Six decades of cardiothoracic surgery: navigating new horizons, mending hearts with science and precision

In the middle of difficulty lies the opportunity

- Albert Einstein

Dear Dr. C. S. Hiremath, I am truly grateful for your gracious introduction. Esteemed Past Presidents of Indian Association of Cardiovascular-Thoracic Surgeons (IACTS), Teachers, Seniors, Members of the Executive Committee (EC), and Members of IACTS, Dr. Marc Moon and other faculty from the American Association for Thoracic Surgery (AATS) and overseas, National Faculty, colleagues, residents, ladies and gentlemen, I extend my heartfelt thanks to each one of you for attending the meeting.

Standing before you as the President of the Indian Association of Cardiovascular-Thoracic Surgeons is an immense honor and privilege. I am sincerely humbled by this recognition and express my gratitude for the trust you have placed in me. Delivering the presidential address for the IACTS is the highest distinction a cardio-thoracic surgeon can attain in our nation, and I approach this responsibility with profound humility and appreciation.

Having served the Association in the Executive Committee for three years as a member of the EC, I can attest to the invaluable experience that has prepared me for this role. Over the past three years and particularly during my one-year term as the President, I have had the privilege of working alongside a dedicated team of Executive Members, and I extend my heartfelt thanks to each one of them (Fig. 1a, b).

Fig. 1

a, b Executive committee of Indian Association of Cardiovascular-Thoracic Surgeons (2023–2024)

Special gratitude is owed to past presidents Dr. K.S. Iyer and Dr. Zile Singh Meharwal, who generously shared their counsel gained from their past presidencies. Dr. K.S. Iyer, my teacher and well-wisher, and Dr. Z.S. Meharwal, a long-time friend and colleague, have been constant sources of inspiration.

I extend my heartfelt gratitude to Dr. Shiv Nair, Dr. V.V. Bashi, and other esteemed past presidents, whose significant contributions have played a pivotal role in shaping our association and bringing it to its current illustrious state. I also thank all the past Editors of the Indian Journal of Thoracic and Cardiovascular Surgery (IJTCVS) for their contribution to the Journal.

I want to take this opportunity to welcome the incoming President Dr. Manoj Durairaj, who is energetic and conducting various outreach programs for the Association. I am confident that he will elevate the association to even greater heights. I thank our dynamic Secretary, Dr. C.S. Hiremath, who has demonstrated unwavering commitment, proactivity, and dedication in advancing the IACTS. My heartfelt thanks go to Dr. O.P. Yadava, Editor-in-Chief of the IJTCVS, for elevating the journal to new heights, securing PubMed indexing, and achieving the first-ever impact factor of 0.7. His valuable comments and advices during Executive Committee Meetings have been immensely beneficial, and I express my sincere appreciation.

I extend my sincere thanks to Dr. Prabhatha Rashmi, Joint-Secretary and Treasurer, for her diligent efforts in streamlining the association's accounts and auditing processes. Special commendation goes to her for tirelessly working to bring order to our accounts.

I also want to express my gratitude to all Executive Committee Members for their unwavering support and valuable contributions. Together, I am confident that we will continue to advance the mission and impact of the IACTS.

I am profoundly grateful to my parents for the invaluable role they played in shaping the person I am today (Fig. 2a). My roots trace back to a humble background of handloom weavers in the remote village of Jandrapeta, also known as Devangapuri, nestled on the East Coast of India near the Bay of Bengal in Chirala Mandal, Andhra Pradesh. I am the eighth child in a family of ten. Tragedy struck early in my life when my father, Shri. S. Veeraiah, passed away at the age of 49, also my eldest sister succumbed to postpartum heart failure caused by severe mitral stenosis. These profound events ignited my passion for medicine, driving me to pursue a career as a Doctor and eventually specialize in cardiac surgery. Following my father’s demise, my two elder brothers took on the responsibility of caring for me—one as an Inspector of Schools and the other a weaver.

Fig. 2

a My parents. b Sajja with family

I express my deepest gratitude to my wife, Dr. Jhansi Vani, a consultant microbiologist at CARE Hospital, Hyderabad, and my son, Mr. Pavan, an Electrical Engineer and Vice-President of Linea Energy, San Francisco, CA, USA. Their unwavering support over the last 35 years has been my pillar of strength (Fig. 2b). Finally, I extend my profound gratitude to the individuals under my care, whose unwavering support has been the bedrock of my research endeavors.

My journey into the field of cardiac surgery began with a pivotal moment at the Association Surgeons of India (ASI) Annual Conference at Guntur Medical College in 1978, where I attended a talk by Dr. K M Cherian on coronary artery bypass surgery. As a final-year MBBS student, I had the opportunity of visiting the Cardiac Operation Theater at Southern Railway Headquarters Hospitals at Perambur, Chennai. Observing open heart surgeries performed by Dr. K M Cherian and Dr. M R Girinath fueled my inspiration. This led me to write an article, “Recent Developments in Surgery of Coronary atherosclerotic heart disease,” which was published in Guntur Medical College Magazine during my final year MBBS [1].

Driven by my passion for cardiac surgery, I reached out to experts like Dr. Michael DeBakay and Dr. Denton Cooley to explore the possibility of getting trained in Houston. I completed my first-year surgical residency at Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, and second and third years at the Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) Pondicherry. Then, I completed M.Ch Cardiothoracic & Vascular Surgery at the All India Institute of Medical Sciences (AIIMS), New Delhi. Then, I did the Fellowship in Cardiovascular Surgery at the Texas Heart Institute, Houston, Texas.

I owe a debt of gratitude to my esteemed teachers at AIIMS, Prof. Venugopal, Prof. I. M. Rao, Dr. Sampath Kumar, Dr. M. L. Sharma, Dr. Balram Airan, Dr. Bhaba Nanda Das, and Dr. K. S. Iyer.

I also want to thank my colleagues at AIIMS particularly, Dr. V. Mohan Reddy and Dr. K. Samba Murthy, both distinguished Pediatric Cardiac Surgeons.

Special thanks to Prof. Sampath Kumar, Prof. Venugopal, Dr. Alexander John, Prof. Denton A. Cooley, and Dr. K. M. Cherian for mentoring me in cardiothoracic surgery (Fig. 3a, b).

Fig. 3

a Sajja with Prof. Arkalgud Sampath Kumar. b Sajja with Prof. Denton A. Cooley

I extend my great appreciation to my colleagues at STAR Hospitals, Hyderabad, Dr. Gopichand Mannam, Dr. D S Bhaskara Raju, Dr. P. Satyendranath, Dr. KVSS Saikiran, Dr. Thomas Mathew, and my former colleague at Care Hospitals, Banjara Hills, Hyderabad Dr. Narasinga Rao Pantula.

I thank my roommates at Guntur Medical College, Guntur for their invaluable support, on the Journey of Career Development Dr. Ramesh Babu, Cardiologist, Dr. Prabhakar Rao, Opthalmalogist.

Establishment of the Sajja Heart Foundation

I founded the Sajja Heart Foundation (SHF) driven by my profound passion for Cardiac Research and goal is to spearhead research initiatives aimed at elevating the standards of patient care within the field (Fig. 4). SHF, a Scientific and Industrial Research Organization (SIRO) Conducted India’s first multi-center randomized controlled trial in cardiac surgery—the PROMOTE Patency Trial. Currently, conducting another multi-center randomized controlled trial (RCT), PREDICT Trial with the support of the Indian Council of Medical Research (ICMR). I extend my gratitude to the esteemed trustee members for their invaluable support Dr. PV Ramachandra Raju, Cardiologist; Dr. Jyothsna G, Nephrologist; and Dr. Jhasni Vani Devana, Microbiologist.

Fig. 4

Establishment of Sajja Heart Foundation

Evolution in cardiothoracic and vascular surgery: navigating the shifting landscape

The realm of cardiothoracic and vascular surgery has always held a unique allure, exuding a sense of prestige that garnered envy from others, especially among Medical Fraternity. Manipulating and mending the human heart was not just a medical task; it was a privilege that elevated us to a distinguished echelon within the field of medicine. Procedures such as coronary artery bypass grafting, valve replacements, aortic surgeries, and heart and lung transplants bestowed upon us a sense of greatness, making us feel like medical superheroes.

However, the landscape is evolving rapidly with the advent of percutaneous coronary interventions (PCIs), transforming the management of coronary artery disease. The sheer volume of PCIs has surpassed surgical revascularization procedures. In our country, while the number of coronary artery bypass grafting (CABG) procedures has been on the rise, the complexity of cases with intricate coronary artery disease and comorbidities has surged. Surprisingly, this contrasts with trends in the Western world.

Similarly, surgical valve replacement procedures are on the decline, yielding ground to percutaneous valve implantations. The realm of percutaneous interventions is expanding, marked by increasing procedural complexity driven by technological advancements. Even in the realm of aortic diseases, once exclusively within the surgical domain, hybrid technology is gaining ground, necessitating proficiency in wire skills. There’s an urgent need to enhance the scrutiny of outcomes from Cardiac Surgical procedures, synthesizing evidence specific to Indian patients to optimize therapeutic strategies. The time is ripe to invite institutions to contribute to the IACTS Database, fostering a robust dataset that could pave the way for Indian Practice Guidelines.

IACTS Database: empowering Indian surgical excellence on the global stage through data visibility and collaboration

The establishment of the IACTS Database could play a pivotal role in elevating the visibility of Indian data. Our Indian Journal of Thoracic and Cardiovascular Surgery recently earned a place in PubMed, with an initial impact factor of 0.7. This presents a golden opportunity for Indian surgeons to spotlight their surgical outcomes on an international stage. A group of Indian surgeons (Society of Coronary Surgeons) demonstrated commendable dedication by contributing approximately 15,000 patient data to the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database. Imagine the transformative potential if a substantial majority of India’s surgical community actively engages with the IACTS database, propelling it into a formidable resource. This endeavor holds the promise of establishing a robust foundation for crafting guidelines and consensus statements, firmly rooted in evidence gleaned from the diverse landscape of Indian patients.

Exploring the evolution of cardiothoracic surgery in India: embracing innovation, education, and publications

In the words of Albert Einstein, “The only source of knowledge is experience.” By pooling our collective experiences through extensive database participation, we empower ourselves to navigate the dynamic intersection of medicine and technology. Now, as we stand at the precipice of the artificial intelligence (AI) revolution in cardiothoracic surgery, let us seize the opportunity to delve deeper into the intricacies of how artificial intelligence can augment and refine our practice.

In the face of the advancing percutaneous technology, it’s imperative to shift towards more minimally invasive cardiac surgery procedures that prioritize patient-friendliness. As we navigate these transformative times, embracing innovation and contributing to collective knowledge will define the future landscape of cardiothoracic and vascular surgery in India. It is imperative to re-evaluate the curriculum, ensuring its alignment with the contemporary demands and expectations of the cardiac surgery specialty.

It is crucial to mentor the upcoming generation of surgeons, ensuring they are well-trained to carry forward the legacy of our esteemed specialty.

The field of cardiothoracic surgery presents a burgeoning landscape of opportunities for young and emerging surgeons. With the escalating prevalence of cardiovascular diseases in India, there is an increasing demand for cardiac surgical interventions. However, it’s noteworthy that only one-third of the patient population currently receives the necessary treatments that involve cardiac surgical interventions. Thus, there exists significant potential to expand the reach of these crucial medical services.

Despite the substantial volume of cardiac surgical procedures conducted in our country, there is a noticeable disparity in the number of publications. The quantity of original publications displays a positive trend in the Indian Journal of Cardiovascular and Thoracic Surgery and the Asian Cardiovascular Thoracic Annals (Asian Annals). However, there is a slight decline in the number of original articles within the Journal of Thoracic and Cardiovascular Surgery (JTCVS), the Annals of Thoracic Surgery (ATS), the European Journal of Cardio-Thoracic Surgery (EJCTS), and the Interdisciplinary CardioVascular and Thoracic Surgery (ICVTS).

Despite this, there is an encouraging volume of publications as a co-author of randomized controlled trials published in the JTCVS, as depicted in the accompanying graph illustrating the growth over the years. It is imperative for all practicing surgeons, especially those in high-volume centers and academic institutions, to go the extra mile in refining their data harvesting measures. Addressing this gap in publication frequency is crucial for advancing the understanding and sharing insights within the medical community.

An American College of Surgeons report highlights India as a preferred destination for cardiac surgical procedures among Americans due to the cost advantage compared to Western countries.

Advancing cardiovascular care in India: trends in CABG and PCI procedures

The frequency of coronary artery bypass grafting procedures in India is on the rise, highlighting the widespread reliance on this surgical technique for coronary artery disease (CAD) management (Fig. 5A). India’s prominence in the realm of CABG surgery extends further, with around 55% of these procedures performed on a beating heart. Notably, the utilization of the multi-arterial grafting technique has gained traction, reaching a rate of 17%, underscoring the commitment to refining and optimizing surgical outcomes.

Fig. 5

a Coronary artery bypass grafting trends in India. b Percutaneous coronary intervention trends in India

In tandem with CABG, India also witnesses a substantial number of PCI, totaling about 550,000 annually (Fig. 5B). This multifaceted approach reflects the comprehensive strategy employed to address diverse cardiac conditions.

The unique Indian patient

Remarkably, despite the high prevalence of comorbidities among Indian patients, the mortality rate associated with CABG procedures remains low, at less than 2%. This commendable statistic underscores the effectiveness of cardiac care delivery in India and the dedication of healthcare professionals to ensuring optimal patient outcomes. Coronary artery disease in India is on the rise, with a noticeable trend of CAD presenting at younger ages. Consequently, there is a growing imperative for multi-arterial revascularization, reflecting the need for procedures that offer sustained palliation over extended periods. As the demand for CABG continues to evolve, the healthcare ecosystem in India remains at the forefront of innovation, shaping the future of coronary artery surgery [2].

Evolution and advancements in heart valve surgery

Approximately 60,000 heart valve procedures are performed annually in India, marking significant advancements in cardiac care. The roots of heart valve surgery in the country trace back to the late 1950s when closed mitral valvotomy emerged as a pioneering procedure for mitral stenosis. Over the years, the landscape of cardiac surgical interventions has evolved, embracing cutting-edge techniques such as minimally invasive mitral valve replacement/repair, aortic valve replacement, and tricuspid valve repair/replacement. A noteworthy trend in recent times is the growing preference for bioprosthetic valves, especially among patients aged 60 and above. This shift underscores the continuous refinement of treatment protocols to cater to the unique needs of the elderly population. Notably, mitral valve repairs have emerged as the default procedure for addressing mitral regurgitation, reflecting the strides made in precision medicine and personalized treatment plans.

Minimally invasive cardiac surgery has witnessed a notable surge in recent years, marking a paradigm shift in the approach to valvular procedures. Remarkably, over 75% of valvular interventions in India are now conducted through minimally invasive techniques within specialized centers. In the realm of heart valve diseases, minimally invasive techniques have proven to be both safe and sophisticated. These approaches are adeptly applied to address a spectrum of valve conditions, including mitral valve diseases, aortic valve diseases, and tricuspid valve diseases. The refinement and precision associated with minimally invasive procedures have expanded their application to complex operations such as the Bentall operation, underscoring the evolving versatility of these techniques. The mitigation of invasiveness in cardiac surgeries has been a pivotal factor in improving patient outcomes and postoperative experiences. Procedures like the Bentall operation, once considered formidable, are now seamlessly integrated into minimally invasive protocols, showcasing the continuous advancements in surgical methodologies. Despite the substantial strides made in the field, the adoption of minimally invasive coronary artery bypass surgery for multi-vessel coronary artery disease remains in a state of ongoing evolution.

Surgery for heart failure

Heart transplant has now become the standard of care in the treatment of end-stage heart failure. Since 1994 after the first transplant by Dr. Venugopal at AIIMS, New Delhi, over 1100 heart transplantations were carried out in India according Indian Society of Heart and Lung Transplantation registry, and more than 70 hospitals were registered. India by April 2021 completed 1113 heart transplants, 101 heart lung transplants, and 338 lung transplants. Left ventricular assist devices: in India, over 120 left ventricular assist devices were implanted.

Navigating acute aortic syndrome in India: importance of timely diagnosis and advanced imaging techniques

Acute aortic dissection, although rare, stands as a menacing and potentially life-threatening medical emergency, often eluding accurate initial identification. The urgency in promptly and accurately diagnosing this condition cannot be overstated, as it significantly influences a patient’s chances of survival and mitigates the risk of severe complications. Raising awareness among both the general populace and healthcare professionals is imperative, fostering a collective understanding that can pave the way for early diagnosis and enhance survival rates. Rising acute aortic syndrome in India: importance of timely diagnosis and advanced imaging. In the Indian context, the incidence of acute aortic syndrome has been steadily increasing, presenting a multifaceted challenge. The diagnosis encompasses a spectrum of aortic disorders, ranging from atherosclerotic aortic aneurysms to dissecting aneurysms and intramural hematomas. Timely identification of these conditions is paramount, forming the cornerstone for successful intervention and management. Notably, the role of medical imaging is crucial in the diagnosis of acute aortic dissection and in devising meticulous strategies for therapeutic interventions. By leveraging advanced imaging technologies, healthcare professionals can enhance their ability to accurately diagnose and plan optimal repair techniques. In India, approximately 5000 to 6000 patients grapple with this formidable condition.

Embracing hybrid technology emerges as a mandate in the pursuit of successful outcomes in treating acute aortic dissection. In essence, elevating awareness, advancing diagnostic capabilities, and embracing innovative treatment modalities collectively contribute to a paradigm where the impact of acute aortic dissection can be mitigated, and the prospects of survival significantly improved.

Evolution of pediatric cardiac surgery in India: from basics to breakthroughs

The landscape of pediatric cardiac surgery in India has undergone a remarkable transformation, progressing from its early stages marked by closed-heart surgical procedures such as patent ductus arteriosus (PDA) ligation, creation of the Blalock-Taussig (BT) shunt, repair of coarctation, and addressing septal defects like ventricular septal defect (VSD) and atrial septal defect (ASD). The field has advanced significantly, moving beyond intracardiac repair of complex conditions like tetralogy of Fallot to more intricate procedures like arterial switch operations and staged interventions for hypoplastic left heart syndrome. A few of the noteworthy developments is the introduction of advanced techniques such as unifocalization for pulmonary atresia and Fontan procedures.

An encouraging trend in this evolving landscape is the early adoption of these sophisticated repair techniques in infants, emphasizing the importance of timely and precise interventions. As a result, the medical community in India has seen a substantial increase in the number of congenital heart disease operations, with approximately 50,000 procedures being performed annually. This surge not only reflects the growing expertise within the country but also underscores the commitment to providing advanced and accessible healthcare for children with congenital heart conditions.

Advancements in thoracic surgery: India’s dynamic landscape

The landscape of thoracic surgery in India is undergoing a dynamic shift, with an increasing number of cardiothoracic surgeons focusing exclusively on thoracic surgery. This trend is driven by various factors, including the growing burden of thoracic diseases such as tuberculosis, lung cancer, and chronic obstructive pulmonary disease (COPD). The demand for specialized care in this area is fueling the growth of dedicated thoracic surgeons. Moreover, advancements in minimally invasive techniques like video-assisted thoracoscopic surgery (VATS) and robotic-assisted procedures have revolutionized thoracic surgery, offering faster recovery times, reduced pain, and improved cosmetic outcomes.

As a result of these factors, India witnesses a flourishing field of thoracic surgery, with approximately 30,000 procedures performed annually. These procedures encompass a spectrum of interventions, including lobar resections, sleeve resection, segmental resections, pneumonectomies, pleural procedures, and mediastinal procedures. The future of thoracic surgery in India appears bright, with a growing pool of skilled surgeons embracing cutting-edge technology and catering to the diverse needs of a large population.

The landscape of cardiovascular and thoracic surgery in India has undergone significant transformations over the decades. The trajectory of the Indian Association of Cardiovascular-Thoracic Surgeons (IACTS) has been profoundly influenced by the dedication of its members, the leadership of past presidents, and the synergistic endeavors of the Executive Committee.

Research journey in Indian conditions: a personal reflection

I want to share with you a short journey of my research efforts within the unique landscape of the Indian conditions. As I embark on this narrative, let us draw inspiration from the wise words of great minds across the spectrum of research and innovation. In the early stages of my medical education, the spark of research ignited within me when I listened to Dr. K. M. Cherian in 1978 at the Association of Surgeons of India meeting held at Guntur Medical College, Guntur, Andhra Pradesh. Reflecting on this journey, I am reminded of the words of the renowned medical researcher, Sir William Osler, who once said, “The best way to learn the art of medicine is to study the great masters, to see them in consultation, and to hear their discussions.”

Then, in 2006, I had the opportunity of presenting the world’s first randomized controlled trial in renal insufficiency patient subset undergoing CABG at the 85th Annual Meeting of the American Association for Thoracic Surgery, which was published in JTCVS. This study, focusing on coronary artery bypass grafting with or without cardiopulmonary bypass in patients with preoperative non-dialysis dependent renal insufficiency, found its way into the prestigious JTCVS, becoming a clinical citation [3]. It was during this time that the words of Dr. Jonas Salk resonated within me: “The reward for work well done is the opportunity to do more.”

My journey took an exciting turn when I was acknowledged as a clinical researcher in coronary surgery in the insightful commentary “Evolution of Surgical Coronary Revascularization” by Sanjeeth Peter in 2015 [4]. As I reflect on this, I’m reminded of the words of the great Sir Isaac Newton, who once said, “If I have seen further, it is by standing on the shoulders of giants.” This recognition propelled me to initiate the PROMOTE Patency Trial, India’s first randomized controlled trial (RCT) in cardiac surgery, comparing off-pump versus on-pump CABG across multiple centers in India.

The global recognition garnered by the PROMOTE Patency trial [5] laid the foundation for the PREDICT study, a multi-center RCT supported by the Indian Council of Medical Research (ICMR). It is essential to embrace the words of Margaret Mead: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.”

In my journey, I had the opportunity to participate in the Arterial Revascularization Trial (ART), conducted by Prof. David Taggart. Additionally, I got the opportunity for both corporate and individual authorship in several key articles published by the ART Investigators [6]. Recognizing my contribution to cardiac surgery, the leadership of the ROMA Trial [7, 8], Prof. Mario Gaudino extended an invitation to serve as an inaugural Indian site, underscoring the collaborative ethos that characterizes ground-breaking research.

In 2017, I was invited as a faculty member for the development of a consensus statement on cardiovascular surgery-associated acute kidney injury (ADQI 20) at the 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) at Brijuni island, Croatia [9]. Reflecting on our accomplishments, I am reminded of Atul Gawande’s insightful words, “Better is possible. It does not take genius. It takes diligence, moral clarity, ingenuity, and, above all, a willingness to try.”

We have systematically gathered data on the contributions of Indian authors serving as first authors in prominent cardiothoracic surgical journals

The Annals of Thoracic Surgery

In the realm of cardiothoracic (CT) surgery spanning from 1966 to 2023, a notable discrepancy emerges between the high number of cardiac surgical procedures performed in India and the relatively low count of publications by Indian surgeons in the Annals of Thoracic Surgery. Over this period, only two original articles found their way into this esteemed journal between 2021 and 2023 (Fig. 6).

Fig. 6

Publications by Indian authors in the Annals of Thoracic Surgery

The Journal of Thoracic and Cardiovascular Surgery

From 1994 to 2023, the Journal of Thoracic and Cardiovascular Surgery (JTCVS) reflects a similar trend, with 86 original articles published alongside 90 others. However, despite a few co-authored publications on RCTs, not a single original article has been authored solely by Indian authors in the last three years, highlighting an area for potential growth and contribution (Fig. 7).

Fig. 7

Publications by Indian authors in the Journal of Thoracic and Cardiovascular Surgery

The European Journal of Cardio-Thoracic Surgery

Similarly, the European Journal of Cardio-Thoracic Surgery (EJCTS) reports a decrease in the number of publications on CT surgery from 1990 to 2023, with 123 original articles and 91 others. This trend suggests a need for increased engagement and representation from Indian authors in this journal (Fig. 8).

Fig. 8

Publications by Indian authors in the European Journal of Cardio-Thoracic Surgery

Asian Cardiovascular and Thoracic Annals

Contrastingly, there is a positive trend in the publications related to CT surgery in the Asian Cardiovascular and Thoracic Annals from 1993 to 2023. With 251 original articles and 417 others, there is an evident increasing trend, indicating a growing presence and contribution of Indian authors in this arena (Fig. 9).

Fig. 9

Publications by Indian authors in Asian Cardiovascular and Thoracic Annals

Indian Journal of Thoracic and Cardiovascular Surgery

The Indian Journal of Thoracic and Cardiovascular Surgery (IJTCVS) showcases a promising rise in publications from 2003 to 2023, with 285 original articles and 936 others. This upward trajectory is commendable, and credit is due to contributors like Dr. O. P. Yadava for their efforts in elevating the visibility of Indian research in this field (Fig. 10).

Fig. 10

Publications by Indian authors in Indian Journal of Thoracic and Cardiovascular Surgery

A cadre of surgeons in India actively engaged in research have significantly contributed to several international multi-center randomized controlled trials, including the Arterial Revascularization Trial, the CORONARY Trial, the STICH Trial, and the ROMA Trial. Their invaluable contributions extend beyond participation, as they have also served as co-authors for publications in high-impact journals such as the New England Journal of Medicine, the Circulation, the European Heart Journal, the Journal of Thoracic and Cardiovascular Surgery, Journal of the American Heart Association (JAHA), the European Journal of Cardio-Thoracic Surgery, and Journal of the American Medical Association (JAMA) Cardiology [10,11,12,13,14,15,16,17,18,19].

A call for cultural shift

The crux of the matter lies in a cultural shift among cardiothoracic surgeons of India—a shift towards meticulously recording and analyzing surgical outcomes, a commitment to data entry, and a more profound engagement in and support of surgical RCTs. Let us heed the words of Nobel laureate Marie Curie, who said, “We must believe that we are gifted for something, and that this thing, at whatever cost, must be attained.” Let us embrace this call for change with open hearts and minds, for in the words of Mahatma Gandhi, “You must be the change you want to see in the world.”

Together, let us forge a future where the pursuit of knowledge transforms the landscape of cardiothoracic surgery and inspires generations to come.

Conclusion

In conclusion, I am reminded of a quote by Winston Churchill: “Success is not final, failure is not fatal: It is the courage to continue that counts.” Let us approach the future with courage, resilience, and an unwavering commitment to the well-being of our patients. The heart is not just an organ—it is a symbol of life, resilience, and the very essence of our humanity. Together, let us continue mending hearts with science and precision, navigating new horizons, and ensuring that the legacy of cardiothoracic surgery in India continues to shine brightly.

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