Surgery team heartened by open heart success

Buoyed by its first successful open heart surgery, the Caribbean Heart Institute (CHI) is gearing up to deepen its work here and persons who suffer heart attacks are now being promised care at its facility.

Those who undergo open heart surgery will have to adhere to an exercise programme and diet modification as part of their after care which CHI would be expected to oversee.

Lead surgeon Dr Gary Stephens along with Dr Sunil Abrol and team performed the first ever open heart surgery in Guyana on Saturday at the CHI located at the Georgetown Public Hospital (GPHC). Dr Stephens stated that the CHI is open for business for patients who suffer heart attacks and they have the medication and the equipment He added that if they are able to stabilize the patient then surgery does not have to be done on an emergency basis. He further stated that not every patient can have surgery since some are at higher risk than others. Some of these patients he said may need to go overseas but so far they have a certain category that they are comfortable operating on.

Anyone undergoing open heart surgery will have to undergo a behaviour modification programme and will have to abstain from smoking. He stated that he will be around to take care of persons if any problem arises. Dr Stephens said that three or four days after the surgery persons will have to be on an exercise programme.

A person is selected for the open heart surgery pending an angio-gram (which checks for any blockages) and if there are, Dr Stephens and team will determine who will have the treatment. It’s all based on the nature of the coronary active bypass which determines which patient will undergo surgery. The angiogram uses a special dye and camera to take pictures of the blood flow in an artery. The coronary angiogram looks at the arteries near the heart.

Persons can have open heart surgery done at a cost of US$3,500 to US$4,000 or sometimes US$5,000 which would include the required medication. This is far less than the US$10,000 or US$20,000 or more that persons pay abroad. Dr Stephens stated that persons who are approved for the surgery would be given a package deal and a separate deal for the medication. The CHI has an arrangement with the Government and private sector. Members of the public are being facilitated for surgery through the efforts of the Ministry of Health.

Dr Stephens stated that CHI is operating at a loss in its present plans but in the long term they will be able to recover the cost for the surgeries. He stated that they have to pay the teams that are brought in but hopefully when the Guyanese team develops the relevant skills there will be no need to bring anyone in.

Open heart surgery will be done in Guyana at the CHI once a month but there will now be a six-week break to review the procedure and fix minor issues that the team was not happy with.

A 64-year-old pensioner, Manmohan Singh, from Better Hope was the first person to undergo `beating heart surgery’ or `off-pump heart bypass surgery’ and is presently recovering at the GPHC. He had been on a list of 30 persons who are in need of this type of surgery.

Dr Stephens, a Guyanese surgeon living abroad, in partnership with Dr Abrol who is originally from New Delhi, India and their team performed the four-hour surgery on Singh.

Dr Stephens stated that they had identified three persons initially for the surgery but they narrowed it down to two then eventually one after running tests on the second patient. Dr Abrol stated that the patient was on some medication which he was supposed to have stopped taking a week before the surgery. Additionally, his heart’s function from the year before had decreased significantly from the normal 60% to 25% and after the cardiologist ran the test they decided against operating. He stated that the patient would have bled and it would have made the surgery more high risk. After considering all these factors it was felt that cancelling the surgery was the best decision.

The team which performed on Singh comprised Dr Stephens, Dr Abrol, anesthesiologists from Trinidad and Guyana, a perfusionist from Barbados, nurses from Trinidad and Guyana and two open heart surgery nurses from New York.

At a press briefing held at the GPHC yesterday, Dr Stephens noted that there are two ways to do heart surgery and one way is the beating heart surgery which requires the doctors to stop the heart using the heart lung machine. They can also do the bypass with the heart beating and this requires greater skill. He stated that they completed Singh’s surgery without the heart lung machine although this was on standby.

The surgery was done by off-pump technique, that is, the patient was under anesthesia and they were able to do a sternotomy (a type of incision in the centre of the chest that separates the sternum). Bypass was then done and while the heart was still beating the doctors used a stabilizer to stabilize the heart.

The patient is expected to be out of the hospital within three to four days and Dr Stephens will be around to make sure that there are no problems.

Dr Stephens expressed his gratitude to the Government and all those persons who helped them to make the dream of having open heart surgery in Guyana a success. He stated that he was able to benefit from medical school training with the aid of Guyanese taxpayers’ money and he decided to give back to his homeland.

Minister of Health Dr Leslie Ramsammy thanked Dr Stephens and his team and the staff of the GPHC which he said played a role in the surgery. He stated that Singh has written his name in history. He added that health care is not inexpensive and that in order to do more with the resources they have to develop partnerships to reduce health care costs. He stated that two years ago Dr Stephens and team presented the proposal and now the first surgery has been completed on the anniversary of CHI.

Dr Abrol said that he was honoured to be part of history in Guyana. The next surgery will be done in six weeks.