The Cardiothoracic Team in Belhoul Apollo Hospital consisting of the Cardio-thoracic Surgeons, Cardiac Anaesthtist, Perfusionists and Technicians were all happy to see the patient smiling and talking to his family after he was taken off the ventilator.

The Cardiothoracic Team, who have performed over 4000 open heart surgeries together all over the world, consists of the Cardiac Surgeons Dr. Roy Korula, Dr. Vinayak Shukla and Dr. Hari Krishna Doshi, the Cardiac Anaesthetics Dr. Lalitha Manickam, Dr. Sara Thomas and Dr. Monica Doshi and including the team’s Perfusionist Mr. Manohan.

The Patient: Management of Coronary Artery Disease

John Silva is a 52 year old gentleman from India. While playing badminton one evening in 1995, he had a massive heart attack, for which he had to be hospitalized for 2 weeks. He was subsequently well till about 2 months ago, when he noticed a tightness in the throat and chest on physical exertion. He was referred to the Cardiologist at the Belhoul Apollo Hospital and underwent an exercise test which showed that he most likely had obstruction to his coronary arteries.

Coronary artery disease is the most common cause of sudden death. 1 person dies every 33 seconds in the USA due to coronary artery disease. Hypertension, Diabetes, Smoking, High Cholesterol, a strong Family History of Heart Disease, and the Stress of modern day living contribute to this. According to Dr Roy Korula, the Chief of Cardiac Surgery at the Belhoul Apollo Hospital, “We are seeing younger individuals with multiple risk factors and more extensive and diffuse coronary artery disease these days.” Presumably because of the stress, Indians working abroad have a much higher incidence of coronary artery disease than people staying on in India. John Silva underwent a Coronary Angiogram at the Belhoul Apollo Hospital. This involves introducing a catheter through the groin into the heart and coronary arteries, and injecting a dye, and recording the flow on a cineangiogram. The angiogram confirmed that he had disease involving all his major coronary arteries. 

In addition, a large part of his heart muscle had been damaged as a result of his heart attack in 1995. As a result, he had significantly poor contraction of his heart muscle, and was a higher risk for surgery. Mr Silva underwent a Triple Coronary Artery Bypass on 12th July. This was the first open heart operation done in the hospital. He had a very smooth uneventful post operative course, and was sitting up in bed, eating and reading the newspapers on the day after surgery. He was discharged a week later. 

The Cardiac Surgical team at the Belhoul Apollo Hospital is an experienced one, with over 23 years of experience in dealing with all Cardiothoracic problems, including surgery for Coronary Artery Disease, Beating Heart Surgery, Surgery for Complex Congenital Anomalies, Neonatal Cardiac Surgery, and Surgery for diseases of the Lungs, and Mediastinum. They have performed over 4500 open heart operations, and an equal number of closed heart and lung surgeries. The team has been working together for over 12 years. 

Several modes of treatment are available for Coronary Artery Disease. The most common is an angioplasty. This involves threading a catheter into the coronary artery, dilating the narrowed segment by inflating a balloon under pressure, and then leaving a stent inside the coronary artery to keep the artery open. In spite of newer refinements in the design of stents, the problem of restenosis of the stents still persists. Some people are not suitable for angioplasty, and will need Coronary Artery Bypass Surgery. Surgical revascularization for atherosclerotic heart disease is one of the great success stories of the last century. It is the most commonly performed operation in the USA, more than 600,000 procedures being done annually. 

Relief of angina, improvement of exercise tolerance, and survival benefit has been the hallmark of the operation. Newer modifications include Beating Heart Surgery, where as the name suggests, surgery is performed on the beating heart, the heart being stabilized by specialized equipment. This reduces the complications seen in conventional bypass surgery, where the heart is stopped to facilitate the operation, a heart lung machine doing the work of the heart and lung during the operation. 

Beating Heart Surgery is also being done at the Belhoul Apollo Hospital. Minimal Invasive Coronary Artery Surgery (MICAS) where surgery is performed through small incisions, and Robotic Surgery, where the surgeon sits at a console far away from the patient, and operates through small holes in the chest, are other recent advances.

Robotic Surgery is still however in the experimental stages. Some time during the next decade or two, a surgeon sitting at a robotic console in one country will be able to operate a patient in another country! 

The future of Coronary Artery Surgery is changing rapidly. In 20 years or so, Gene therapy, Nanotechnology, and possibly Cloned Hearts will replace bypass surgery as we know it today. Whatever the strategy, there is uniform agreement amongst Cardiologists and Cardiac Surgeons that regular Exercise, stopping Smoking, controlling Cholesterol levels, keeping Hypertension and Diabetes well controlled, and regular Meditation and Relaxation are the best methods to prevent if not prolong the onset of Coronary Artery Disease.