Robotic Heart Surgery Is A Fantastic Tool For Treating Structural Heart Diseases: Dr Sathyaki Nambala

What are Structural Heart Ailments? 

Structural Heart ailments are heart diseases that affect the structure of the heart which includes the heart valves and the fibrous skeleton of the heart. These diseases are present at birth, but some heart diseases develop in the later stage of life. These include conditions like- Valvular heart disease affecting the mitral valve, aortic valve or tricuspid valve and less commonly the pulmonic valve.

Other most common conditions include- Mitral regurgitation - a condition in which the blood leaks backward into the heart, Aortic valve stenosis - reduces or blocks blood flow from your heart into the main artery of your body, Tricuspid valve disease - causing leakage or obstruction in the right heart and Septal defects present at birth such as an Atrial Septal Defect (ASD) or Ventricular Septal Disease (VSD). 

What are the signs and symptoms of SH Ailments? 

Structural heart disease can manifest in various ways. For example, in the case of aortic stenosis, some patients may feel chest pain and other patients may have no symptoms at all until it becomes too late, the heart is absolutely dilated leading to heart failure. Hence, it’s a spectrum of symptoms that may be mild in a few patients and on the other hand, can be very severe in others. It depends upon the structure of the heart that has been affected.

 In the case of Valvular heart disease, a leaking or severely narrowed valve can manifest in symptoms like breathlessness with minimal exertion or on lying down, arrhythmias, fatigue, loss of appetite, loss of weight, dizziness, loss of consciousness etc. Further, in advanced stages when heart failure develops a patient can develop symptoms like swelling in the feet, significant weight gain from fluid accumulation and breathlessness with routine activity. While it is important to be aware of the symptoms, left untreated it leads to life-threatening disease and diagnosis by a specialist at an early stage can be lifesaving.

What are the therapy areas? How it is different from early modalities? 

Earlier, open-heart surgeries were performed via a sternotomy where the breastbone was cut and a  heart lung machine was routinely used. Excessive blood loss was common. Several factors from multiple blood transfusions, infection, delayed bone healing and slow recovery contributed to poor outcomes. Heart surgeries have now evolved with the advancement in technology and specialty hospitals of today use state of the art technology to do the same operations without the ill effects described above.

Use of robotics in heart surgery is something new where a valve replacement or repair can be done through 8mm ports that are smaller than the little finger. However, this technology may not be available in all hospitals, especially in smaller towns and cities. Robotic heart surgery is a fantastic tool for treating structural heart diseases.

That means if we need to replace the aortic valve, and mitral valve, repair any of the valves or need to close a hole inside the heart, we use a robot. Robotic surgery helps a surgeon with enhanced vision and advanced tools, making it a more precise and better way to get treated. It involves small, strategic incisions instead of larger ones used in the earlier techniques performed. This offers greater safety with faster recovery. 

What are the criteria's for performing robotic surgery in India? 

Whether a patient is suitable for robotic or a conventional technique (open heart surgery) depends on several factors like severity of the defects, previous surgical history, and other medical conditions. Every patient who is suitable and safe to have open heart surgery is also suitable to undergo robotic surgery. There are no specific criteria to perform robotic surgery. However, in complicated cases where multiple problems require correction, robotic surgery is not recommended. For instance, if a patient requires a bypass and mitral valve repair simultaneously, then he/she is not suitable for robotic surgery.  

How is the robotic cardiac surgery program at Apollo Hospital, Bangalore making a difference? Tell us a little about the recently launched robotic surgery unit?

Robotic Surgery is an invention that holds remarkable promise. This new revolution is one of the most talked about in the field of surgery today. The idea of robotic surgery is not new in India. It started way back in the 90's but was soon discontinued as the first-generation robots were difficult to use in heart surgery. However robotic surgery picked up very well in abdominal surgery, urology, and oncology.

 Nevertheless, in the past decade robotic heart surgery has seen a slow but definite increase in adoption in Europe and America. We started minimally invasive cardiac surgery in 2008 and it is now commonplace. Similarly, there is no doubt that robotic heart surgery will become an important tool in heart surgery as well, but the scope of its use is still evolving. The robotic heart surgery program in Apollo Hospital, Bangalore, has a strong background considering our considerable experience (13 years) in minimally invasive cardiac surgery (MICS).

It’s been 3 years since we started doing robotic surgery at Apollo Hospital in Bangalore and our experience is now the largest in India. This program is the only one in India where all types of heart surgeries from robotic bypasses to valve repairs and replacements are done with a dedicated robot. It’s incredible to see patients go home in 24 hours after a major heart surgery such as a mitral valve repair/replacement or closure of a hole in the heart and this is exactly why this kind of technology is going to play a huge role in surgery.