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Surgery or No Surgery – Surgery is not the last resort; it might be the best

Dr Vijay Dikshit,
Senior Consultant Cardiac Surgeon,
Apollo Hospitals, Hyderabad

Often the word Surgery fills most people with dread, even though it might be in their best interests. Many international studies and randomised trials have firmly established superior long term benefits of Coronary Bypass Surgery compared to coronary stents or any other medical treatment in patients with triple vessel Coronary Artery Disease, especially in people with diabetes. In spite of excellent outcomes and low complications, the message to the general public has not been adequately conveyed. The apprehension and misinformation regarding surgery lead them to choose alternative methods of treatment.

Coronary Artery Bypass Surgery (CABG) which completed its 50 years, and has saved millions of lives, is facing new challenges in India. Nearly 2 Lakh of these operations are done every year in our country. The advancement of technology and the growing experience of Cardiac surgeons have made the surgery safer and in an uncomplicated planned (elective) bypass surgery; the mortality rate is nearly 0%.

‘Beating Heart Surgery Technique’ which is practised by most Indian surgeons, has significantly contributed to the excellent outcomes over the years. Indian surgeons have acquired vast experience of these procedures. Out of over 22 thousand heart surgeries which we have done at Apollo Hospitals Hyderabad, more than 16 thousand are Coronary Bypass Surgeries.

Near explosion of serious coronary disease in young population appears to be more of an Indian phenomenon. We now regularly see patients in their twenties with advance CVD (Cardio Vascular Disease). Surgery or other treatment can save their lives but the long term health benefits can be achieved only by life styles changes. Largely sedentary life style, irrational food habits and stress are among the major culprits. This is unfortunately going to be a major health issue in modern India and Coronary Bypass Surgery, with most dependable outcomes, will play a central stage in the therapy of Coronary Artery Disease.

Today, the trend is to be minimally invasive for surgical procedures. But for Coronary Bypass Surgery, in spite of concerted efforts over two decades, only limited success could be achieved in doing these operations with a small incision or a ‘Key Hole’. Robotic-assisted and Totally Endoscopic Coronary Bypass (TECAB) is yet to be universally applicable. Newer technologies like mechanical anastomotic devices and percutaneous wire techniques hold a promising future

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