Why robotic heart surgery is better option for patients —Dr Bansal

Dr Varun Bansal, a cardiac surgeon and consultant of robotic cardiac surgery, with specialisation in minimally invasive and robotic heart surgery, which involves heart surgery without cutting open the chest, is in Nigeria on a medical mission. He speaks with Laolu Afolabi in Lagos. Excerpts:

What are symptoms of congenital heart disease syndrome and treatment options?

A patient with congenital heart disease is born with a heart problem. The child feels breathless, gets tired easily and sometimes unable to suck breast milk. Sometimes the child may turn blue in colour while drinking milk. These are the main symptoms of congenital heart disease.

Congenital heart disease can be treated in many ways. It could be just periodic monitoring, that is checking the baby or could be trans-catheter options. It can be done through wires to close that defect or it could be surgery. Surgery can again be done in open chest or minimally invasive way through small cuts.

 

Briefly state reasons for increase in cardio heart disease in the world.

That is multifactorial. It is because the diet habits are changing. We all have stress in our system. The increase in diabetic population in the world is because of smoking and because of lifestyle changes, the heart disease is increasing across the globe.

 

What can be done to reduce heart-related deaths?

For decreasing the mortality rate because of heart related problems, one, we should get ourselves checked early. Secondly, we should concentrate on our lifestyles. We should exercise regularly, eat a balanced diet, not too much fats and carbohydrates. We should stop smoking. If there is diabetes record in the family, we should take care of blood sugar levels. We should get ourselves checked and treated early for any complications to be avoided. We have to get checked in time and in case we we find that the patient has a problem, he should get treated early so that the risk of mortality and complications is less.

High blood pressure is not a death sentence. But yes, it does affect the heart. It does affect the whole body and it does affect the kidneys, so high blood pressure definitely leads to many other diseases.

 

High BP in adults is worrisome. What can be done to reduce it?

One is, consume less of salt. Also, take less of stress out, regular exercise, reduce body weight if possible.

 

It is surprising today to see young adults less than 30 years coming down with high BP. What is responsible for that?

Again, there are many factors. One is genetic. Their parents have high blood pressure. Second is our diet habits. We are using more of fast foods these days. Third is stress levels. We are growing into the increasing competitive field where the stress levels are high and lack of exercise, even the young population do not want to exercise. They just want to do bodybuilding, but less of cardio exercise. So these are contributing factors, including smoking, which is always there.

Everybody should do intermittent cardio exercises, maybe two to three times a week at least, if they can do it regularly, it will even be better if they do it every day.

It could be anything from running, jogging, cycling, swimming. It could be an aerobic exercise. Brisk walking is also an exercise.

Dieting controls high blood pressure by reducing the body weight and definitely in diet, you should take less of salt to control the blood pressure.

Sugar is for diabetes. Salt is for blood pressure. So in case the patient has high BP, you should restrict salt and in case the patient has diabetes, you should restrict sugar.

 

What are the best ways to manage high blood pressure?

They’re all together, everything has to go hand in hand, diet has to be modified. Body weight has to be decreased. Regular exercise needs to be done and they have to get checked early and start medications if required.

 

When will a patient need heart transplant?

So heart transplant is usually done for a patient whose heart does not work adequately as to the needs of the body. And there is no other mechanism where we can actually get it better. Heart failure can be because of multiple issues. It could be because of dilated cardiomyopathy when the heart muscles are weak. It could be because of the valvular heart disease or disease of the coronary arteries. When the heart is about to fail and there is no other modality like machines which can help, then the patient needs heart transplant. It is a challenging mode of treatment in which an organ needs to be available and that organ can only be available if there›s another patient of similar age, height, weight and matching blood groups who dies unfortunately, only then heart transplant can be performed.

 

Your area of specialisation, minimally invasive or robotic cardiac surgery, what is it about?

So I specialise in minimally invasive and robotic cardiac surgery. It is doing the heart surgery for coronary arteries, the blood vessels of the heart or valves of the heart or tumors, or even the congenital heart diseases in the adults when there is hole in the heart without opening the chest. The problem or the fear of people when they go for heart surgery is that of long cuts on the body weight, on the chest or on the legs. In robotics, we don›t have to do that, we can go into the chest through small incisions of around eight millimetres. We can access the heart from outside from in between the ribs. There is no ribs breaking, no cutting of the bone and the patient can get the surgery done, even better, without any complication. There is less bleeding. The patient does not have pain and can get home within two or three days and get back to activity within a week. So robotic surgery and minimally invasive heart surgery is for the benefit of the patients. Even the blood transfusion rates are less than this. The painkiller requirements, the antibiotic requirements are less in the patients who are diabetic. It really benefits them because the wounds are small. The recovery is fast and they›re very less chances of wound infection for CABG that is cabbages surgery, the vein grafts are not used in robotics, this total arterial CBG can be done, which is better for the patient on the short term because of less wound pain, less bone complications, and better in the long run because it has total arterial, the patient might not need the heart surgery ever again, as I believe heart surgery should be done only once in lifetime. You should not keep coming back to cardiac OT.

So robotics is the best thing that a patient can get across the world now. We are currently working on the fourth generation of Robot. It is extremely equipped with the latest technology with which we can see inside the magnified vision, which is around 10 times the normal vision. The robotic arms have a lot of dexterity. They can move 360 degrees inside the chest and we can replace heart valves, we can repair heart as we can close heart defects. We can remove heart tumors, we can correct the coronary artery disease, we can do cabbages or CRPGs using this technology with minimal amount of pain or suffering or any blood transfusion or any restriction to the patient.

 

How affordable is this?

Overall, the cost isn’t nearly the same because the surgery itself is a little expensive because of the robot involved. But the patient needs to stay in the hospital for just three days. And he can get back to work within seven days. The patient, when he can get back to work in seven days, can start earning again when compared to the open surgery. For open surgery, the patient needs to be at home for six to eight weeks, that is two months out of work and out of business. In comparison, the robotic surgery patient actually saves money getting the surgery done. They don›t have to spend more. I agree that first initial payment is more but because of the surgical and equipment used but overall, the patient saves money. A lot of pain is avoided as well as a lot of complications, and definitely money is saved.  We are doing all this advanced treatment options in the Indraprastha Apollo hospital, New Delhi.