Dr K M Cherian, founder director Institute of Cardio Vascular Diseases, a unit of Madras Medical Mission of Chennai, is one of the most respected cardiac surgeons in the world today. He and his team of doctors have created sort of a record by performing 25,000 open-heart surgeries and 35,000 angioplasties so far. Apart from these, Dr. Cherian has also done 12 heart transplants including one pediatric heart transplant during his career. It is not surprising, therefore, patients from 26 countries, most of them hopeless cases, had to come to him after having rejected by surgeons in their own countries. Dr. Cherian who has been to Hyderabad recently to participate in the annual conference of Cardiological Society of Hyderabad, talked to P N V Nair of Pharmabiz.com about his achievements as a surgeon and the advances taking place in cardiac surgeries in India and worldwide. Following are the excerpts:

You have been an outstanding medical practitioner in the area of cardiac treatment with a rare record of successful heart surgeries. What do you think is the reason for this achievement and how do you feel about it?

I consider every patient as a relative or a family member and treat him or her with dedication and commitment. Several patients come to us as a last hope and get cured. And every day miracles do happen at our hospital. It is not the building, not the equipment but the cutting edge technology together with a distinguished and committed team of doctors, nurses and paramedical staff that make this success.

Give a brief account of the Hospital, what it stands for and its services to the patients?
The Institute of Cardio Vascular Diseases (ICVD) was started in June 1987 and I am its founder Director. It is a unit of the Madras Medical Mission, a registered charitable society. The Institute's social commitment is visible through it various programmes intended to deliver quality healthcare services to the under-privileged population. In recognition of its excellence in patient care, medical training and research, ICVD is a specialised training centre for the FRCS, Edinburgh, and the National Board of Examinations. In collaboration with the Birla Institute of Technology and Science, ICVD conducts graduate and post-graduate courses in vocational sciences. Post-graduate diploma courses are also conducted in microbiology, medical sociology, medical records management and dietetics.

According to you what are the major achievements of the hospital?
So far, we have done more than 25,000 open-heart surgeries and 35,000 angioplasty / bypass. We have successfully operated upon a 94-year-old patient for valve replacement and bypass. The patient, a Jain, lived 8 years after the operation and died at the age of 102.
Ours is the only hospital in the country which does heart & lungs transplants. We have done 11 heart transplants, one paediatric heart transplant and two heart & lungs transplants.
We have a very unique procedure called Ross Procedure for valve replacement using the patient's own valve. We were also the first to perform Transmyocardial Laser Revascularisation process. The only other place where it is done is the Escorts Hospital in Delhi. We also hold the record for treating the largest number of infants for arterial switch operation. We have done 325 such operations on infants below the age of one month.

There is an increasing preference for non-invasive procedure for cardiac operations world over. Do you think they are more reliable and efficient than traditional invasive methods of cutting open the patient's body?
The advancement in technology has revolutionised both diagnosis and treatment. It has also reduced the risk of operations. Now new devices and tools are inserted or implanted into the human body through a small hole to correct or remove the diseased organ. This is more safe, accurate, infection-free and takes less time for recovery, avoiding longer hospitalisation. There will be minimum open surgeries in the future.

Do you think Robots will take over operations from surgeons in the near future? How do you foresee the future scenario?
Robotic surgery is quite exciting. But it will take some more years to develop it into a reliable and acceptable system. The most remarkable thing about the first robotic surgery is that a surgeon sitting 4,000 miles away did it. Though it will be clean (without the surgeon's hand touching the internal organs), efficient, accurate and infection-free, decision-making will have to be done by the surgeon.

The new innovations and devices have reduced the risks but pushed up the cost of medical care beyond the common man's reach. How do you propose to make healthcare more affordable?
So far India was depending more on imported equipment, which used to be very costly. Now many of these equipment are being manufactured indigenously at a very cheap price. Take the example of the Kalam-Raju stent developed by the President, Dr APJ Abdul Kalam and Dr Somaraju of CARE Hospital in Hyderabad. Now a drug eluting stent is being manufactured by a company in Surat. Heart valves are also being made indigenously. This is the case with all other disciplines. Now one can have a bypass surgery for the equivalent of $ 3,000 in the country, instead of $30,000 in the US. In quality, we are as good as the best in the world.

Till the 1970's the mission hospitals were the mainstay of healthcare services in the country. Then came the corporate hospitals. How do you rate the mission hospitals at present?
They do not invest in the latest technologies and knowledge. The needs are different, the diseases are different. The medicines are changing, the diseases are changing and the world itself is changing. The mission hospitals cannot survive without keeping abreast of the new developments. The corporate hospitals have become the latest healthcare providers, with world-class treatment at Indian cost.

Can you enlighten us on the recent mitral valve replacement done on an American patient at your hospital? How many foreign patients come to your hospital every year?
Let me answer the second question first. Patients from 26 countries --the Gulf, Africa, South-East Asia, the Saarc countries, including Pakistan, Bangladesh and Sri Lanka -- come to us. And the latest is an American, the 87-year-old Brennen Berhard Emerson, who needed a mitral valve replacement. As he was too old and had undergone multiple surgeries before, including a triple bypass, none of the hospitals in the West, including the US, wouldn't perform the operation. Some Indian friends suggested to him that he come to us for the operation. Now more than a month after the surgery he has fully recovered. It would have cost him more than $ 50,000 in his own country. But at ICVD, he spent only the equivalent of $8,000, including the cost of his travel and the stay at the hospital for more than a month. The patient's damaged mitral valve has been replaced with a bio-prosthetic valve whose life is assured for at least 15 years.

Do you undertake any research activities and try to develop indigenous substitutes for imported tools and devices at ICVD?
We are conducting studies on developing genetically engineered heart valves, which will be more acceptable to the human body. Cells from the patient's tissues (endothelial cells) are used for growing the required valve genetically. At present, patients are fitted either with a metal valve or a bio-prosthetic valve. The bio-prosthetic valve could be either synthetic or of porcine or bovine origin. The metal valve is lasing but runs the risk of hurting the patient and thus (lead to) bleeding. And the patient needs to be on an anti-coagulant (blood-thinning) medication all his or her life. The prosthetic valve, though acceptable to the human body, has a shorter life of 10-15 years and is generally recommended for elderly people. The genetically engineered valve combines the advantages of both. But the valve is only at the trial stage and it will take some time to reach the market.
Besides the genetically engineered valve, ICVD is also doing research on stem cells in association with Reliance Life Sciences.

What is your future plan? Are you starting any hospitals outside Chennai and Tamil Nadu?
We have some big project for Delhi which is still at the discussion stage.