Dr Ashok Seth is a world-renowned cardiologist, known for introducing pioneering techniques in curing heart ailments. He has contributed extensively to the growth, development and scientific progress of Cardiology especially Interventional Cardiology in India and across the world. For his exemplary contribution and achievements in the field of medicine, he was honoured with Padma Shri, one of the nations highest civilian awards, in 2003. Dr Seth, in an exclusive chit-chat with Ekta Srivastava, ENN, shares his insights on an era of cardiac science
You have contributed extensively to the growth, development and scientific progress of Cardiology especially Interventional Cardiology in India and across the world. How has your journey been?
I started in the year 1984, when Interventional Cardiology was basic and devices were crude. The start of Interventional cardiology was in the year 1977. There were very few centres across the globe during 1980-1981 who were experimenting with interventional cardiology. I was in England at Birmingham University Teaching Hospital, one of the first centres to start Angioplasty. We lived in an era where we did not know where science could take us. In those days 50 percent patients would be diagnosed with recurrent blockages, 5 percent of people would have problems within the hospital like heart attacks were salvaged. A key breakthrough in Angioplasty was the advent of stents. Between 1980 and 1994, we tried a lot of techniques and I pioneered many of those techniques for the Asia-Pacific region. We realized if the balloon cant hold on things, then we should cut these blockages out from within the arteries, and that was called directional atherectomy, a technique of actually cutting the blockages within the coronary arteries. This technique was slightly better than the balloon, but again not dramatically better. In the early 90s, we brought out a drill. I was one of the biggest proponents of this drill-like device. We were looking for ways of removing the blockages rather than blowing them up.
The efforts were towards finding that magic bullet that can treat these blockages. By 1994, we had metallic stents, stainless steel ring-like tubes, and which actually transformed Inter- ventional Cardiology and increased the safety measures for angioplasty. At that time, everyone used to think that Angioplasty was temporary, while surgery was permanent. This transformed in 2002, this was the third era of Angioplasty when medi- cal stents called drug-eluting stents came in. The same stainless-steel device coated with a drug was explored, that not only saved but also prevented the re-occurrence of the blockages. The technique worked in a manner where the drug reached till the arteries and stopped the reoccurrence. The re-occurrence of the blockages came down from 25 percent to 5 percent which lead to making Angio plasty as the first choice of patients. This was the third era of Angioplasty, because it became the treatment of choice. It actually relegated surgery by 25 percent. Now, its the fourth era of Interventional Cardiology with the dissolvable stents, which dissolve after a few months of its placement into the body.
Angioplasty has transformed from being a crude technique with re-occurrence and complications to extremely safe durable and a robust technique which can be applied literally to 75 percent of the patients suffering with coronary artery diseases. The second era of Interventional Cardiology has been what we call structural heart dis- eases”Non-invasive technology.
We have always felt that the only way to treat valves was performing an open-heart surgery”open the heart, take the valve out, put a new valve, stitch it and there you have it. It was a complex technique but was the only one to be able to change valves till early 2000s. In 2004, at Fortis Escorts Heart Institute we were the first inventors of the device which could implant valves without surgery, the procedure was called percutaneous treatment. We pio- neered this technology and therefore formed the most robust set-up of per- cutaneous valves in India.
aneous valves in India. What we do today is so differ- ent from what I did 20 years ago. There has been a huge transforma- tion. Now, it has become a routine ” changing valve through a cath-lab method. Most importantly, safety, du- rability and expertise in Angioplasty ”all have evolved over the years.
“In China, 90 percent of the stent market is indigenous, in a similar manner we should also encourage indigenous manufacturing of stents”
What is the present scenario of cardiac diseases in India?
Cardiac diseases have gone through a radical transformation over the years. It is the biggest killer. It is feared that 50 percent of deaths in India will happen due to heart diseases. It is reoccurring both in urban and rural population. There has been an increase in heart diseases where women are concerned. Over, last 15 years there has also been a rise in younger population.
The worry is that 50 percent of our population is youth. Over thirty years down the line the extent of heart diseases would be so enormous that everybody will have somebody who will be suffering from a heart disease. These are the reasons we have to look into every aspect of this disease and do a vigorous research and diagnosis. Most importantly, we need to look at the prevention aspect of the disease. Working in the area of prevention is most important. The treatment processes are getting expensive by day and the disease proportion is getting more rampant.
How Fortis Escorts Heart Institute is planning to provide sustainable healthcare in rural sector?
This is possible through good public private partnership. Actually, there are four stake holders in the process”the Government, the private sector, the industry (the device and the medicine manufacturers) and the doctors.
We talk about treatment options. We talk about expensive stents. Only 5 percent of Indian population can afford them. We are still not giving enough emphasis on micro insuranc- es. We are still not creating a scope for manufacturing low-cost. To have a solution, we can increase the manufacturing of these devices in zones where they are tax-free and we can save ourselves from the expenses of importing these devices. In China, 90 percent of the stent market is indigenous, in a similar manner we should also encourage indigenous manufacturing of stents. We have to create a milieu for encouraging innovation, as innovation can create intravenous therapy and make it affordable at a low cost.
These things can happen only through partnership of all four stake holders. We will offer a low-cost model to serve the people in rural markets. We can provide services to more and more people in these areas, with prevention being at the core.
What would be the role of interventional cardiologist in the next 10 years?
Interventional cardiology has become the cornerstone of treatment of heart diseases.
In future, I believe more inter- ventional cardiologist and surgeons would come together to treat patients
Interventional cardiology will continue to increase, but in close collaboration with cardio-surgeons. There will be innovations of new de- vices and new techniques. The way forward is through minimally invasive techniques and make future surgeries less invasive.
“We have transformed the landscape of healthcare delivery in India. Now, we are expanding our reach by providing critical-care facilities to the patients in a manner where we are not only providing critical care to the patients but also following a low cost model. In this sphere, even England started a year after us.”
“What is needed today is common sense and ethics amongst physicians, so that they do the right thing for the right patient at the right time”
Do you think technology is helping in giving best care to the patients?
Yes, technology is helping in a tremendous way”technology is the future. Telemedicine should be more wide- spread. We were pioneers in ICT format. In India, we do not have enough critical-care centres. So, we created a concept of providing critical care through our e-facilities. We are monitoring 400 beds remotely. We are able to see patients directly in Raipur, Bareilly by being here. We have specialists and we are able to monitor every patient of our 400 remote facilities. We are not only able to look at them, but also advice treatment.