by The Welthi Bureau 5th Feb, 2020
Advancement of technology has made life easier in many ways. The continuous research in biomedical sciences led to the invention of improved tools which helped make even the big operations painless.
Of late, medical experts have found that even lengthy and complicated procedures could be done through a very small cut, which would not be sufficient even for a scalpel to enter the body. Such procedures, called minimally invasive surgeries, are being performed to rectify disorders in different organs, as and when needed.
Today, let us know about Minimally Invasive Cardiac Surgery (MICS) which involves only a small cut and promises of a faster recovery.
Dr. Gopichand Mannam of Star Hospitals is a name to reckon with in cardiac healthcare with more than 28,000 heart operations to his credit in his 25 years of experience as a heart surgeon. Awarded Padma Shri in 2016, Dr. Mannam has the reputation of performing the first heart transplantation surgery on an eight-year-old boy in Telangana and is an expert in MICS.
Welthi had a tête-à-tête with Dr. Gopichand to understand what MICS is all about and let us know of it in his words.
What is MICS?
Minimally Invasive Cardiac Surgery (MICS) is a new operational procedure being done on patients suffering from different types of heart ailments. This has been in practise for the last few years. As the name suggests, it is aimed at giving maximum freedom to the patient with less possible intrusion into the body and at the same time, repair/rectify the disorder in the heart just like in the open operation.
In a standard heart operation, i.e. the open heart surgery (OPS), the sternum (breast bone) is cut in the middle for 20-25 cm and pushed aside to gain access to the heart to perform the operation but in MICS only a 5-6 cm cut is made on the right side of the chest to gain access to the heart through the ribs and perform the surgery.
What are the advantages of MICS?
MICS allows a patient to recover fast with minimum risk of infections, diseases and it also assures patient of less pain. This type of procedure will also enable quick mobility after operation and also leaves minimum scars on the body. Despite being minimally invasive, it accomplishes the same technically superior results as in the standard procedure.
A patient can come out of the ICU within a day, walking the ward the next couple of days, get discharged from the hospital in 4-5 day sand be back at work between 2 weeks-1 month.
In OPS, it takes 2 months to recover as the bone which was cut has to heal and some restrictions are also imposed on the patient like they are cautioned not to lift weight for a certain period.
How is it performed?
Unlike in the standard procedure, no bone is cut. In MICS, a small incision is made on the right side of the chest and the surgery is performed on the left side through high-precision tools and high-definition viewing equipment to ensure safety to the patient. MICS is suitable for all repair/replacement of valves and holes in the upper chambers of the heart. The patient need not worry that the doctor could commit a mistake due to less working space in his/her chest as the viewing equipment in MICS will enable the surgeon have a clear view of the patient’s body. The incision is made either on the side of the chest or under the arm for better cosmetic result. As no bone is cut during the procedure, recovery is faster and pain is less. Further, blood transfusion is not necessary for MICS. Even if needed, it is required in a minimum amount.
Is MICS suitable to treat all heart ailments?
Replacement and repair of valves without coronary artery problem, holes in the upper heart chambers and ASDs in the upper heart chambers can be set right through MICS. Even bypass surgery, wherein a blood vessel of the heart is bypassed, can also be performed through MICS. For this, a 5-cm incision is made on the left side of the chest. All that can be done through open heart procedure can be taken up through minimal access. However, MICS is not suitable for all the patients and all surgeons. The surgeon has to carefully in picking the patients for MICS.
What steps should be taken for a faster recovery?
Patients should remember that OPS is being done through MICS. Hence, all the necessary precautions about lifestyle changes that are followed for recovery in case of a standard operation need to be followed for MICS too.
Among the two, which would you prefer personally?
In case of OPS, patients complain of pain in the chest, numbness and some other complications as the bone is cut. Sometimes, the wire used to bind the sternum might cause infection and at times, the bone gets broken when the patient needs to be operated again. Lung collapse and fluid formation are some other complications which a patient might face in case of open heart surgery. In MICS, such problems do not arise in a majority of the cases.
All these can be avoided through MICS which means visits to the surgeon seeking consultation for complaints can be reduced. This saves time both for the surgeon as well as the patient.
I would personally prefer MICS as it is in the interest of the patient. However, some surgeons would prefer the standard procedure as it would give them full access to the heart and they can work in their own experienced style. At the same time, some surgeons would prefer to explore new areas and procedures to give maximum comfort to the patient.
Which among the OPS and MICS is affordable?
As the tools and viewing equipment necessary in MICS cost more, MICS is definitely an expensive affair but it is advisable for faster recovery and minimum pain. This will allow the patient to return to work faster to continue earning their livelihood.
Tell us of any complications that can occur during MICS?
If there is any bleeding while MICS is being performed, sometimes locating the source of the problem becomes hard. In an OPS, the place from where bleeding is occurring can be identified easily. If there is such a problem, we have to go for an open heart surgery to stop the bleeding. Such cases are rare like in a 100 cases, there might a couple of patients who would need another operation.
All said and done, the success rate of MICS is 99 per cent. A surgeon can go for MICS to repair/replace valves even if the pumping efficiency of the heart (ejection fraction) is less.
In case there is a complication with a patient who had undergone MICS. Can that be rectified by performing MICS again?
Once MICS is performed, some organs like lungs get stuck and accessing the heart through MICS for a second time will pose a problem. It is advisable to go for the standard operation in case of complications. Sometimes, for patients who had undergone standard open heart operation, a second operation when necessary could be performed through MICS.
What is the durability of MICS?
Like in the case of open heart surgery, MICS too lasts for a lifetime. For bypass, there should be a change in the lifestyle or else, there will be complications. Patients should go for regular check-up to know if there is any problem inside the heart. In case of MICS, the patient needs to come for a check-up after a week of discharge from the hospital and then after a month. There is no need to visit a surgeon continuously.
How many surgeries have you performed? Tell us about your memorable experiences during this period.
We perform nearly 1,600-1,700 operations in a year both on children and adults. I performed 28,000 heart procedures so far.
Tell us about your charity initiative, Hrudaya Foundation.
Through Hrudaya Foundation, we have performed more than 5,000 free heart operations on children below 12 years of age, including those from neighbouring Chhattisgarh, Maharashtra, Odisha and even Bihar. Through this charity organisation, we also did the first heart transplantation in an 8-year-old boy and it is a highlight in my career. For this, we also received some aid from the government. More than 2 years have passed after the operation and the boy is keeping good health. He is going to school and his mother is a daily wage worker.
For this heart transplantation, the boy was kept in the ICU before the surgery. We were worried if we would be able to get the same size of the heart as that of the boy to fit it into his body. If we cannot get such a heart, then our patient will die. We felt many anxious moments. At that time, we knew of a 18-year-old male who was brain dead. Our patient’s heart got enlarged due to the disease and hence, his chest had space to accommodate the teen’s heart.
On the specific day, I and one of my colleagues went to Kamineni Hospitals in Hyderabad to harvest the heart early in the morning. It took us 20 minutes to come back to Star Hospitals and then we performed the surgery. The Telangana police escorted us to avoid traffic snarls on the way.
For the first two days, the boy ran high blood pressure as the transplanted heart was big and thick. This was expected but gradually, the boy got adjusted to the new heart and now, he is okay.
Also, I remember operating on a 3-day-old baby for aortic ailment. He was the son of Tollywood hero Vinod and he was born with transposition of the great arteries. Now, the boy is 18year old and healthy. There are many such satisfying moments in my life.
You were conferred with Padma Shri in 2016. How do you feel on being awarded with one of the country’s top honour?
Basically, I think an individual should not work for awards or rewards, riches on mind. One should work considering it their responsibility. One should be happy for the opportunity their profession has given them. I am happy that many budding surgeons are enthusiastic to work with me and many other organisations are coming forward to help our Hrudaya Foundation.
Awards will not change my way of approach to the profession. However, the award made my parents and my friends feel elated. I felt happy that I could make them cherish those moments.
It has been 11 years since we set up Star Hospitals and I feel satisfied for having cured many heart patients through our healthcare facility.
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