Dr. Parth Vaghela: The traditional and reliable pathway is, after MBBS, you do a Master of Surgery (MS) in General Surgery which is a 3-year course, and then a 3-year course for M.Ch. in CTVS. Recently, the DNB seats have been introduced, which is an integrated 6-year training program you can join after MBBS.

Dr. Parth Vaghela: Being a CTVS surgeon in India, the primary challenge is patient compliance, because many patients who come to us don’t know how big or complicated the disease is. Another challenge is that nobody can directly come out of M.Ch. and do the surgery independently. It takes time for the clinician to learn the skills and improve those skills over a period of time.

Dr. Parth Vaghela: CTVS is made up of cardiac, thoracic, and vascular surgery.
In cardiac, apart from what you mentioned, there are heart valve surgeries, aortic surgeries, correction of ASD, ventricular septal defect, etc. Any malignancy around or inside the heart, or any tumor inside the heart, will be done by cardiac surgeons. In the thoracic part, any surgery in the lung, periphery of the lung, chest wall, or ribs can be done by a cardiothoracic surgeon. Blood vessels coming out of the heart are also operated on by cardiothoracic and vascular surgeons.

Dr. Parth Vaghela: Right now, post-CTVS, one person can go for cardiac surgery, valve surgery, cardiac aortic surgeries, or only artery bypass surgery or thoracic surgeries. But there are centers in India which give exposure to all kinds of surgeries during training. Luckily, I was able to learn every single kind of surgery at the same time, from the same center.

Dr. Parth Vaghela: The timeline totally depends upon the pathology of the patient. With recent advances, the time has comparatively reduced, but it still takes a long duration. Any cardiac surgery is around a 5–6-hour job, from going into the OT to coming out. There are other major surgeries which can take around 12, 14, or even 16 hours.

Dr. Parth Vaghela: CTVS is a team branch, you don’t work alone. I have a team of 11 people. The responsibility is shared according to the caliber of the person. When we want to do multiple surgeries in a single day, there will be multiple cardiac surgeons involved in the team too.

As the team increases and more qualified people join, things get easier for everyone. But it is a demanding branch. Anytime, any post-operative or pre-operative patient can demand a lot of time from you. So, work-life balance is difficult to achieve.

Dr. Parth Vaghela: As you know, recently even the younger generation is getting heart attacks or coronary artery disease. So, heart checkups are necessary for everybody.

In the past, we were prone to it, but we had poor detection. Now, people are aware and go to diagnostic centers for evaluation. So, post 30 years of age, basic checkups are necessary, and then post 40 years of age, advanced heart checkups like 2D Echo, coronary angiogram, or other tests depending on the pathology should be done. Stress, sedentary lifestyle, poor diet, lack of awareness, and lack of physical activity all play a role.

Dr. Parth Vaghela: Any kind of chest pain. The majority of people think it is gastritis. Irrespective of whether it’s in a rural or urban area, chest pain, palpitations, or dyspnea (difficulty in breathing) should not be ignored. If you feel like you have to sit after walking a few miles due to breathlessness, it is a warning sign. And any kind of syncopal (blackout) episodes occurring multiple times should also be taken seriously, after ruling out anemia.

These days, the detection rate is so high that, out of 10, 8 older people will get diagnosed with some kind of CVD.

Dr. Parth Vaghela: As the name suggests, a cardiologist has a medicine-oriented career, and they focus on the medical point of view of CVD and pathologies. Cardiologists diagnose and treat patients medically. We, cardiac surgeons, learn surgical aspects. If a person has coronary artery disease, they need to be evaluated and diagnosed by a cardiologist, usually by angiography, and then they come to us for coronary artery bypass surgery. So, from the diagnostic point of view, cardiologists diagnose and treat medically. If the disease requires surgery, then we intervene.

Dr. Parth Vaghela: Primarily, it depends on what you call advanced cardiac surgery. Ten years back, coronary artery bypass surgery was considered advanced. Now, minimally invasive surgery, LVADs, RVADs, and heart transplants are considered advanced, and those are concentrated in tier-1 cities at present. But tier-2 and tier-3 cities are coming up with every kind of facility that normal pathologies demand.

Dr. Parth Vaghela: Primarily, the doctor-patient ratio is not adequate. Since cardiac surgery is a super specialty, the ratio is not at par.

CTVS surgeons, I can roughly say, would be near 10,000. Among them, some still need guidance and are currently in the learning period, not routinely doing independent work.

So, the functional cardiac surgeons are about half, around 5,000 in India.

Dr. Parth Vaghela: Every kind of cardiac surgery is being performed at government hospitals also, where the equipment and facilities are present, as well as in private hospitals. So, there is no differentiation. I finished my 3-year M.Ch. training and 10 years of practice in a government facility.

Dr. Parth Vaghela: Post introduction of the Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme, it is very accessible to the rural public and to people in tier-2 and tier-3 cities, or with low socioeconomic status. Cardiac care in India is also very cost-effective compared to any other country in the world.

Dr. Parth Vaghela: Cardiac care is a very dynamic branch. Every day, just like a heartbeat, it changes. To tag one case is difficult, but still, I will mention a patient of age 80 who had a hole in the heart post myocardial infarction, a Ventricular Septal Rupture (VSR).

[Ventricular Septal Rupture after a myocardial infarction (heart attack) is a serious and often fatal mechanical complication where the heart muscle ruptures, creating a hole between the heart’s lower chambers, i.e., ventricles.]

We operated on him. It was a very high-risk, high-mortality surgery. After we operated on him, we put him on an IABP (Intra-Aortic Balloon Pump), a mechanical support device. He was in the ICU post-surgery for almost 10 days. He was not neurologically well and was not showing signs of recovery. But after 9 days, he suddenly showed good response to medications and from a neurological point of view. On the 10th day, he suddenly woke up and was just like a normal person.

It was a miraculous thing for us. Within a span of 12–14 hours, he improved fantastically. It showed us that God is great, and He is the one who manages everything. We are just human beings doing our work.

Dr. Parth Vaghela: The primary myth is that it is a highly risky surgery. Another is that it is very costly. A third misconception is that it doesn’t yield results. These are all misconceptions because every kind of surgery is risky, whether cardiac, neuro, or any other. But with advancements in both diagnostic and surgical fields, these surgeries now come with a lower morbidity risk. The cost burden on the patient has also decreased because of government schemes and third-party insurance.

Dr. Parth Vaghela: Yes, it still is, especially for patients from lower socio-economic backgrounds or with limited education, as not everyone may be mentally prepared.

Undergoing surgery requires a lot of time, patience, and regular dedication in the post-operative recovery period, which is still difficult. Multiple precautions need to be maintained before, during, and after surgery. Compliance is the main issue in India, whether financial, mental, or social. The conceptualization of cardiac surgery is better in tier-1 cities, and in tier-2 cities once the person understands the disease. But in lower educational or socioeconomic circles, it is still difficult.

Dr. Parth Vaghela: After detection of the disease, we need to make the patient and their relatives understand the kind of disease they have. The stratification and the risk management ratio depend on the pathology. So, I primarily start with totally educating the patient about what pathologies they have and how we are going to rectify them.

Post-surgery, I advise everybody to avoid smoking, avoid tobacco, and avoid spicy or oily food. Most patients are diabetic, around 50% or 60%. So diabetic control should be done with regular physical activity and lifestyle modification. This is necessary because diabetes affects every kind of organ and leads to multiple pathologies.

Dr. Parth Vaghela: CTVS is a demanding career. It takes a lot out of you during your training and also later. You need to have a clear idea that you want to pursue this kind of chaotic life. It is not an easy job. No job is easy, but you need to be ready and oriented about what you are going to do. You need to love the job, and then, when you opt for it, you will be able to justify your life. Otherwise, long working hours and lack of work-life balance will burn you out.

Dr. Parth Vaghela: Do regular physical activity, whichever kind of exercise you prefer—jogging, running, or yoga. Avoid smoking or any kind of tobacco. My World Heart Day message would be to align your body for your heart, because the heart takes care of you 24/7, from birth to death, so please take care of it too.