Dr. OP Yadava Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi
Dr Yadava completed his medical graduation and Master’s in Surgery from Maulana Azad Medical College and had joined Armed Forces as a Surgical Specialist. He cleared his DNB Examination in General Surgery in the year 1983 and completed his training in cardiothoracic surgery at the Cardio Thoracic Center, Armed Forces Medical College, Pune in 1985. For advanced training, went to Australia and worked under and along with some of the greatest cardiac surgeons of recent times. Besides adult cardiac surgery, he was also trained in Paediatric Cardiac Surgery in Melbourne & Japan and successfully cleared the National Boards in Cardiothoracic Surgery (DNBE). He was honoured with Membership of the National Academy of Medical Sciences (MNAMS) in 1994; FICC in 2003, FIACS in 2005 & FCSI in 2012. He has as an experience of over 12,000 open heart surgical procedures and his special field of interest is coronary artery bypass surgery especially total arterial revascularisation & beating heart surgeries (Minimally Invasive).
Bypass surgery is based on multiple factors such as patient’s symptoms, the coronary anatomy, the type and degree of the blockage, the financial status whether the patient could afford the surgery and also his psychological state.
He also talks about how to manage mild to moderate blockages with the help of medical therapy. And patients who have disease which can be corrected by angioplasty then it is a preferable option over bypass surgery.
He Describes About Different Forms Of Minimal Invasive Surgeries Used Currently And Which Helps To Avoid Pulmonary Complications, Deep Wound Infections And Also Disadvantages Which Were Caused Due To Open Heart Bypass Surgery.
The Complication Rates Depend Upon The Retrospective Or Prospective Clinical Studies. Serious Complications Include Stroke, Deep Sternal Wound Infection Or Life Threatening Tachyarrhythmias. Temporary Complications Such As Superficial Infections, Lung Infections, And Pleural Effusion Can Be Managed With Conservative Treatment.
Normally, A Person Can Drive From The Very Next Day Of The Bypass Surgery As There Won’t Be Any Problem With The Functioning Of His Heart But The Problem Is Of Safety. The Patient Has To Swirl While Driving And This Can Pull His Pectoral Muscle Leading To Severe Sternum Pain.
Driving Is Not Recommended For At Least 4 – 6 Weeks After The Bypass Surgery.
Second Time Bypass Has Become A Very Standard Procedure Nowadays. As Many Of The Patients Are Operated In Late 60’S And 70’S So The Need For A Second Bypass Surgery Arises. There Is No Specific Limit Of Times That A Person Can Undergo Bypass Surgery. But With Each Number Of Surgery, The Risk Also Goes On Increasing.
It Can Be Performed Using Various Configurations. Free Grafts, In Situ Grafts, Single Grafts Or Sequential Grafts Are Used In Bypass Surgery. In Sequential Grafts, One Conduit Can Be Used To Bypass Two Arteries. Dr. Yadava Will Also Describe That A Free Graft Can Be Attached To A Pedicle Graft And Can Do T Or Y Configuration Of Total Arterialrevascularization Known As T Or Y Grafts.
Robots Were Introduced To Perform Robotic Bypass Surgery With Equal Human Dexterity. Robotic Surgery Has Advantages Over Open Heart Bypass Surgery. Dr. Yadava Talks About Fourth Generation Robots And How Robotic Surgery Is Gaining Attraction. Also, The New Arms Of The Robots Have Received Good Feedbacks And Has Become Feasible In Cardiac Robotic Surgery.
The Results Of Total Arterial Bypass Surgery Are Mostly Superior To The Venous Revascularization. Almost 10 – 15 % Of The Venous Grafts Are Blocked By The End Of One Year. Whereas, The Patency Rates Of Arterial Grafts Is High Even At 10 – 20 Years.
Total Arterial Bypass Surgery Revascularization Is Done When A Patient Is Young But It Also Depends Upon Various Factors.
Normally, a person can drive from the very next day of the bypass surgery as there won’t be any problem with the functioning of his heart but the problem is of safety. The patient has to swirl while driving and this can pull his pectoral muscle leading to severe sternum pain.
Driving is not recommended for at least 4 – 6 weeks after the bypass surgery.
Dr. Yadava discusses that if arterial revascularization has given then the results are for long term and if veins are used then chances of failure are higher. Hence, he tells that control of blood pressure, lipids, control of diabetes status, weight control is very essential. Also the patients should be involved in some physical activities for a long term benefit after bypass surgery.
The percentage and results of these grafts also depends on the control of risk factors. Quitting smoking, regular physical activities and control of diet will prolong the efficacy of these grafts.
The reason behind it is that the side branches, the microcirculation, each coronary arteries branches 10 – 14 times before it becomes a capillary, all these are not bypassed. The cholesterol can also saturates in major arteries as well as microcirculation. Even after bypass surgery, there are certain areas which continues to be ischemic. If the graft has failed, then 3% of patients might get a heart attack within a year.
In short term, it is seen that diabetes is a systemic disease and even atherosclerosis. Cholesterol gets deposited in the arteries of the heart, also in the arteries of the brain, kidneys or the other vasculature. Thus, in these patients, there is multisystem involvement with increased chances of renal failure, CVA or wound infections in diabetes. These patients spend longer time in the hospital with high mortality and morbidity.
Dr. Yadava will also talk about long term results in terms of survival and drug patency rates are lower in diabetics as compared to non-diabetics. In such patients, an aggressive treatment is required for glycemic control.
Dr. Yadava will also explain the condition if the coronary artery is critical or the patient gets unstable angina. In such cases, first CABG should be done with certain precautions. He will discuss these precautions to be taken in critical patients. Also avoid using nephrotoxic drugs in such patients.
He will also talk about advantages and disadvantages of the methods used. The simultaneous method is the best option for this type of surgery but the patient has to be selected carefully. The patient should be symptomatic and carotid stenosis should be significant.
He tells us that bypass surgery can be done with peripheral artery intervention. It reduces the hospitalization and is cost effective. It can also be done under the same anaesthesia. Dr. Yadava will also explain the pros and cons of the intervention. Normally coronary bypass is done and the patient is allowed to recover. 4 – 6 weeks is generally recommended for recovery and then peripheral artery intervention is done. If the limb is threatened then both interbventions is done under same anaesthesia.
Dr. Yadava tells us that the problem arises when the patient has an elective cardiac surgery. In such patients, it is recommended that the patient should recover which is generally 4 – 6 weeks and then the non-cardiac surgery is scheduled.
He will also talk about the consequences if we stop the anti-platelets treatment for non-cardiac surgery and what can be done.