It was world Health Day just a few hours ago. At Indian Vocal we make it a point to speak about issues concerning health. India Vocal spoke to Dr. Ajit Jejurkar, Consultant Cardiothoracic Surgeon, giving insight on the risk factors associated with cardiac surgeries, the increasing number of heart ailments and his success rate on 2500 cardiac surgeries till date.
Dr. Ajit Jejurkar, the Consultant Cardiothoracic Surgeon, spoke to us on why he chose to be a Cardiothoracic surgeon, the heart ailments addressed by him, the qualities of a good cardiac surgeon and lastly his future plans.
Could you tell us about your education and family?
I have completed my MBBS from B J Medical College, Pune. Later, my specialization in General surgery (MS in General surgery) was pursued from the Govt. Medical College, Aurangabad. During my specialization in general surgery, I developed a keen interest in cardiothoracic surgery so I decided to join the super-specialization in cardiothoracic surgery. I got selected for Mch (cardiothoracic surgery) at Nizams Institute of Medical Sciences, Hyderabad. Here, I got the opportunity to learn various cardiothoracic surgery procedures from stalwarts of the field. I joined in the same department as the assistant professor. As a faculty, I got an opportunity to train junior fellows apart from clinical job responsibilities. After about 2 years, I left the job and decided to start my private practice in cardiothoracic surgery. For last 8 years, I have done different kinds of cardiothoracic surgeries at various private hospitals with excellent results.
Why did you decide to specialize in this field?
I developed an interest in cardiothoracic surgery during my specialization studies in cardiothoracic surgery. This field is very challenging and there is a lot of scarcity of cardiothoracic surgeons due to tremendous hard work and commitment required for this specialty. During my course, I felt that by becoming a cardiothoracic surgeon, I can serve the society in a much better way and fill the lacunae in this particular field.
What do you like most about being a specialist in cardiac surgery?
As a cardiac surgeon, every surgery is a new challenge and life and death situation for the patient. It requires a lot of qualities like proper planning, precision, temperament, quick decision making on the operation table. I have to lead the team and get the best out of everyone to complete a surgery successfully. It gives a lot of fulfillment when a patient operated by me opens his eyes in the postoperative recovery room.
Why do we see so many heart ailment cases these days?
Cardiac diseases are the lifestyle diseases. There is a major lack of adequate exercise, sedentary lifestyle, an improper diet with low fiber and high intake of junk food. The psychological stress, lack of adequate sleep and rest, familial history of heart disease, high cholesterol in the blood, increasing diabetes and hypertension are also the major causes of increasing cardiac diseases. We are witnessing nowadays, in India as compared to the western world, heart diseases are occurring in more younger people and outcomes are heart-wrenching.
Why heart attack/disease does occur?
Our heart is made up of a special type of muscle which keeps working continuously from birth till one’s death. For its proper functioning, the heart muscle requires a continuous supply of various nutrients like oxygen, glucose, calcium which is delivered through blood via coronary arteries. Whenever there are significant blockages in these the blood carrying vessels (coronary arteries) to heart, heart muscles have to work without the supply of nutrients, which results into a damage and eventually death of heart muscles. This death of heart muscles is called a heart attack. The extent of damage will depend upon how many coronary arteries are blocked.
What are the risks and difficulties associated with a heart surgery?
For doing most of the heart surgeries, we need to divert patients whole blood to the heart-lung machine which is doing the work of a patient’s heart (pumping) and lung (breathing) during the heart surgery. Also, the heart needs to stop from beating to perform the heart surgeries. This whole scenario puts the patient into un-physiological state causing triggering of inflammatory markers. These inflammatory markers have deleterious effects on patients various organs causing renal failure, lung dysfunction, stroke or paralysis, bleeding, etc. Apart from these risks infection, arrhythmias, cardiac arrest are other complications in cardiac surgery. Cardiac surgery is a team work where all team members like a surgeon, an assistant surgeon, an anesthetist, a perfusionist (a healthcare professional who uses the cardiopulmonary bypass machine (heart-lung machine) during cardiac surgery), and an OT nurse have to work with utmost coordination. Even the best cardiac surgery can be a failure if not managed properly in postoperative recovery.
How long did it take you to get to where you are now and what did it involve?
It took almost 25 years since I joined medicine (MBBS) in 1994 to reach to the current status for me. Since I joined this field in 2005, it has been continuous hard work, commitment to excellence, a lot of sacrifices and sleepless nights. There were a lot of moments I felt frustrated but patience is the only solution for all problems. I had to ignore all my family issues and stay focused on my work during all these days.
Our professor used to tell us that, “Heart is like a God in the temple, the priest who follows all the rituals is only allowed to enter the temple and touch the God”.
What ailments related to the heart do you address?
With increasing experience and sub-specialties, cardiothoracic surgery has again been subdivided into Adult Cardiac Surgery, Pediatric Cardiac Surgery, and Thoracic Surgeries. With my experience, I have trained in all these sub-specialties and can perform all these surgeries with good results. My key areas of surgery are coronary artery bypass surgery (CABG), Heart Valve surgeries, Aortic aneurysm surgeries, simple pediatric cardiac surgeries and thoracic surgeries.
What is the maximum hour you have given to one surgery?
Cardiac surgery is not only surgery but a lot of post-operative care. Sometimes you have to take back the patient to the OT due to excessive bleeding, cardiac tamponade, graft revision or delayed chest closure. This is a continuous process until the patient is stable and out of danger. Several times I have spent almost 24 hours continuously with the patient.
Tell us a little about your work in surgery, we have learnt that you have done 2,500 heart surgeries, what has been the success rate to date?
Yes, I have operated various cardiac surgical patients with almost 99% success rate which is as per international standards. My special interest is in coronary artery bypass grafting with beating heart techniques, various valve surgeries though I do operate other cardiac and lung diseases patients.
What are the different kinds of heart/cardiac surgeries do you perform?
I do operate on a variety of cardiac surgical patients like Bypass surgery, Valvular heart diseases, congenital heart diseases, aortic aneurysm surgeries
Out of these surgeries, which surgery is more prevalent in your patients and why?
As I mentioned before my major work is Coronary Artery Bypass surgery and Valvular heart diseases as these are more prevalent in India. Though congenital heart diseases requiring surgical interventions are also more prevalent in India, however, it requires very specialized setups. We also need very skilled and experienced manpower to handle such cases. There is a severe scarcity of pediatric cardiac surgical centers in India.
Over these years what are the common symptoms you have seen in your cardiac patients?
Common symptoms are shortness of breath or breathlessness and angina pectoris (chest pain) in cardiac diseases even though palpitations, recurrent respiratory infections, syncopal (fainting) attacks, blue babies are other commonest symptoms.
What are the essential qualities a surgeon needs?
Surgery is not only science but also an art. A good cardiac surgeon should be a good artist apart from having sound knowledge of the subject. Also, a good cardiac surgeon should be a good team leader who can get the best out of his colleagues. He should be quick and bold in decision making which comes with experience. He should be hardworking and have the temperament to work for long hours.
How difficult is it to come to terms with a patient’s death during the surgery?
Death of the patient is always a big trauma not only for the family members but also for doctors. It is really very difficult to communicate it to the relatives of the patient. In fact, the doctor has to be very skillful and soft-spoken to communicate the demise to the relatives. A doctor should be able to handle the emotions of the relatives of the dead patient.
As a cardiac surgeon, how do you keep up with the developments taking place in medical techniques?
There are always new developments happening in medical sciences and it is very important to keep yourself updated about these developments. I personally keep reading the latest journals, news and attending various conferences and workshops. Apart from these, I keep discussing some uncommon cases with my friends and senior cardiac surgeons.
Any anecdote that you still remember in your career that has changed the way you look at things as a doctor?
About five yrs back, when I was working with a private hospital in one of the suburbs in Mumbai, a young businessman was brought to the casualty with severe chest pain and uneasiness. He was having his lunch at a nearby restaurant and started feeling uneasy. So he was immediately shifted to our casualty where within few minutes he had a cardiac arrest. Our senior doctors took charge of the situation and started resuscitation (CPR). Once his condition was a bit stabilized, he was immediately taken into the cath lab and an emergency angioplasty was done on himThe patientnt was discharged within 3 days and today he is happily leading his life. Reaching the hospital on time is very important. This patient was so fortunate that at the time of a severe heart attack he was just 5 minutes away from the only cathlab in that area. A delay of another 10-15 minutes could have costed the patient’s life.
What breakthrough you would like to make? Where do you see cardiac surgery in the next 10 years?
As you know, the cost of a heart surgery is very high. Due to this, a lot of poor patients are deprived of a proper treatment. I wish no patient should be deprived of heart surgery in India due to financial constraints. The solution is promoting “Make in India” to reduce the cost of items required for heart surgery.
In the next decade, acceptability and affordability will increase for cardiac surgery. More cardiac surgery units will come up at remote places and the surgery will be within the reach of even the poorest section of the society. Simultaneously newer advances like minimal invasive surgery, Roboti surgery, Heart transplants and Heart failure surgeries will become more established.
What are your future plans?
Prevention is the best treatment. Treating after heart disease involves a lot of financial and emotional stress on the individual and his/her family. I would like to work on preventive cardiology to educate people for a healthy living.
Doctor associated with the hospitals in the city:
I am on the panel of consultant cardiothoracic surgeon at all major hospitals in Pune and PCMC. Just to name a few hospitals like Ruby Hall Clinic, N M Wadia institute of cardiology, Poona hospital, Sahyadri hospital, Ruby alicare.
Unconstruction at Shivajinagar, Pune will be operational in next few months. I am available for consultation at all above hospital by appointments.