Secondary prevention vital for patients who have undergone the procedure, says Dr.Girinath

Long-term survival of patients must become the focus of coronary artery bypass grafting (CABG), popularly known as bypass surgery, rather than merely reducing hospital deaths due to coronary artery disease, said renowned cardiac surgeon, M.R.Girinath, who has over 40,000 open heart surgeries to his credit.

Having standardised safe bypass surgical procedures, concentration must shift from prioritising minimal hospital mortality to ensuring patients live for 20-30 years after the procedure, said the chief cardiac surgeon of Apollo Hospitals, Chennai. Speaking at the zonal meet of Association of Physicians (API)-Tiruchi Chapter, Dr. Girinath said bypass surgeries were being increasingly adopted for elderly patients today.

Bypass surgeries that are redone are being done as ‘beating heart’ surgeries as opposed to the conventional ‘on pump’ surgeries where a beating heart is stopped and a heart lung machine is used, he said. This aims to reduce risk of death.

Secondary prevention or active treatment for cardiac disease is paramount in patients who have undergone bypass procedures as CABG is not a curative procedure; it can possibly extend life span by improving flow of blood to heart, the surgeon emphasised.

Accord importance to clinical diagnosis

Delivering the endowment lecture on ‘Medicine-yesterday, today and tomorrow’, M.S.Ramachandran, retired director of medicine, Madras Medical College, Chennai, stressed that clinical diagnosis cannot be substituted by investigations. The thumb rule of 70 percent medical history, 15 percent physical examination and 15 percent medical investigations is relevant even in today’s scenario, he said.

For instance, recommendation of MRI scans for spinal problems unless it affects an individual’s routine severely is irrelevant, as success of spine surgery is only 30 percent even in the developed world.

“Listen to patients for a few minutes and your diagnosis will be revealed. Be careful before ordering investigations and take economic considerations into question,” he appealed, dwelling briefly on various subjects like future of cancer cure, gene therapy, creating a tobacco –free India and a new perspective on euthanasia from the point of improving quality of life of patient.

Origin of medicine

Tracing the origin of medicine from early ages, he said Hippocrates’s ethical values, Sushrutha’s medical contributions and use of penicillin bear contemporary relevance. Similarly, basic measures like avoiding smoking, moderate alcohol consumption, maintaining body mass index less than 23 which incorporates exercise, active lifestyle and healthy diet, good sleep for 7 to 8 hours and annual health check-ups still good hold as the cornerstones of good health.

He stressed on threefold duties of doctors to treat patients, teach and carry out research. Though there are 35000 pharmaceutical companies in India, only five per cent carry out fruitful research. K.V.Murali, chairman, API-Tiruchi branch, S.S.Lakshmanan, president, API Tamil Nadu, spoke.