There seems to be a popular myth that Cardiac Surgery is a “thing of the past” and that Interventional Cardiology has completely replaced it. This is actually far from the truth.
Though cardiology has made huge strides in the last two decades, there continues to be a clear role of surgery in the treatment of heart disease. Dr. Ganesh Kumar Mani, Chairman - MAX Smart Super Specialty Hospital, Saket, vividly describes the heart surgeries in India today:
CORONARY ARTERY DISEASE:
Technological advancements in biomedical engineering have made almost coronary blockages to be tackled by catheter based interventions which are relatively more appealing to the patient. Whereas this could hold true for short segmental lesions, long term results of long lesions especially close to the left main bifurcation are inferior to arterial bypass grafts (by surgery). Well conducted randomised trials (SYNTAX, FREEDOM) have proven that the benefits of CABG remain for longer periods in diabetic patients.
Biomedical technology also made cardiac surgery a progress and the operations that were carried out by big incisions and by stopping the heart to operate have been replaced in many centres around the world by BEATING HEART SURGERY (operating even as the heart continues to beat, as the name implies) without the assistance of the Heart Lung machine or its inadvertent complications. Vein grafts (harvested from the leg) have been replaced by arterial grafts from within the chest or from the forearm. Average length of stay in hospital has been reduced to less than a week with less chance of repeat intervention for at least a decade.
VALVULAR HEART DISEASE:
Though simple mitral stenosis (the common Rheumatic heart problem) can be adequately treated by catheter based balloon dilatation, most other valve related problems require CARDIAC SURGERY. Repairs are the first modality offered. Valve replacements are required for a large majority of patients because of late presentation and extensive calcifications. Anticoagulation (blood thinning) is mandatory for mechanical valves but optional after 3months when TISSUE valves are implanted. The third generation tissue valves last more than 20 years and ideally suited for the elderly. However, whenever anticoagulation is prescribed, frequent blood tests are mandatory to optimise the dose of the drug.
CONGENITAL HEART DISEASE
As per World Health Organisation estimates, nearly 8 out of 1000 live births are born with Congenital heart defects. Most congenital heart diseases have to be tackled by Open Heart Surgery. Technological advances in perfusion have made corrective surgery safe even in the neonatal period. Young parents of these unfortunate children do not find the resource to fund these operations. Philanthropy by Rotary International and non- Government Organisations like the Health Education And Research Trust make it possible for these poor kids to receive lifesaving cardiac surgery in tertiary care facilities.