The future of cardiothoracic surgery in India

The population of India had just crossed one billion mark when we entered the new millennium and open-heart operations were carried out in 42,000 cases last year which is in sharp contrast of 42 operations/million population as compared to 1700/annum/million in USA. Cardiovascular diseases are major contributors to mortality and morbidity in India. Each year between 48,000 and 128,000 children are born in India with congenital heart diseases. In 1999, 6750 operations were done for congenital heart diseases. Though excellent results were achieved, but enough surgeries could not be done. There are more than one million rheumatic heart diseases in India and 50,000 new episodes are added every year. Well over 100,000 valve replacements have taken place during the last two decades. But the cost of valve replacement surgery is beyond common man's reach. There is need to set up an agency to provide heart valves at a subsidised rate. The rapid escalation of coronary heart disease in India is a matter of concern. In 1980, coronary by-pass surgery made up less than 10% of the work that was done by a cardiac surgeon. Today it is more than 60%. At present only 25,000 coronary by-pass operations and 12,000 coronary angioplasty procedures are done in a year. The Human Organs Transplantation Act though passed in 1994, but still only 50 heart transplants have been performed. The past two decades have seen remarkable changes in cardiac surgery in the country. The public hospitals need to be upgraded. The time has come for the MCI to permit joint training programmes between public and private hospitals. As insurance sector has come to the field, so a dramatic growth of health care facilities is expected. Until now, cardiac surgery in our country has developed in an unplanned manner. Progress has been the result of individual initiative. While significant progress has been made, it has not reached the nation's needs. With a planned approach, co-ordinated by IACTS, we can do better.