You don't have to fear open heart surgery
Every time one hears that a family, friend or colleague will undergo an Open-Heart surgery, most people literally shake in their boots. This fear of hearing that a heart will be stopped, and operated on, leads to some patients who have heart conditions seeking medical assistance when the disease is already advanced.
Most patients who seek treatment for heart conditions at such an advanced stage, are not seen elsewhere across the world.
Cardiovascular and Thoracic Surgeon, Dr. William Manyillirah says this often means that instead of operating on one heart valve, in some cases, they end up operating on three. The higher the number of valves which they operate on, the higher the risk.
Dr. Manyillirah is the only Cardiovascular and Thoracic Surgeon, in the country. He is based at Bokamoso Private Hospital, which is the only hospital in the country which can perform Open Heart Surgeries. The doctor told Botswana Guardian that in his field of medicine, they are working in a population that presents very late.
“People are scared of heart surgery. I am using the word scared. They are nervous when you talk about opening someone’s chest, let alone stopping their heart. So, they delay seeking appropriate medical attention until the disease is advanced,” he explains, noting that the kind of patients that come to his clinic, are not seen elsewhere in the world. He says that most come with advanced diseases. For example, someone will start with one damaged heart valve, but because of delaying to seek medical attention, the second and third valves will also be affected.
“So, you end up operating on three heart valves. And it is common in Botswana, operating on three heart valves instead of one. The risk of dying when you operate one valve is as low as one percent. Two valves go up four percent add on the third one, you are looking at eight percent. Your risk of dying is two or three times higher, the more valves we operate on,” he says, adding that they urge people to come early. The delay to seek medical attention also means that when they come late, the heart function has deteriorated, and has increased pressure in the lungs, and that is a risk factor for poor outcomes.
A Cardiovascular and Thoracic Surgeon is a specialist who treats mainly by operation and diagnosing diseases of the heart, lungs and other organs in the chest or thoracic organs. These diseases are wide ranging and can either be acquired or congenital. Diseases of the heart for example, can either affect the valves of the heart, blood vessels of the heart, and congenital conditions of the heart. These include what is popularly called holes in the heart especially in children.
He notes that acquired diseases of the lungs, especially in this part of the world - Sub-Saharan Africa - are infectious diseases such as TB which destroy the lungs. His role in terms of treatment, is to remove part of the lung or clean it. “I can remove the one lung, or a quarter of the lung,” he points out.
Other conditions involve the oesophagus, windpipe, lining of the lungs, and insides of the ribs, and even the ribs themselves. The other conditions, are cancers of the lungs, cancers of the chest wall, ribs, cancer of the windpipe, and food pipe, which is by far one of the most common cancers which they treat at the hospital. “Regarding cancer of the chest wall, you will get a lump or growth on your chest that might involve the ribs, muscles between the ribs, or muscles outside the ribs,” he explains. His speciality also includes treating blood vessels outside the chest, neck, arms, and abdomen. A blood vessel, he explains, might balloon or bulge. The condition is called Aneurism. Other conditions include narrow vessels.
Dr. Manyillirah, who is most-sought after, took time this Tuesday morning to share his fascinating field of medicine.
According to the good Doctor, there is a difference between Open and Closed Heart Surgery. In Open Heart Surgery, the heart is stopped, while Closed Surgery, the heart is not stopped while operating, and the operation is carried out while the heart is beating. “We operate a beating heart,” he says. The most complex is the Open Heart surgery, where the heart is stopped. Once the heart is stopped, the lungs also stop working.
“You must provide a machine called a Cardio Pulmonary Bypass or a heart lung bypass machine that takes over the function of the heart and the lungs. Using specialised pipes, a patient is hooked on that machine using specialised pipes, then we take blood out of the heart, and do not allow blood from the body to enter into the heart,” he explains.
The machine has an artificial heart, and an artificial lung. The artificial lung performs two main functions, removing the carbon oxide which we breathe out, and instilling oxygen. The blood, will go to the artificial heart, and that pipe will pump the blood into the aorta, and the rest of the body including the brain and other organs will get blood except the heart and the lungs. Dr. Manyillirah explains that they will then move on to cutting open that part of the heart which needs to be fixed.
To allay the fears of patients with heart conditions, with each procedure they provide extensive counselling to a patient, explaining everything in detail. In his field of medicine, he says that it is not just about surgery. A lot of investment goes into what they do.
Each patient must be assessed by Cardiologists, who are their gatekeepers. By the time, the patient reaches them, they must be fully aware of their disease. The patients also undergo counselling which can take up to one hour. “I have spent two hours with a patient, explaining the disease. The complications that have already happened before surgery, and what we are going to do, and all the complex stages of the operation and what can go wrong. This takes almost 50 percent of my time, as they must provide informed consent,” he points out.
They must also explain what life will be like post operation. All their patients go to ICU, called Cardiovascular Intensive Care Unit (CICU). The ICU stay is challenging as patients are hooked on all sorts of machines and pipes. “That is quite haunting to many patients. It is distressful to have things around you, and have alarms ringing,” he notes.
For all their procedures the heart team includes Cardiac Anaesthesiologist, Critical Care Nurses, Critical Care specialists, and Radiologists, and other specialists.
“Common things that we fix include Coronary Artery Bypass grafting or CABG, which involves taking a blood vessel from another part of the body such as arm, leg or chest, and is performed when there is a blocked vessel, and bypassing that blocked vessel.
“We can also open inside the heart, and fix a valve. Valves are like doors; they control the flow of blood between the chambers. Any of them can be deceased either because of infection or a disease. We either repair or replace it,” the doctor says.
The valve procedure is one of the most common operations in Sub-Sahara. On average, they do two to four of these complex procedures per week. 'We are busier in terms of heart surgery even more than most Private Hospitals in South Africa,” he points, noting that they are the only ones doing Open Heart surgery in the country. On average they perform almost 10 surgeries, comprising cardiac, thoracic, and vascular surgeries.
The operations they perform range from the simplest like removing fluid around the heart which can be puss or blood. The heart he says has a sack that protects it.
“Sometimes you get infections around the heart, and you will get fluid accumulating. And when there is fluid around the heart it compresses the heart such that it cannot function the way it should,” he explains, noting that the function of the heart is to receive blood, which means that it has to relax, and increases in size, after blood has returned to it, it must contract, and push it out.
“If there is fluid around it, especially the function of expansion, will be impaired. This fluid must be drained,” he notes.