“Heart disease” - The very words can invoke a wave of panic for most people. And when the doctor’s diagnosis comes with a call for surgery, it can throw a person’s life into a tizzy.
While heart ailments and heart surgeries have grown more common over the years, there is no denying that heart surgery is still a very scary proposition for most patients. However, says Dr Siva Muthukumar, cardiothoracic surgeon at Apollo Hospitals, Chennai, surgical technology has advanced in leaps and bounds in recent years, making heart surgeries and procedures much safer, giving patients faster recoveries, and giving those with inoperable conditions a new lease of life.
Heart assist devices
One of the cutting-edge technologies that Apollo Hospitals is beginning to specialise in is the implantation of heart assist devices. “We’re not talking here about just a pacemaker,” the surgeon clarifies. “A pacemaker is a simple tool which is implanted in the body. It generates an electrical impulse that triggers a heartbeat,” he says.
Heart assist devices, on the other hand, are highly sophisticated miniature pumps that take over the pumping action when a part of the heart is failing. “The most commonly used heart assist devices are left-ventricular assist devices (LVADs). These are mechanical hearts that help maintain the circulatory system,” explains Dr Siva.
Fortunately, says Dr Siva, one of the advantages in India is that there is no shortage of donors for heart transplants. “But if you look at it from another angle, it’s very unfortunate because most of these organ-donations are due to road traffic accidents,” he adds. Therefore, where LVADs come into play are in the case of patients who cannot go in for immediate transplants for a variety of reasons. They also provide a new lease of life for patients who are ineligible for transplants.
Minimally invasive and robotic surgery
While heart transplants are fairly uncommon, one heart procedure that nearly every Indian is familiar with is the bypass surgery. Nearly every person knows someone who’s had to undergo a cardiac bypass, and the growing shift in our lifestyles is only making the need for these procedures more pressing.
One of the biggest steps in this direction is the pioneering advances in minimally invasive and robotic surgery. “Earlier, bypass surgeries and valve surgeries would be performed as open heart surgeries, with a large incision on the front of the chest, cutting through the rib cage,” explains Dr Siva.
However, with the growth of specialised instrumentation, surgeons are now able to access the heart in a much less invasive way. “With minimally invasive surgery, we make small incisions on the side of the chest, less than two inches long. This is not only cosmetically better, but it also gives the patient minimal pain post-op, and makes recovery much more speedy,” he says.
The precision and finesse of these procedures has only grown with the introduction of robotic arms into surgery. Here, the doctor controls the robot from a console, while the robotic arm performs the actual surgical movements. “With robotic surgery, we are able to perform the procedure with three or four very small incisions. It is so precise that after the recovery you can barely even see a scar on the patient,” adds Dr Siva.
Percutaneous valves
Another major advancement in specialised cardiac units such as at Apollo Hospitals is the use of percutaneous valves. Heart valves control the flow of blood from one chamber of the heart to the next, making sure that all of the valves equally bear the load of blood flowing through the heart and keeping it functioning smoothly.
“But due to calcification, aging and so on, the valves can become narrowed, and they get fixed in that position and are not able to open and close properly, and this reduces blood flow. This is called valve stenosis,” explains Dr Siva.
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Dr. Siva Muthukumar, Cardiothoracic Surgeon, Apollo Hospitals
The traditional method of repairing this problem is, again, open heart surgery to replace the defective valves with artificial ones. However, some patients are inoperable, because they are not fit for surgery either due to age or due to co-morbid conditions like lung diseases. “The problem for many of these patients is that they may not be able to take the anaesthesia needed for open heart surgery,” explains Dr Siva.
That’s where percutaneous valves come to the rescue. Explains Dr Siva, “Unlike traditional artificial valves, which are made of rigid materials, percutaneous valves are collapsible. That means they can be folded and fitted onto a small tube, threaded through the femoral artery in the groin and taken to the site of the defective valve and unfolded to fit across the native valve.”
Instead of the majorly invasive open-heart surgery that their bodies are unable to bear, this procedure becomes much like a routine angioplasty, adds the surgeon. While this procedure is currently restricted only to high-risk patients who cannot withstand open heart surgery, attempts have been ongoing in the West to open up these procedures to intermediate-risk patients too.
No need to fear heart surgery
With the rapid advances in medical technology and surgical knowledge and practices, says Dr Siva, the field of cardiac surgery is seeing great progress. “The surgical outcomes have really improved in the last few years,” he explains. While heart surgery can still be a major cause for concern, all patients are in safe hands due to these technological advancements, he concludes.
This article was produced in association with Apollo Hospitals by TNM Brand Studio.