To his credit, Dr Sarma has done aortic root replacement with artificial aorta for marfan's syndrome (hereditary condition where the patient has extremely long fingers and toes, with abnormalities of the heart, aorta and eyes), repair of post myocardial infarction, ventricular septal defect (rupture), left ventricular aneurysm and CABG in a same patient; combined cerebral, myocardial, and both lower limb revascularisation procedure in same sitting in a critical patient successfully first time in Bangladesh.

Dr Sarma has been awarded many prizes for his outstanding contribution to the medical science. He has been selected for MARQUIS Who's Who in medicine and healthcare for 2006-2007, which is published from USA.

Recently, in a brief interview session with Star Health, Dr Sarma talked about different aspects of various cardiac surgeries and gave valuable suggestions about post surgical management of coronary artery bypass graft (CABG), which is better known as bypass surgery.

Star Health (SH): What is beating heart surgery ? Do you perform it?

Dr Sarma (DS): Beating heart surgery most commonly refers to coronary artery bypass graft surgery performed on the beating heart. Standard coronary artery bypass surgery is performed by "arresting" the heart and supporting the vital organs of the body by pumping oxygenated blood from the heart-lung machine into the patient.

I perform both the conventional cardiac surgery and beating heart surgery.

SH: Between those two methods, which one is better?

DS: Standard CABG is time tested, beating heart CABG is not the replacement of standard CABG, rather both are complementary to each other.

SH: Does conventional CABG cost more than the beating heart surgery?

DS: No. Cost involved in beating heart surgeries are always more as tissue stabilising devices are disposable.

SH: What is "off-pump" coronary artery bypass surgery?

DS: The beating heart surgery, done without using heart-lung machines is called as "off-pump" coronary artery bypass surgery.

SH: Tell us something about Robotic heart surgery?

DS: The trend in cardiac surgery is to minimise surgical trauma while reducing the incidence of perioperative morbidity. The goal is to return patients to functional levels as early as possible after surgery. Minimally invasive techniques have been introduced to fulfill such expectations. It is still on research level.

The cost is extremely high. A 3D camera is attached with an intelligent robot and via small incisions, operations are performed, which helps patients for early recovery.

SH: Some cardiac surgeons avoid high risk patients for surgery, whereas you have handled so many high risk patients. How do you do this?

DS: I am particularly interested to coronary artery reconstruction surgery, which is one of the most complicated and high risk procedure. More than 30 percent patients I did in Bangladesh were high risk and everybody is doing fine.

SH: What are the complications of CABG and when it is a risky procedure?

DS: Now-a-days complications of CABG are very rare. Bypass surgery is now a very safe procedure throughout the world. Normally the risk is around 1 percent. However risk may increase to 3-5 percent, if patients have following conditions like:

* Age more than 75 years.

* Pumping capacity of the hearty is reduced from normal (less than 25 percent).

* Diffuse coronary artery disease.

* Longstanding poorly controlled diabetes mellitus, hypertension and dyslipidaemia.

SH: Please, give your advice to a patient of CABG?

DS: A patient of CABG should --

* Control blood pressure and diabetes adequately

* Quit smoking

* Daily work

* Avoid exertion upto six weeks from the discharge from hospital

* Avoid heavy works as well for 3 months

* Perform exercise slowly

* Avoid much work bending forwards

* Avoid lifting heavy goods (more than 5 kg)

* Avoid lifting anything suddenly by one-hand

* Strictly avoid swimming for 8 weeks

* Sexual contact should be avoided for 3 months after operations

* Bath: Take a bath using soap. You can sit on a stool while bathing, if you feel necessary. It is better to avoid bathtub after operation for 3 months

* Travel or car driving: You can travel by airplane, train on car/bus after discharge from hospital. But you should yourself refrain from carrying suitcase, briefcase and carrying little children for three months. Driving should be avoided for 3 months

* Walking: Maintain a habit of walking and increase it gradually. Increase the speed of walking and distance slowly. Empty stomach walk is preferable

* Rest: You need physical as well as mental rest. Mental stress may be harmful for you. Sleep for 5-6 hours at night

* Return to work: Start your normal work according to the advice of a physician.

SH: Please tell us about food habit after surgery.

DS: Loss of appetite of the patient after surgery is common. The appetite increases with time. Give up lipid, fat, and salt. Chicken meat is comparatively better that beef or mutton. Similarly shrimps and lobsters also have high amount of unhealthy fats. Yellow portion of the eggs has a lot of cholesterol. Milk and dairy products like cheese, butter etc. should be avoided. Remember, boiling, steaming or grilling are better styles of cooking than our traditional methods. Eat plenty of row vegetables and fruits.