At the heart of it all: Demystifying heart surgeries | India News

Cardiovascular surgeons are the custodians of the most vital organ—the heart—working tirelessly to keep it beating. For the latest instalment of the Times Conversations series, three leading cardiac experts from Welcare Hospital, Kochi, shared their insights and expertise in a panel discussion organised by The Times of India.The participating doctors were Dr Shiv K Nair, senior consultant and head of Cardiovascular and Thoracic Surgery; Dr Riju Nair, consultant in Cardiovascular and Thoracic Surgery; and Dr Mary Smitha, senior consultant and head of Cardiac Anesthesiology. Together, they addressed myths, answered common questions, and offered sound medical insights into cardiac surgery, heart health, and lifestyle adjustments.Understanding cardiac surgery: Cardiac surgery, Dr Shiv explained, is a versatile speciality that can treat nearly all forms of heart disease. From bypass surgeries and valve repair / replacements to repair of congenital heart defects and vascular disorders, he explained that the field covers a wide spectrum. He pointed out that in today’s era, coronary artery disease—the leading cause of heart attacks—is commonly treated through cardiac surgery, specifically coronary artery bypass grafting or bypass surgery, as people call it. In addition to bypass surgery, other conditions can also be treated with cardiac surgery. These include problems with heart valves, congenital (present from birth) heart defects, and diseases of the aorta. Some lung conditions and blockages in blood vessels, from the legs all the way to the brain, can also be treated surgically by cardiac surgeons. “Among these, aortic surgeries deserve special mention. Conditions affecting the aorta—the body’s main artery—can be extremely serious, often acting like a ‘ticking time bomb’ that can rupture without warning. Timely diagnosis is key and expert surgical intervention is critical, and in many cases, these procedures can be truly life-saving. Ultimately, it is a combination of medical and surgical approaches that ensures the best outcomes for patients,” said Dr Shiv.Recognising a heart attack: A heart attack, or myocardial infarction as we call it, is a consequence of coronary artery disease. Dr Shiv explained that a heart attack occurs when there is a mismatch between the heart muscle’s need for oxygen and what the arteries can supply due to the blockages, citing that the condition was especially common in diabetic patients and is among the leading cardiac emergencies across India. He laid special emphasis on saying that, “Heart attack is the most common cardiac condition we encounter, particularly in the Kerala population. Lifestyle changes, Diabetes and tobacco dependence are primarily the cause for this increase. Role of anesthesia: Addressing a frequent concern, Dr Mary Smitha assured that patients undergoing cardiac surgery are given general anesthesia, because of which they would remain completely unaware and pain-free during the procedure. “Before surgery, we explain about what to expect in detail to patients to ease their worries. Most cardiac surgeries are performed under general anesthesia, so the patient is completely pain-free and not awake during the procedure. With modern monitoring technology, we can track the depth of anesthesia to ensure the patient remains fully unconscious throughout.”As for duration, the average cardiac surgery lasts around 3-4 hours, she said, but that it could vary depending on the specific procedure and the patient’s condition. The process includes several steps, such as inducing anesthesia and setting up monitors, which also take some time. She claimed that despite the complexities involved, the overall experience of undergoing anesthesia has now become far more safe and comfortable due to technological advancements.Risk factors for women: The doctors agreed that women are somewhat protected from heart disease until menopause due to hormonal factors. “After that, their risk levels become similar to men,” said Dr Shiv, who articulated that fewer women undergo surgery, possibly due to social factors, not medical ones. Unless there is a strong family history, women are protected in the initial years, but after menopause, the incidence of coronary heart disease in women becomes similar to that in men. Overall, the impact of heart disease on women and men is about the same, though the age of onset may vary slightly,” he said. Identifying the symptoms: Dr Riju Nair emphasised that symptoms of a heart attack can vary significantly from person to person. While chest pain and breathlessness are common, some people may experience pain in the jaw, arms, especially the left arm, the throat or even the back. While chest pain remains the most commonly encountered symptom, not all chest pains are a heart attack. While not a strict rule, cardiac-related chest pain is often described as a sudden, intense pain in the chest with a feeling of anxiety or a strong sense that something is seriously wrong- an impending sense of doom.People with risk factors—such as smoking, diabetes, high blood pressure, or a family history of heart disease—should never ignore unusual discomfort. “Even mild symptoms can be a warning sign,” Dr Riju noted. “It’s always better to be safe and get checked.”Doctors also warned against waiting for the “right time” to seek help. Heart attacks often happen during the early morning hours. What may seem like gas or indigestion could actually be a sign of a heart attack.The doctors warned against waiting for the ‘right time’ to seek help. They shared that many heart attacks occur in the early morning hours, especially around 4 am. Even sensations mistaken for gas or indigestion could be signs of cardiac distress. “Timely medical intervention significantly improves outcomes,” they added. On the question of monthly check-ups, Dr Riju stated, “Monthly check-ups may not be necessary for everyone. After cardiac surgery, people return to their routine personal and professional life soon. However, the recommendation is to have basic blood work-up done at least once a year. If you belong to the “high risk” group, it is advisable to have this done every six months. Lifestyle diseases like diabetes may require more frequent check-ups but not otherwise.”The obesity paradox: While obesity contributes to diabetes and hypertension, Dr Shiv noted that not all obese people would develop heart disease, instead claiming that its role was indirect. However, he emphasised that being fit and maintaining a healthy weight was essential, especially as the aging process begins to affect arteries from as early as age 20. He illustrated this by saying, “In my experience of over 15,000 cases, I have seen only about 150 patients weighing over 100 kilos. This suggests that heart disease does not exclusively affect obese people. That said, you should not be obese. It is important to keep yourself fit and try to lose weight if you are obese, as obesity contributes to other major conditions, which in turn increase the risk of blockages.”Recovery and follow up: Dr Riju outlined that recovery is far quicker today than the myth of a compulsory three-month rest period. “Patients are out of bed within a day, walking by day three, and climbing stairs by day six. Within weeks, most can resume 80 percent of their normal activities,” he said. The first follow-up after surgery is after one month. Essential medications are optimised. After heart surgery, it’s completely normal to continue taking certain medications as part of your recovery. These may include medicines to lower cholesterol, blood pressure pills, and blood thinners to prevent blood clots. Taking them as prescribed helps keep your heart healthy and reduces the risk of future problems. “Diabetics must maintain tight sugar control. Lifelong lifestyle modification in this regard is the key,” he shared.After surgery, it was common for patients to soon return to normal life, even undertaking pilgrimages as Dr Shiv noted. He said, “So many patients go on pilgrimages. In fact, I have many patients who call me from these places to share their joy at being able to do what they’ve long wished to do. Often, they have spent five to six years before their surgery yearning to make this journey but being unable to. One of the first questions they ask me after the procedure is, ‘When can I go?’ I tell them that, given their age, they can resume all age-appropriate activities. I remind them that if they are 70 years old, having had bypass surgery doesn’t make them 40 again. It’s important to respect your body’s limits while enjoying life fully.”Post-surgery, strenuous gym routines were discouraged by the doctors. Instead, walking was recommended. According to the doctors, a morning walk of at least 2 km was seen as not only safe but beneficial for metabolic activity.Stents, bypass and minimally invasive surgery: Dr Riju explained the procedure of stenting, distinguishing the process from bypass surgery by outlining that stenting involves placing a spring-like device to keep arteries open. Bypass surgery, on the other hand, creates a new route for blood flow. He added that both have their uses depending on the severity and location of blockages. “Minimally invasive surgery or key hole surgery as it is referred to, is the art of doing cardiac surgery through a small incision. Advanced instrumentation has enabled us surgeons to perform this art with ease but however, patient safety always takes priority,” Dr Riju said.While cosmetically appealing, Dr Shiv answered that minimally invasive surgery was only suitable in select cases. Safety and long-term effectiveness would always take precedence, was his opinion.Diet and lifestyle: Kerala diets can be quite healthy, said Dr Shiv, if modified slightly. Those who wanted to take charge of their health were advised to avoid deep-fried snacks, excessive sugar, and bakery items. They were recommended to replace them with vegetables, pulses, and moderate portions of rice or wheat. Dr Mary added that eating salads before meals can reduce sugar absorption. Among their recommendations were that raw fruits and vegetables be preferred over juices, local ingredients be utilised and that extreme diet shifts (like switching entirely to quinoa) were unnecessary.Dr Shiv highlighted that smoking alone greatly increased the likelihood of developing heart problems, and if paired with diabetes or hereditary risk, it became even more dangerous. “I don’t understand why it hasn’t been banned outright because in my view, it is the worst thing anyone can do,” he said.When it comes to cardiac emergencies, location, technology, and expertise can make all the difference. Being treated at a centrally located hospital with advanced equipment and a skilled team greatly improves the chances of survival—even in the most critical situations.Moreover, access to life-saving technologies like ECMO (Extracorporeal Membrane Oxygenation) and E-CPR (ECMO assisted CPR) can provide vital support when the heart and lungs are under extreme stress, giving patients the best possible chance at recovery.The message of the panel discussion was simple yet urgent: Take symptoms seriously. Don’t wait. A timely response and ongoing care can help patients not only survive but thrive. – Resp.Edit@timesofindia.comDisclaimer: The views and opinions expressed in the story are independent professional judgment of the experts and we do not take any responsibility for the accuracy of their views. This should not be considered as a substitute for medical advice. Please consult your treating physician for more details. 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