ASIAN HEART INSTITUTE: A CULTURE OF ETHICS AND EXCELLENCE DR. RAMAKANTA PANDA
VICE CHAIRMAN ASIAN HEART INSTITUTE
The COVID-19 pandemic reminded us of what Hippocrates famously said, "Wherever the art of medicine is loved, there is also a love of Humanity.” Even in the middle of the pandemic, when lifesaving cardiac surgeries were needed, Asian Heart Institute continued to maintain a 100% cardiac free zone. The hospital conducted several heart surgeries in the hospital - fully protected from COVID, while performing its civic duty by relocating 60% of its staff to the COVIDMMRDA hospital.
SERVICE TO HEART PATIENTS DURING THE PANDEMIC
In 2020, at the height of the pandemic, the hospital operated over 25 highly vulnerable patients who would not have made it. Let's take a look at two of these cases
81-year-old Akshay Bhatia (Sept 2020): He was a patient of heart failure. Detailed investigations revealed severe calcific aortic stenosis, mild aortic regurgitation and moderate mitral regurgitation. The patient also had long standing diabetes mellitus and systemic hypertension. He was a known case of coronary artery disease and had already undergone coronary artery bypass surgery in 2010. He also had chronic kidney disease. Initially, it was planned that he would have surgical aortic valve replacement and mitral valve repair. Dr Vijay Dsilva of Asian Heart Institute says, “due to high surgical risk in view of age and other comorbidities, TAVR was the only way to save this life.”
60-year-old Shailesh Kanani (August 2020): Mumbai-based businessman Shailesh Kanani was successfully and safely operated on at the Asian Heart Institute. Doctors performed a valve replacement surgery to fix his severely narrowed heart valve and treat the abnormal enlargement that had developed in his aorta - the largest artery in the body. Kanani, who was diagnosed with a narrowing of his heart valve in 2006, suddenly started experiencing difficulty in breathing in March 2020 and was rushed to the Asian Heart Institute. Remembering Kanani's heart condition, Dr Ramakanta Panda, Chief Cardiovascular Thoracic Surgeon and Vice Chairman, Asian Heart Institute, shares, “His valve narrowing had progressed to a very critical level. Further, the aortic valve was filled with calcium deposits, as a result of which his heart was not able to pump enough blood.” Kanani underwent a nine-hour long TAVR procedure.
"In fact, during the COVID pandemic, it became evident that a minimally invasive procedure called Transcatheter Aortic Valve Replacement (TAVR) was the best option for many patients,” notes Dr Dsilva.
Rajeeva Ranjan Sinha (August 2021): Post pandemic of course, surgeries are in full swing. Take the case of Nerul's Rajeeva Ranjan Sinha, who was wheeled in in August 2021 with a double valve impairment and other coronary complications
that required a combination of five procedures - one bypass, an aortic valve replacement with 23 mm Magna Ease Tissue Valve, Mitral valve replacement with 29 mm Magna Ease Tissue Valve, ascending aorta replacement, and Left Atrial Appendage Closure.
All the three cases described above have a very high level of difficulty. Perhaps the only team that can pull this off, and enjoys a 99.8% success rate in bypass surgery, is the team led by the world’s leading cardiovascular surgeon, Dr Ramakanta Panda.
WORLD RECORD
In 2014, Dr Panda created history when they performed an extremely high risk and rare procedure using a record number of 12 bypass grafts on a patient with 17 heart blockages. With this case, Dr Panda, globally known for successfully operating extremely high risk cardiac cases, broke his own record of operating a patient with 10 grafts. This patient, Mithalal Dhoka from Karnataka, was suffering from diabetes and hypertension for more than two decades. In early February that year he developed chest pain and breathing difficulty, for which he was initially admitted to a local hospital. An angiogram showed severe multiple blockages (17 blockages) in all three major arteries of his heart. All the arteries were very small (1 mm in diameter). In view of very small arteries, too many blockages and too much cholesterol deposits in the arteries, the patient was considered inoperable. However, Dr Panda took up the challenge. At Asian Heart Institute, Dhoka was taken to the operation theatre in a critical condition with low BP and high lung pressure. An intra-aortic balloon pump (IABP) was put inside his heart to support his BP and circulation while he was being operated upon. He underwent bypass surgery with bypass grafts to 12 arteries. The entire surgery was done on a beating heart technique. The only way to keep the grafts open was to use arterial grafts. Unfortunately there are only four arterial grafts available (two mammary arteries and two radial arteries ) to do the bypass. Dr Panda used a unique technique of sequential grafting where he attached one bypass graft, one after another, to three to four arteries, to bypass all the blockages.
THE CORE TEAM AND THE CULTURE
Dhoka is one of many legendary patients operated by Dr Panda and his team of surgeons at the Asian Heart Institute since its inception in 2002. Dr. Panda has successfully performed over 25000 successful cardiac surgeries till date and is recognised for pioneering many techniques in cardiac surgery. The secret, of course, is humility and perseverance.
“There is no substitute for hard work in life. One of my longest heart surgeries lasted for 16 hours at a stretch. But these things are inconsequential in the face of a precious life. This is the greatest satisfaction a man like me can get to help a person who is almost dying to recover and lead a normal life. This is not possible without my stellar team, comprising Dr Vijay D’silva, Dr Pradyot Kumar Rath, Dr Sunil Vanzara, Dr Tilak Suvarna, Dr Santosh Kumar Dora and Dr Manoj Chauhan, who have stood by me, with consistency, passion and perseverance. It is thanks to them that in the last 19 years our results have been the best in the world. Our infection rate is among the lowest in the country and among one of the lowest in the world. In the area of complex angiography and angioplasty, we have done a lot of innovative work, saving lives even for the most inoperable cases. AHI is the highest accredited hospital in India; with triple gold certificates from JCI (Joint Commission International), NIAHO (National Integrated Accreditation for Healthcare Organisations) and ISO (International Organisation for Standardisation).
“At Asian Heart Institute we believe in creating a culture of excellence. We are also one of the few centres in the world which conducts nearly all bypass surgeries on a beating heart, with almost 90% patients getting arterial grafts,” adds Dr Panda, who has performed more than 4400 extremely highrisk procedures.
Born in the Damodarpur village of Jajpur district in Orissa, in 1954, he is the son of a farmer who has proved that perseverance and persistence can fulfil the most ordinary persons’ dreams. He is often spoken of in the same breath as Dr. Michael E. Debakey and Dr. Denton A. Cooley. With a post-graduation in surgery and heart surgery between 1980 and 1985 at India’s revered AIIMS, he proceeded to Cleveland Clinic for his fellowship. Blessed with a string of great gurus, he trained under legendary cardiac surgeons like Dr Floyd Loop and transplant specialist, Prof Magdi Yacoub at Harefield hospital in UK, thereafter. In 2002, he set up India’s
famed Asian Heart Institute. In 2009, he led the team that successfully operated on the then Prime Minister of India, Manmohan Singh. This was followed by highly complex surgeries on several leaders of Indian politics, such as Lalu Prasad Yadav, Tarun Gogoi, Narasingha Mishra, D Raja, Rajiv Shukla and many others.
Hollywood, Bollywood and the thespians of corporate India trust only his hands when it comes to open heart surgery. Dr Panda is recognised for pioneering many techniques in cardiac surgery. However, an unflinching quality to excellence is often accompanied by ethical practice. Largely a very humble man known for his philanthropy and mild-manners, Dr Panda is feared for his ethics. He is a crusader against the cut-practice and other malpractices that ail certain pockets of the healthcare system in India. His famous campaign - “Honest Opinion, No Commission To Doctors’ shook the very foundations of India’s medical practice. Doctors all over the country, came out in support of Dr Panda in large numbers. Dr Srinath Reddy backed the campaign with the view that the "The initiative to de-normalise and eliminate cut practice in the medical profession is very welcome and long overdue. The ethical foundations of this profession need to be reinforced by the professionals coming together to cleanse it of distortions that have crept in. This will only happen when we speak up. Asian Heart Institute needs to be congratulated for opening the door to honest introspection and sincere selfcorrection by the medical profession.” Today, Dr Panda is an ambassador for healthcare reform in India, and, as the team of doctors at Asian Heart Institute grows larger, the world's most inoperable cases are finding their way into their safe hands. His close friend and ambassador Akshay Kumar and he routinely spread the message of heart-health to all. Here is a detailed narration of two more cases operated by the team at Asian Heart Institute.
Asha Phatak (2017): Mumbai resident Asha Phatak (68) who weighed only 35 kilos and had a fatal heart condition got a new lease of life after a successful aortic valve replacement and bypass surgery. Phatak, who weighed 60 kilos, lost 25 kilos in one and a half years due to her heart condition. She was in a critical
condition and had suffered congestive heart failure. She also had fluid in her lungs and low blood pressure. “The patient’s heart pumping was very weak (only 20-25 % pumping function). She had two major heart blockages (on Left Anterior Descending Artery and Ramus Intermedius) and narrowing of a heart valve for which she needed to undergo both bypass surgery and aortic valve replacement. Besides, she was extremely fragile and weighed only 35 kilos at the time of the operation. She was in the ICU for 19 days before the surgery. All these factors together made this a highly complex and risky operation,” reminisces Dr Panda. In a 10-hour long surgery, doctors performed a part of her bypass surgery with the beating heart technique and part with the help of a heart lung machine. After the bypass surgery, her heart was stopped temporarily to replace the narrowed valve with the new one. Post-surgery, she was shifted to the ICU and put on ventilator support. She was in the ICU for two months, till the time of her discharge from the hospital.
Mamta Pani (2011): Mamta Pani came to Mumbai from Orissa with a heavy heart, literally. She could hardly breathe or walk. Scans revealed that she had a tumour the size of an infant's feeding bottle growing in her heart. What amazed doctors at the Asian Heart Institute was that Pani's tumour weighed 150 gm and was 17 cm long. "We have never seen a tumour this big growing in the heart. What made this case even more difficult was that the tumour was growing from the right ventricle rather than the aorta, which is generally the case with this condition called myxoma," says AHI head Dr Ramakant Panda.
During the surgery, the doctors realised that the tumour had eaten up a major part of the heart's right valve, called the tricuspid valve. "(It) was completely damaged. We had to use the pericardium (the thin membrane covering the heart) to reconstruct the damaged valve after removing the tumour," shares Dr Panda.
Pani, who lives in Orissa, had earlier undergone surgery in Pune for the tumour's removal. But it grew back. A myxoma is a rare, usually non-cancerous, tumour of the heart. But of all benign heart tumours, it is the most common. Seventy five percent of myxomas are found in the left atrium (one of the four chambers of the heart), and almost all of the rest in the right. It is rare for a myxoma to be found in either of the ventricles (the lower chambers of the heart) The tumour takes either of two general shapes—round and firm or irregular, soft and gelatinous. The myxoma afflicting Pani weighed 150 gm and was shaped like a 17-cm-long baby feeding bottle. It grew in the right ventricle. It had damaged her heart's tricuspid valve, which had to be reconstructed with the organ's covering membrane.
Such challenging cases are routine for Dr Panda and his team, because the culture of ethics, expertise, empathy and excellence is alive and well at Asian Heart Institute.