Complex Heart Surgeries Made Safer- Dr. Pavan Kumar

Patients who suffer from heart diseases along with other health problems like increased age, high blood pressure, diabetes etc are often scared about the complexity involved in their treatment.  Dr. Pavan Kumar, an expert heart surgeon brings forth the conditions that makes the heart surgery complex, and also provides with the safety methods to be adopted to reduce the risk.
1.      Increased age: As the person grows older, he is likely to become a victim of many health problems. If a person is of 75 years or more, the body’s immune system and function of organs like lungs, brain and kidney start getting weak. If the body is already affected by any other disease, the bypass surgery gets complicated and the possibility of recovery of the patient is lessened. The risk involved in such surgeries is around 5 %. However, the use of beating heart surgery, MECC or centrifugal pump device and fast track anesthesia can make heart surgery safe. Incidentally, Dr. Pavan Kumar is the first surgeon to use centrifugal pump device in western India in 1988. MECC perfusion system was introduced in India for the first time this year at Lilavati Hospital. Both these systems have increased safety factors tremendously in risky heart surgeries.
2.      High BP & Diabetes: These are very common associated diseases in heart patients. Problems due to hypertension, smoking, tobacco use, alcohol use, high cholesterol, lack of exercise and unhealthy diet increase the risk of heart diseases. They cause severe damage to the arteries all over the body. Blockage takes place in the arteries, as well as, new disorders crop up. Under such circumstances, strict control of BP and diabetes recommended by specialists gives much required safety to patient undergoing heart surgery.
3.      Reduction in Pumping capacity of the heart: If the heart has sustained several attacks directly or indirectly, and its pumping capacity has been reduced to 25 % or less, a bypass operation becomes complicated. Under such circumstances, the presence of an experienced surgeon is a guarantee of success. In these patients mortality is normally 4 % and beyond as per international standards depending upon co-existing diseases/ infirmities/morbidity. However the use of heart support devices, IABP and on pump beating heart CABG has made it safe.
4.      Coronary bypass surgery along with heart valve replacement: Many a times, a patient requires this double procedure due to advanced stage of disease. This takes double the time as these patients are unwell and makes the surgery risky. (Mortality is around 10-12% as per international standards). But, the use of latest heart protection methods and normothermic perfusion with centrifugal pump keeps heart safe during this very long operation lasting more than 6 hours.
5.      Repeat Bypass surgery: With advancing age, patients who have gone bypass surgery in their 40’s and 50’s can develop newer blocks which will require repeat bypass surgery.  Basic problem in these patients is the patient’s advanced age and the heart pumping becomes poor with abnormal coagulation system of the body. Another problem is adhesions around the heart which requires carefully clearing without damage to heart. With careful dissection and surgical experience, repeat heart surgery is now less risky and also availability of coagulation factors and platelets has made post-op bleeding less of a problem.

6.      Patients with kidney failure and brain stroke: Patients of chronic renal failure or those on dialysis or having paralytic stroke pose serious risk during heart surgery and mortality is around 5-10 percent. They require special attention during operation as the kidney may stop working or the brain can have another stroke. In such cases, the surgeon’s experience is of paramount importance. Nowadays, portable dialysis machines are available which reduce kidney related complications. Similarly, brain protection medicines and latest anesthesia machines, where depth of anesthesia can be measured, are of great importance, so that only the right amount of anesthesia is delivered.

7.      Patients who have undergone angioplasty: Ballooning and stenting is becoming increasingly common to treat coronary artery blocks. Actually, due to this attractive non-operative option, many patients undergo multiple vessel multi -stenting angioplasty. In many cases, it has been observed that patients get 4-5 stents implanted in their heart. These stents are foreign body material and attract clot formation. It has to be very clearly understood that each stent, even drug coated ones, have 5-10 percent re-block rate per year. More the stent you get, the higher the chances of getting early blocks. At the same time, these stents are put in where surgeons put their grafts on the blocked arteries. This poses very special problems for cardiac surgeons. As he has to do a special procedure called endarterctomy, which means coring out of blocked material, in this case, blocked stents. This is a risky procedure in inexperienced hands, and damage can be done if proper instruments and skill is not applied.

8.      In case of heart failure: In patients with heart failure or aneurysm formation, where dead muscle is taken out, poses serious complexity to heart surgery. Mortality is around 10-15 percent. With use of heart support devices this complex operation has become safe now.

Success rate of specialist surgeon in such serious cases remains almost equal to an ordinary bypass surgery. Therefore, if the case is absolutely ‘serious’, an experienced surgeon having knowledge of latest technology becomes highly helpful for saving the life of patient.

By- Dr. Pavan Kumar – Consultant Cardiovascular Surgeon

Head of Department of Cardiovascular Surgery at Dr. Balabhai Nanavati Hospital