Well into the twenty first century, the word cardiac surgery commonly called heart surgery continues to evoke the same level of fear and awe as it always has despite improved and durable outcomes in a higher risk population and better patient compliance.
The fear of the scalpel has meant that today surgeons are toiling hard to perfect their techniques which make the incision smaller and also ensure that the patient has a faster recovery time which converts to a lesser stay in the hospital and hence lesser costs too. One of the major advances in coronary bypass surgery has been the development of beating heart bypass surgery. Traditional bypass surgery was performed by first placing the patient on the so called ‘pump’ the CPB machine. This also meant that the heart had to be stopped for surgery and restarted after the procedure was over.
Today surgeons have perfected the technique of doing the surgery without stopping the heart and using the ‘pump’ a true revolution indeed. In fact the cardiac surgery team at Platinum Hospitals performs almost 99 percent of their cases using the beating heart technique.
The recent developments in minimally invasive surgery include robotic surgery and the enabling technologies have now got well entrenched in India and specifically in Mumbai. Recently a bypass surgery was performed at Platinum Hospitals, Mulund by minimal invasive technique whereby the patient underwent bypass surgery through a small three inch cut below the left breast thus avoiding the large vertical cut on the breastbone which has become synonymous with a bypass surgery or heart surgeries.
The surgical management of heart failure is rapidly advancing with newer options of surgical ventricular restoration and biventricular pacing through placement of devices much like the pacemaker. The use of the so-called artificial heart (ventricular assist devices) and cardiac transplant is now a reality and will increase in days to come.
Another major development has been in the field of valves where newer tissue valves are slowly replacing traditional mechanical valves. The most important benefit to the patient is that they do not have to take blood thinners which at times cause catastrophic bleeding.
What do these new techniques mean to the patient, to doctors and the society in general? Apart from an enhanced cosmesis with smaller incisions that is the demand of the day their benefits have wider ramifications. A developing country like India which is today sitting on an epidemic of Heart disease can ill afford its citizens being debilitated by cardiac symptoms. Our hospitals especially the public care systems are resource wise fully stretched and we must thus actively look at maximum resource mobilization with cost cutting measures without affecting the care.
This is where modern techniques come into the picture, for example beating heart bypass surgery not only reduces the cost but also the stay of the patient in the hospital thus allowing more patients to be treated with the same resources with better tangible results. Successful patient friendly results motivate other patients to seek cure especially younger patients who get affected during their earning phase and want a quicker healing period that does not affect their economic productivity.
The latest diagnostic tools which have emerged like the CT angio help in early detection of heart disease which ensure that proper treatment can be instituted well in time to avoid complications. Newer drugs especially the statins have been used that are cholesterol lowering agents and have a big role to play in decreasing the risk associated with heart disease.
Thus, today it is safe to say that surgical treatment for heart disease has been been revolutionized by new modalities which have become patient friendly and more acceptable with successful outcomes.
The writer is MBBS, MS (Gen Surgery), MCh (CTVS)
