'We Always Wanted To Give Back Whatever We Had To Our Country': An Exclusive Interview With Cardiac Surgeon Dr MM Yusuf

We are currently dealing with a pandemic that has swept away many lives around the world. Nevertheless, even today, cardiovascular diseases (CVDs) are the leading causes of mortality in India. According to a research journal published in 2019, the prevalence of CVDs in India was estimated to be 54.5 million. They affect people in the long run especially those patients who are in the most productive years of their lives. This then results in catastrophic and socio-economic consequences. There are several techniques that are used to cure heart-related diseases. However, recently a technique termed 'robotic minimally invasive heart surgery' has been gaining a lot of popularity. Currently, there are very few robotic minimally invasive heart surgeons in the world and one of them is Dr Yusuf.

Dr M M Yusuf specializes in robotic minimally invasive heart surgery. He completed his M.B.B.S at Stanley Medical College, Chennai and gained FRCS at the Royal College of Surgeons, Edinburgh and Royal College of Physicians and Surgeons, Glasgow. He also gained FRCS in Cardiothoracic surgery before taking up a fellowship programme at Old Lady Victoria Hospital, Belgium where only 1 student from the world gets admitted each year. After 3 years of hard work and constant trials, he was finally able to get a chance to do his programme at the OLV hospital.

Speaking exclusively to The Logical Indian, Dr M M Yusuf shared the importance of robotic minimally invasive heart surgeries, the need for awareness about heart ailments in India and how to act in dire circumstances. In addition to this, he also shared his journey as a doctor in India and the differences between the U.K and the Indian health care systems.

TLI: Could you share in brief your experience of pursuing this unique field in medical science and why did you choose the same?

Dr M M Yusuf: My urge to do cardiac surgeries was from the time I did my primary school. I lost (my) maternal uncle to a heart attack and cardiac surgery in India was primitive during that time. I always wanted to train in the U.K because of the belief people had in the FRCS degree. My aim was always to get back to India as a specialist heart surgeon. When I left India, I thought we would come back in 10 years. Nevertheless, it took almost 20 years by the time I got back.

I did both my basic and higher surgical training in the U.K. While I was completing my higher surgical training, that's when minimally invasive heart surgery was becoming popular in the western world. I wanted to bring something new to India because it will benefit the country and the people. Also, something that is popular grows at a faster pace. Back then, there were very few centres in the world offering the training that I wanted to take up. It took me three years to get into the OLV Hospital, Belgium. During the three years of my wait, I did other fellowship programmes as well, such as training in Aortic aneurysm surgery and Mitral valve repair surgery. Robotic minimally invasive heart surgery had a very small name back then and when I started the programme, that's when I developed my interest in it.

TLI: What was your inspiration to come back to India 20 years later? How has your journey as a doctor in India been?

Dr M M Yusuf: It was always our plan to come back to our country because this is where we belong. Although my wife is a lawyer and I am a medical graduate, we both did our degrees from government colleges. We always wanted to give back whatever we had to our country. In addition to this, although our children were born in the U.K, we wanted them to be familiar with their roots. We wanted them to have their identity.

After (basic medical) graduation, I immediately left for the United Kingdom. It was surely very different when we came back 20 years later. In the U.K we have the National Health Service (NHS) and all we must do is do our work and move on. After coming back, I realized that the corporate way of working is very similar to the western standards in hospitals. Obviously, after coming back, it was important for me to make sure that people knew who I was and what I was doing. To get that recognition or to be 'known' is surely a gradual process. Going around and creating a network and making people aware was a huge challenge. Although cardiologists in India trusted my work, initially, they recommended me to do traditional open surgeries.

Finally, when people started to see the results of the minimally invasive heart surgeries, I then moved on to start the robotic programme which took a while. I was placed at the Apollo hospitals, and it helped me spread the word faster. It's teamwork and for robotic minimally invasive cardiac surgeries, you need a better team. My trainer and mentor Dr Frank Vanpraet came from Belgium and helped me start the programme in India. This then became the only robotic cardiac surgery programme in the country. During the COVID-19 scenario, it has helped people to recover quickly. The longer you take to recover, the more you are susceptible to infection. I also believe that communication is the key in the medical field. You need to inform your patients about everything.

TLI: Being one of the few robotic minimally invasive heart surgeons, how did it feel after getting admitted into the OLV hospital, Belgium?

Dr M M Yusuf: The day I stepped in, it was wonderful! The feelings weren't an 'all high' because I had to wait for three years to get into the hospital. We first had to learn and train in performing heart surgeries without the heart being stopped. I then started to look at places I could go and then went to the U.S for some time. Moving from Europe to the U.S and then back and forth would be a difficult task because I also had my family with me. Dr Hugo Vanerman was the surgeon at OLV hospital and was also one of the pioneers of devising this minimally invasive technique. I then attended several conferences and meetings to show my interest in the field. I also visited their department and made myself known to the people there. When I finally got in, I was ecstatic. The day I walked in was more about expectation and apprehension. These fellowship programmes are for 1 year. Hence, my goal was to make the best out of it and try to be the best as well.

TLI: What is your vision of a healthy India?

Dr M M Yusuf: First and foremost, it is important for people to be aware. Prevention is better than cure. When I came back to India, I realized there existed a divide. In the peripheries, people were unaware of when to seek medical attention and where to go for the same. Preventing cardiac diseases is my prime goal as a cardiac surgeon. Secondly, in India, almost 50 per cent of our patients are below 60. There must be changes in our lifestyle to be healthier in the long run. We have taken up the development of the western world. Nevertheless, our cultural and traditional habits are at a halt now. When we have a heart problem, it is important to be aware of the signs and symptoms. Standardized medical facilities need to be available throughout the country. I have tied up with Medtronic India and Edward's India which are two major companies that provide equipment related to cardiac surgery. This is also done to promote academic work and we train surgeons under us. Our aim is that minimally invasive cardiac surgery must be available throughout the country for the betterment of people.

TLI: What are a few advantages of going through a robotic minimally invasive heart surgery?

Dr M M Yusuf: The major advantage is that the patient's fear is avoided. One question that a lot of patients ask when they come for cardiac surgery is whether their chest needs to be split open to perform the surgery. In robotic surgery, this scare is avoided. However, what we do inside is the same. Instead of our hands, we insert small robotic arms through a pinhole, however in a very safe manner. The robot has 360-degree arm movement and it has four arms. In addition to this, the vision is magnified to 10 times the normal vision. Hence, everyone in the operation theatre can have a view of what is going on. It is foolproof and transparent. There is hardly any blood loss and because the cuts are tiny there is hardly any risk of infection. Patients undergoing robotic cardiac surgery are usually discharged in 48-72 hours.

TLI: How are robotic minimally invasive heart surgeries better than other heart surgeries?

Dr M M Yusuf: Coronary Artery Bypass Graft (CABG) surgery is performed to bypass the blockage of blood supply to the heart muscle. It is like building a bridge on the road to avoid traffic congestion. In by-pass, the blood is diverted from a spot before the blockage to a spot beyond it. The same is performed in robotic minimally invasive heart surgery. However, in the latter, the chest isn't split apart to perform the surgery.

TLI: Could you share an incident of anyone who went through this surgery? What was their feedback after undergoing the same?

Dr M M Yusuf: We started off by doing straightforward procedures and now we deal with extremely complex cases as well. There are two groups of patients who really benefit from robotic and minimally invasive heart surgeries. The first being youngsters who are the breadwinners of the family. These people fall in the age range of 40-60 years and for them, it becomes extremely important to get back to work early. These people recover within 2-3 weeks of performing the surgery and get back to work. The second group includes the 'elderly' with other medical problems and co-morbidities. This includes people above the age of 70. They cannot tolerate the pain of open surgery. The trauma is worst in them!

Initially, I was thrilled about the fact that patients could be discharged in about 48 hours. Recently, an 85-year-old was bed-ridden due to heart failure. He was treated with stents, but his heart function kept worsening with recurrent hospital admissions. To get him back to a decent lifestyle, the only option was to perform bypass surgery. In such patients, it is important to prepare the patients first. We did Robotic Minimally invasive bypass-surgery and got him home walking after a week. This might not have been possible with traditional open-heart surgery. It has now been a year and he has been leading a comfortable life without any further admission to the hospital.

Heart surgeries are primarily done for two reasons. One- 'symptomatic' relief which refers to giving a good quality of life. The second being the 'prognostic' relief which refers to preventing death.

TLI: Are minimally invasive heart surgeries cost-effective as compared to other heart surgeries?

Dr M M Yusuf: Open heart surgeries aren't extinct even today. There are still 20-25% of patients who need to be treated using open-heart surgeries. We look at the disease pattern, the age of the patient and the heart function to make sure that they can undergo this surgery. 'Immediate safety' and 'Long-term benefits' must always be kept in mind while performing the surgery.

Talking about cost-effectiveness, it surely costs more than open surgery. However, considering the benefits of this surgery, people tend to pay for the same. In a sentence, it costs twice the amount as that of open surgery. This isn't unaffordable. The additional cost is due to the robot and other special equipment that we use to perform the surgery efficiently.

TLI: India has a considerable number of people with heart ailments. Why do you think our country is in such a position today?

Dr M M Yusuf: Awareness plays a crucial role. In addition to this, there was a time when people only used to eat traditional home food. However, we have now moved towards a western outlook where junk food is consumed at appalling rates. In the U.K, you have 'Big Breakfast', with smaller meals in the afternoon and at night. However, in India, it is often vice-versa. It is important to take the best of our culture. Going to gyms and doing physical activities is coming up in the younger generation. I never use the lifts and choose to take the stairs. Hence, taking care of your health is extremely important.

TLI: What are some of the major differences between the health care system in the United Kingdom and India?

Dr M M Yusuf: In U.K we have the National Health Service. It is available for everyone since it is government-funded. The NHS provides a standardized health care service. On the contrary, since it is government-funded, incorporating newer technologies can be a challenge.

In India, the accessibility and availability of health care depend on where you live and what you are. The population is extremely high in India and hence the system is compromised a lot of times. In India, it is important to standardize the care provided in the private sector. Several corporates are doing this efficiently today. We do have a divide in our country. On one hand, you have someone who is the best and can provide all the facilities and on the other, we have the peripheries where people are unaware of the basic practices as well. Awareness and bench-mark standards need to be brought throughout our country.

TLI: We are dealing with a time where the health care system of our country is crumbling. There is a lack of oxygen, beds, and lesser doctors to treat COVID-19 patients. What are your thoughts regarding this?

Dr M M Yusuf: Lack of planning is the key to all of this. When the cases first started coming up, we had an indication of how deadly this would be in the future. We are responsible for our own health. It is important to know the problem and how to mitigate it. Over the last year, the awareness about COVID-19 and its implications has been massive. Today, almost every household has someone who has been affected by COVID -19 or died of the same. When people neglect the awareness, that's when the catastrophe begins. In a way, we as the common man are responsible for the problem that we are facing today. Now, we have to find our way out, swiftly.

TLI: Do you have any message for our audience at 'The Logical Indian' and how to stay safe during such uncertain times?

Dr M M Yusuf: Personal hygiene is something that we all have to follow. This isn't something that would develop overnight. This must be practised in our daily life. Medicines, Allopathy or Ayurvedic should be taken only when prescribed. COVID-19 is preventable and treatable which will go down in time. Nevertheless, it is all in our hands. Masks, sanitisers, and vaccines are our go-to solution for now.

Cardiac diseases can occur as a complication after COVID infection. Clots tend to be formed in the lungs and the heart. If anyone has such an issue, please seek medical help immediately. We the doctors are providing our services 24/7. To be aware and take action is to stay healthy. If this is kept in mind, you are good to go!

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