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Heart surgery sans general anaesthesia

T.V. Sivanandan



PIONEERING SURGEON: Vivek Jawali

GULBARGA: Totally closed heart surgery, including bypass surgery, with the help of advanced endoscopic equipment will soon be a reality.

Vivek Jawali, a leading heart surgeon who pioneered the revolutionary Awake Heart Surgery (AHS) in India told The Hindu that he is working on a new procedure for totally closed heart surgery.

Dr. Jawali is a product of Mahadevappa Rampure Medical College here and hails from an agricultural family in a village in Aland taluk of Gulbarga district. He said AHS reduces anatomical and physiological trauma, both at the chemical and cell level, and minimises mechanical trauma.

Dr. Jawali has performed 415 heart operations from June 2000 onwards using the awake procedure, which avoids the use of general anaesthesia and the patient remains fully conscious during the operation. Explaining the procedure, Dr. Jawali said it uses "Continuous High Thoracic Epidural Analgesia" or spinal anaesthesia. Minute doses of anaesthetic drugs are given to the patient, which makes the whole chest portion numb. The patient remains completely alert and can talk to the surgeon while the operation is being done.

One of the benefits of the procedure is that the risk of respiratory infection, which is common and can prove fatal in heart operations, is totally averted. The risk of strokes and neurological complications that can occur during heart surgery is also averted. There is no need for expensive brain monitors. Since the patient is awake, he can tell the doctor about any complications, including drowsiness or paralysis, whereupon the surgery can be stopped and remedial measures taken immediately.

Dr. Jawali said the procedure is particularly beneficial to diabetics. Seventy per cent of bypass surgeries in India are done on diabetics, and many of the patients have kidney malfunction. In AHS, nephrotoxic drugs used in general anaesthesia are completely avoided. He has successfully conducted the new procedure on 22 dialysis-dependent patients.

Overall, for patients undergoing AHS recovery is much faster, and if the condition of the patient is stable he can be shifted from the intensive care unit the same day.

Now Dr. Jawali and others are working on "totally closed heart surgery," which is an improvement on AHS.

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