Such procedures improve short-term outcomes in heart patients and are associated with a faster recovery in comparison with the traditional approach

The nation has been in lockdown mode for more than four months now and has only just started opening up. Hospitals, research and development (R&D) institutions are trying their best to bring out a vaccine for the Coronavirus. In fact, human trials for the vaccine have begun in India. We have seen many reports that have said that there has been a decline in the number of people opting for surgeries, especially low and medium-risk patients.

A lot of patients, who had surgeries scheduled, have postponed them and are avoiding hospital visits for routine checkups as they fear being exposed to the Coronavirus. There have been reports of people losing their lives due to a heart attack or stroke. Even though they had prior symptoms of heart disease, they did not venture out due to the fear of COVID-19.

It is extremely important for cardiac patients and people with heart conditions to take care of their health in such testing times, especially as there are a lot of restrictions on access to various facilities. 

Exercising, maintaining a proper diet and taking the prescribed cardiac medication or anti-diabetes medicine are all very important for patients, since these are the co-morbid conditions which make the Covid-19 infection serious as the cardiac/diabetes patients are already immuno-compromised. With that said, it is also impossible for high-risk patients with severe heart conditions to not opt for surgeries. When it is absolutely essential depending on the conditions, patients might have to undergo surgery.

The need to safeguard themselves and their patients has prompted most surgeons to develop their own protocols to tide over the pandemic situation. The decision for surgical care should be based on the doctor’s own surgical and clinical judgment and assessment of resource availability. Patients should get the surgical care based on practice of evidence-based medicine. A non-operative line of management is advised when it is clinically appropriate for patients, specially looking at risk and benefits of surgery.  

Heart surgeries are arduous and long procedures that take a toll on patients physically and mentally. Open-heart surgeries are back breakingly expensive and procedures last for days. Since the surgical team has to be careful not to get infection, all the precautionary measures that are being practised are also the most rigorous for the surgical team. Apart from that, in the COVID-19 era, there is a dire need for minimum contact which is only possible through minimally- invasive surgical  techniques. Minimally invasive surgery improves short-term outcomes in patients and it is associated with a faster recovery in comparison with the traditional approach. If a patient needs valve replacement, then a trans catheter aortic valve replacement is an alternative, but the long-lasting results of these valves are still questionable. There is a certain amount of industry drive to make these procedures popular without really knowing the long- term results. I am sure that there are cardiologists who will object to this contention. But this remark is only because of the fact that I am one of the few surgeons in this country who has been replacing valves (single, double or treble since 1975) and hence I have experienced the long-term results of conventional valve replacement.

Currently these valves are highly expensive in India, going up to Rs 22.5 lakh, owing to which this technology is not available for common Indians. Even the cost of conventional valve replacement, that is between Rs 2.5 to Rs 3 lakh, is not affordable for the common man.  The solution for this dilemma is indigenisation. Some hospitals in the country have been in the forefront of bringing about indigenisation in Transcatheter Aortic Valve Implantation (TAVI) along with the National Aeronautical Laboratory and Council of Scientific and Industrial Research, using Nitinol stents. The valve material used is bovine jugular veins which is after all a waste. This could be a classic example of “waste to wealth, but unfortunately, there has been no support from any Central Government agencies such as the Department of Biotechnology, the Department of Science and Technology or any regulatory bodies.

Children with congenital heart disease or structural heart disease undergo multiple heart surgeries in their lifetime. Of course, closing a hole in the heart through the  Transcatheter route is available. Most of these patients who have these “corrections” can go home within 24 hours.

This reduces their risk of catching infection, which is vital in the Covid-19 era.  This also means more beds will be available for elective patients who need such therapy, which does not need long-term hospitalisation.  It is not the technology alone but the logistics, the patient’s comfort and affordability of the procedure that are also important.

(The writer is a Padma Sri awardee and cardiothoracic surgeon credited with India’s first bypass. He is Chairman and CEO of Frontier Lifeline Hospital)