Dr Udgeath Dhir ,Senior Consultant Cardiac Sciences, Medanta Heart Institute, has done his MBBS from S.N Medical college and had earlier worked with King George Medical university, G B Pant hospital , Escorts heart institute and Sanjay Gandhi PG Institute
His interest lies in coronary artery bypass grafting, aortic root surgery, transapical aortic valve replacement, heart failure surgery, endovascular thoracic aneurysm. Dr Dhir in an interaction with Ekta Srivastava, Health technology elaborates on Cardiothoracic and Vascular Surgery…
What is the patient focus at Medanta heart institute? Is there a particular problem in which Medanta excels?
The main onus is “Patient first” at Medanta heart institute we deal with a wide array of cardiac ailments, which can be broadly categorized into super subspecialties like, I) Pediatric cardiac science, II) Electrophysiology, III) Interventional, IV) Non – invasive, V) Surgical, VI) Preventive cardiology, VII) Heart failure. We excel in all the above mentioned specialities with added crown of minimally invasive prodecures.
Why has cardiovascular disease been a focus of Medanta? Is the patient POP growing? Is this problem particularly acute in country now?
Cardiovascular disease has both financial & psychological implication on the society. By the year 2020 our country would be accounting for 35% of world population suffering from cardiac ailments. Definitely due to enormous change in lifestyle, cardiovascular disease with diabetes is expected to be an epidemic. There are various other factors for an upsurge in patients.
What changes have you observed in treating these patients? Have outcomes improved, stayed the same or gotten worse.
Our cardiac science treatment which progressed immensely had made the management of cardiac patients extremely fail proof with excellent results. Just a mere example the morbidity and mortality rate for patients undergoing coronary cardiac surgery is less than one percent (1%). Nevertheless there are still certain lacunae which need further improvement. Though general awareness is there among the common population and they are also becoming vigilant about their symptoms. So we are able to detect a problem earlier and thus enabling us to deliver better results.
Please discuss your level of interest regarding cardiology & cardiothoracic surgery. What changes in energy are most affects the way you are practice.
Cardiac sciences are an astonishing branch but to me preventive cardiology, in which detection of disease at earlier stage can change the spectrum of disease, is really close to me. Secondly in cardiac surgery all the minimally invasive procedures be it valvular surgery, congenital surgery or coronary I have a slight bent. Heart transplant is another arena where due to shortage of organ we are lacking but which has an awesome role in management of heart failure patients. Imaging has drastically made us wise in early detection, decision making& overt management. The echo cardiography has progressed from 2-Dimensional to 3D and 4 dimensional and added reconstruction of images made our lives easier. 128 slice CT images, MRI of heart, stress thallium & PET scan of heart have made our generation of surgeons & physicians wiser in taking appropriate decisions, which were quite tough in earlier years. Virtual imaging with 3D reconstruction and printing, which is right now in infant stage in cardiac sciences, will be the future.
Please tell us about the one HEART TEAM concept in India?
Teams make better decisions than individuals, old concept with new features. Without doubt we are not so enthusiastic about heart team concept as the west, but still we are looking forward. Conceptually it’s a very good that a group of experts discuss together “the best customized treatment” for that particular disease pattern. The team gives inputs and discusses the pros and cons and then design the best evidence based treatment for the patient. It’s gradually being incorporated in various anecdotes of cardiac sciences and has a bright future.
What have been the biggest advances in Cardiothoracic Surgery in the last ten years?
Cardiology & Cardiac surgery go hand in hard. The imaging which progressed in making early detection made us wiser in performing cardiac surgery. As far as advances are concerned our anesthesia has now been more refined & safe with advent of newer anesthetic agents and post operative pain management. With the advent of newer stabilizers now we are now doing off pump coronary bypass in nearly all the patients. Total arterial bypass is now being performed more often. Similarly port access surgery with very small incision and not involving traditional long steronotomy is being performed with minimal risk .The advent of newer tissue valves, now the patients who have undergone valve replacement, don’t require blood thinners. With minimal approach now we can replace & repair valves which were not possible previously, credit goes to the imaging technology which made the fraternity wise in endeavoring such surgeries even in high risk group of patients.
The development of ventricular assist devices for patients who were in terminal stages of heart failure has brought of new ray of hope. In this group of patients with the advancing technology of magnetic levitation newer ventricular assist devices have overcome previous problems of old generation devices and is now being given as destination therapy instead of bridge to transplant therapy.
The miniaturization of cardiopulmonary bypass circuits and bio compatible circuits we have cut down some unforeseen& predictable complications. The use of ECMO (extra corporeal membrane oxygenation). IABP (Intra Aortic Baloon Pump) and other temporary devices to assist heart and lungs has been a big relief to patients and doctors both in treating really tough patients. The new feather to cap is trans-catheter aortic valve implantation in patients who needs valve replacement but could not be done previously because of very high risk factors, is possible now with good early results.
Surgery can be quite unforgives especially because you can see the outcomes of your operation. So you have any advice for asping cardiothoracic surgery.
Cardiac surgery is an integration of knowledge, skills and attitudes. Continuous flow of learning with practice and incorporation of confidence sans ego should be the motto. There are no shortcuts in cardiac surgery. I must end by saying from Michelangelo “If people knew how hard I had to work to gain my mastery it would not seem so wonderful at all”.