Is Heart surgery risky?

Date: October 17, 2014

Lets start with this: Heart Surgery is safe. 99.4% of patients survive the surgery & live a better longer fruitful life.

Decades ago in 1953, simple heart operations often times led to about 66% deaths. Research was mounted in a big way across the western hemisphere, and monumental advances were made in cardiac surgery over the decades as a direct result. This led to a steep decline in death rates and better post-operative practices.

By 1995, the death rates for cardiac surgery fell to 8%. Knowledge, science, technology and techniques have improved once again and in the last 10 years we have come a long way once again with the average death risk of about 2% for most cases. However, the most complicated patients with multiple other problems obviously have higher risks invovled.

Major risks include Death (as above), paralytic stroke and other major organ system failure. Paralytic stroke is a devastating complication that has troubled cardiac surgery over the years. The risk of stroke is significantly lower now that what it was even 2 decades ago, the recent studies reflect an incidence of 2.0-2.3%.

Why a stroke:
The heart almost never develops narrowing in its arteries in isolation, atherosclerosis is a whole body process affecting arteries of the brain, spinal cord, kidneys, liver, bowel and also the arms and legs. Should a patient develop a low blood pressure or go in shock, anytime during or after an operation, all these organs are at risk of temporary or permanent dysfunction. There are some operations when we operate upon the aorta at the root of neck, such operations especially carry a higher risk of stroke.

Kidneys can similarly fail after an operation. Provided heart resumes adequate function rapidly, renal failure following surgery should also recover. Some patients with preexisting chronic kidney disease could end up becoming dialysis-dependant following surgery. In general if the kidneys were healthy before a heart op, they would regain function. However, for patients where kidneys fail secondary to heart failure, the chances of survival reduce significantly.

There are a group of patients where heart surgery itself might reverse kidney failure. These are patients with right heart failure or with constrictive pericarditis. I have seen individuals treated by kidney and liver specialists, who had this condition that precipitated organ failure; cured not only of their heart condition, but also of kidney or liver failure after heart surgery. Patients with heart failure are often given large doses of pills called diuretics, that can often aggravate renal dysfunction and cause frank failure. If the underlying cause of heart failure can by treated effectively such patients can have miraculous recoveries.

The worst complication for the elderly heart patients is gangrene of the intestine. Quite possibly in India we operate upon a slightly younger population that is not so much at risk for bowel gangrene.

My observation is that though cardiac surgical techniques have been fine tuned, no major surgical innovations can take credit for reducing risks of heart surgery. My belief is that the treatments, drugs and monitoring as well as personnel available nowadays for a patient undergoing Cardiac Surgery is much more definitive and reliable. That clearly would be the reason why all surgeons working in a particular hospital get almost similar results and why also some hospitals continue to get poor results when rest of the world has marched ahead.

We challenged ourselves a few years ago to see if we could improve upon the readily acceptable figure of 2%. At Sir Ganga Ram Hospital, we aimed to have 99% survival but kept our mission close to our chests. We have been blessed, our team has been successful 1194/1200 times. That is a 99.5% survival rate. This result is truly remarkable for we do some of the most complex and riskiest operations including mechanical complications of heart attacks, aortic dissection surgery, surgery for HOCM as well as Heart Transplantation.

The patients undergoing heart surgery nowadays are more of a challenge; patients are older and operations more complex. Looking at the rate of improvement in cardiac surgery however, we can finally start thinking about 100% survival rates – something unthinkable only 15 years ago.

Copyright by Dr. Sujay Shad 2020-2022. All rights reserved.

Copyright by Dr. Sujay Shad 2020-2022. All rights reserved.