the standard set-up for a routine angioplasty here, not a sign that anything unusual is expected.
Is a cardiac surgeon present for every procedure?
Not for every one. A surgeon is available around the clock, with a theatre ready, for complex angioplasty and for every structural procedure.
Why does someone need to watch only the imaging?
Because reading images from inside an artery and steering a wire are two different jobs, and doing both at once means doing one of them less well.
A note
From Dr Kunal
I have kept this page free of the things such pages tend to carry — team photographs, procedure counts, success rates. Not because those things do not matter, but because they are usually chosen to impress you, and I would rather you simply knew what happens.
You are trusting us with a great deal. I believe that trust should be built on plain description, honestly given — and on your questions, all of them, answered before anything is done.
If anything on this page worries you, bring the worry with you. We will go through it together.
— Dr Kunal Patankar
A team you can meet before you decide
Bring your reports for a consultation with Dr Kunal Patankar — and ask anything about how your procedure will run.