Serial killer Charles Sobhraj to undergo open heart surgery; all you want to know about the procedure, risks, who needs

Serial killer Charles Sobhraj who has reportedly walked out of jail after Nepal's Supreme Court ordered his release on the grounds of old age and poor health conditions is in a need of an open heart surgery as per the SC verdict. According to his biography, Sobhraj also known as 'the serpent' is believed to have killed 20 people up to the late 1970s, including in Nepal and India. (Also read: Top lifestyle changes to make after a heart attack)

He spent 21 years behind bars in India and escaped from Tihar Jail in 1986 after serving security guards sweets laced with drugs. Sobhraj has been in prison since the Supreme Court sentenced him to life for murdering an American tourist, Connie Joe Bronzich, in Nepal in 1975. He had been linked to many killings of backpackers.

WHAT IS OPEN HEART SURGERY

According to Dr Preet Pal Thakur, Co-founder of Glamyo Health, an open heart surgery refers to any procedure where the chest is opened and the heart muscle, valves, arteries, or other heart structures are operated on.

"The chest, not the heart, is referred to when the term “open” is used. The surgical procedure usually determines whether or not a patient heart needs to be opened," says Dr Thakur.

Dr Aditya Kumar Singh, HOD and Senior Consultant, Cardiothoracic and Vascular Surgery, Marengo QRG Hospital, Faridabad describes it as a technique where the surgeon performs procedure on the heart to correct or improve any disease of the heart.

WHO NEEDS OPEN HEART SURGERY

Dr Singh says open heart surgery is needed if one has severe coronary artery disease, valvular problems of heart, arrhythmia or congenital defects of heart.

Sobhraj had undergone open heart surgery in 2017 after he was diagnosed with leak in mitral valve and had suffered a mild heart attack as per previous reports.

WHAT IS THE PURPOSE OF OPEN HEART SURGERY

“A patient could benefit from open-heart surgery if they have any of the following cardiovascular problems: arrhythmias, including atrial fibrillation; congenital anomalies, such as atrial septal defect (hole in the heart) or hypoplastic left heart syndrome (underdeveloped heart structures); coronary artery disease; heart failure; heart valve disease; and thoracic aortic aneurysm," says Dr Preet Pal Thakur.

Dr Thakur says the ultimate aim of open-heart surgery is to rectify any of these dysfunctionalities or to implant medical devices that optimise the work rate of the heart.

HOW MUCH TIMES DOES THE OPEN HEART SURGERY TAKE

"Heart surgery is a complicated task that can take six hours or more to finish. The reason why patient is administered general anaesthesia, which keeps them asleep and pain-free throughout the procedure. The turnaround time depends on the medical operation, comorbidities, and the patient’s overall health prior to surgery," says Dr Thakur.

RISKS OF OPEN HEART SURGERY

"Open-heart surgery is a major surgical procedure. Therefore, like all surgeries, there is risk of complications and death. It may be greater if the patient has other health conditions such as kidney or liver problems, diabetes or obesity, chronic obstructive pulmonary disease (COPD) etc. People who smoke are more susceptible to surgical and postsurgical issues. Complications for open-heart surgery though rare are chest wound infection, most commonly seen in patients with obesity or diabetes, brain stroke, irregular heartbeat, lung or kidney failure, breathing difficulty and pneumonia etc," says Dr Singh.

"There are risks with any surgery. Complications are more likely if the patient has an existing health condition such as diabetes or obesity. Lung diseases such as chronic obstructive pulmonary disease (COPD) also multiply the risk. Similarly, people who smoke a lot are more inclined to have surgical and post-surgical complications. The following risks are associated with surgery: allergic response to anaesthesia, arrhythmias (abnormal heart rhythm), bleeding and damage to adjoining blood vessels or organs such as the lungs or kidneys, infections and strokes," says Dr Thakur.

PREPARATION FOR OPEN HEART SURGERY

"Patients should openly inform the doctor about any drugs they are taking, even over-the-counter medications, vitamins, and herbs. Also inform the doctor If the patients have any illnesses like herpes outbreak, cold, flu, or fever. In the two weeks before the surgery, the patients are advised to quit smoking. Patients should also tell the doctor about alcohol consumption before preparation of the surgery. The day before the surgery Patients may be advised not to eat or drink anything after midnight," says Dr Singh.

HOW IS OPEN HEART SURGERY PERFORMED

"A coronary artery bypass grafting (CABG) is performed in three to six hours. Some basic steps are followed to perform the surgery. First, the patient is given general anaesthesia. Under anaesthesia, the patients remain asleep and pain free during the whole surgery. Initially, the surgeon makes an 8- to 10-inch cut in the chest and cuts through all or part of the patient’s breastbone to access the heart. Once the heart is visible, the patient may be put on a heart-lung bypass machine. The machine starts moving blood away from the heart so that the surgeon can operate easily. A healthy vein or artery is used by the surgeon to make a new path around the blocked artery. Then the surgeon closes the breastbone with wire, leaving the wire inside the body. The original cut is stitched up. Now more and more frequently heart bypass operations are done without the need of heart lung machine that is called off pump coronary artery bypass surgery. Minimal invasive cardiac surgery is now possible where we perform bypass operation without cutting through the sternal bone but rather left lateral 5 cm below nipple incision with faster recovery and less blood loss and trauma to patients," says Dr Singh.

"To brace for open-heart surgery, a patient must inform the surgeon about his or her medical history and then follow the surgeon’s professional opinion. The doctor may advise the patient to stop smoking, drinking, and give up blood meds such as aspirin, ibuprofen, or naproxen two weeks before surgery. The key for the patient, however, is to be prepared both mentally and physically," says Dr Thakur.

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