US-based heart surgeon showcases ‘Y-incision’ in city

Kolkata: Newer surgical techniques and methods need to be adopted for better outcomes in cardiac treatment, and younger surgeons are more receptive to innovations, said US-based thoracic aortic surgeon Bo Yang, who has devised a prosthetic opening to the aorta — the largest artery in the body that carries blood from the heart to the rest of the body. Now in Kolkata to attend a conclave on the aorta, where he demonstrated his pioneering innovation that has revolutionised aortic surgery, he said he was impressed with younger cardiac surgeons in India who were eager to learn and adopted improved methods better."Younger surgeons learn quickly and are ready to adopt new methods. This is absolutely necessary to ensure that surgical techniques keep improving. Senior doctors often find it difficult to change the style of practice and surgical methods that they have got used to. This, in a way, blocks improvement in surgical techniques. It is important to adopt and change to ensure that surgical techniques and outcomes keep advancing," said Yang, renowned for his Y-incision aortic root enlargement technique. In 2020 Yang observed something missing in aortic valve replacement surgeries. On closer scrutiny, he noted that prosthetic replacements to aortic valves were actually smaller in diameter than the natural ones, which obstructed blood flow. This ‘patient-prosthetic mismatch', he realised, needed to be corrected for better results and ensuring that the patient had a longer life. "The natural valve opening is about 23 mm while the prosthetic replacements were 16 mm-17 mm, which did not cure the patient since the blood was made to flow through a narrower opening. Over time, many developed a further narrowing and the surgery eventually failed. It did not raise chances of survival since blood was now flowing through an opening that was 5-7 mm smaller," said Yang.It led him to devise the ‘Y-incision' technique that involved cutting open a portion of the natural valve to increase its diameter. "I cover the incised part with a patch and then implant a specially engineered prosthetic valve which is bigger and lets blood flow easily. This reduces the stress on the heart significantly, improves quality of life and extends life span," said Yang.Fifteen per cent of patients undergoing aortic valve replacement in the USA now use the ‘Y-incision'-induced bigger valve, up from 5% three years ago. "In fact, we now use a prosthetic valve which is significantly bigger than the natural one, about 27-29 mm. It lasts longer, allows easy blood flow and patients are showing better haemodynamic results. It's a new method and we are still observing the patients who have undergone the surgery. Most feel better than the previous patients who did not have the ‘Y-incision'," added Yang.Awareness about the technique was very low in India and Yang's visit is aimed at making it known to more cardiac surgeons, said Pradip Narayan, chief scientific officer, NH Group of Hospitals. "The idea behind having Yang in Kolkata is to reach out to as many surgeons and cardiologists as possible through the aortic conclave. He demonstrated the method and spoke on its efficacy. We are working with him and soon many will hopefully adopt the technique," added Narayan.