What are structural heart diseases?
Structural heart disease is heart disease that affects the structure of the heart, which includes the heart valves and the fibrous skeleton of the heart. These conditions are present at birth, but some heart conditions develop later in life. These include conditions such as valvular heart disease affecting the mitral valve, aortic valve or tricuspid valve and less commonly the pulmonary valve.
Other common conditions include: mitral regurgitation – a condition in which blood leaks to the heart aortic valve stenosis – reduces or blocks blood flow from your heart to your body’s main artery tricuspid valve – causing leakage or obstruction in the right heart and septal defects present at birth such as atrial septal defect (ASD) or ventricular septal disease (VSD).
What are the signs and symptoms of HS conditions?
Structural heart disease can manifest in a variety of ways. For example, in the case of aortic stenosis, some patients may experience chest pain and other patients may have no symptoms until it is too late the heart is fully dilated leading to heart failure . Hence, it is a spectrum of symptoms that can be mild in some patients and on the other hand can be quite severe in others. It depends on the structure of the heart that has been affected.
In valvular heart disease, a leaky or severely narrowed valve can manifest with symptoms such as shortness of breath with minimal exertion or when lying down, arrhythmias, fatigue, loss of appetite, weight loss, dizziness, loss of consciousness, etc. In the later stages where heart failure develops, a patient may develop symptoms such as swollen feet, significant weight gain due to fluid buildup, and shortness of breath during routine activity. Although it is important to be aware of the symptoms, if left untreated they lead to life-threatening illness and early diagnosis by a specialist can be lifesaving.
What are the therapeutic areas? How does it differ from the first modalities?
Previously, open heart surgeries were performed via a sternotomy where the sternum was cut and a heart-lung machine was routinely used. Excessive blood loss was common. Several factors such as multiple blood transfusions, infection, delayed bone healing and slow recovery contributed to poor outcomes. Cardiac surgeries have now evolved with advances in technology and today’s specialty hospitals use advanced technology to perform the same surgeries without the adverse effects described above.
The use of robotics in cardiac surgery is something new where a valve replacement or repair can be performed through 8mm holes which are smaller than the little finger. However, this technology may not be available in all hospitals, especially in small towns. Robotic heart surgery is a fantastic tool for treating structural heart disease.
This means that if we need to replace the aortic valve and the mitral valve, repair one of the valves or close a hole inside the heart, we use a robot. Robotic surgery assists a surgeon with improved vision and advanced tools, making it a more precise and efficient way to get treatment. These are small, strategic incisions instead of the larger ones used in previous techniques performed. This provides greater security with faster recovery.
What are the criteria for performing robotic surgery in India?
Whether a patient is suitable for robotic or conventional technique (open heart surgery) depends on several factors such as severity of defects, surgical history and other medical conditions. Every patient who is fit and safe to undergo open-heart surgery is also fit to undergo robotic surgery. There are no specific criteria for performing robotic surgery. However, in complicated cases where multiple issues require correction, robotic surgery is not recommended. For example, if a patient requires bypass surgery and mitral valve repair simultaneously, they are not suitable for robotic surgery.
How is Apollo Hospital Bangalore’s Robotic Cardiac Surgery Program Making a Difference? Tell us a bit about the recently launched robotic surgery unit?
Robotic surgery is an invention full of 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 in the 90s, but was quickly abandoned because the first generation robots were difficult to use in heart surgery. However, robotic surgery has picked up very well in abdominal surgery, urology and oncology.
Nevertheless, over the past decade, robotic heart surgery has seen a slow but steady increase in adoption in Europe and America. We started minimally invasive heart surgery in 2008 and it is now commonplace. Likewise, there is no doubt that robotic cardiac surgery will also become an important tool in cardiac surgery, but the scope of its use continues to evolve. The Robotic Cardiac Surgery program at Apollo Hospital, Bangalore has a solid track record considering our considerable experience (13 years) in Minimally Invasive Cardiac Surgery (MICS).
It has been 3 years since we started doing robotic surgery at Apollo Hospital Bangalore and now our experience is 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 performed with a dedicated robot. It’s amazing to see patients going home 24 hours after major heart surgery such as mitral valve repair/replacement or closing a hole in the heart and that’s exactly why this kind of technology will play a huge role in surgery.