Young Peshawar cardiac surgeon does 515 open heart surgeries in less than 2 years

PESHAWAR: Dr Muhammad Aasim is apparently the only cardiac surgeon to have done 515 heart surgeries in a short period of less than two years at the Hayatabad Medical Complex (HMC).

The young surgeon single-handedly started cardiac procedures on December 1, 2017 (12 Rabiul Awwal) with a small team. He operated the first open heart surgery (coronary artery bypass grafting) on December 6, 2017.

By June 12, 2019, Dr Aasim completed 515 cardiac surgeries, which is stated to be a record for a single cardiac surgeon led team at a cardiac surgery unit anywhere in Pakistan.

He belongs to Dir district in Khyber Pakhtunkhwa. Before joining HMC, Dr Aasim was serving in a Fortis escorts’ group hospital (Amiri Medical Complex) in Kabul. He got trained in cardiac surgery (FCPS) under supervision of the legendary surgeon Prof Dr Mohammad Rehman in RMI Peshawar from 2009-2016.

People close to him told The News that Dr Aasim turned down offers to work abroad as he had made up his mind to return home and serve his people suffering multiple cardiac problems. But there was no proper set up in KP where he could have worked and trained people.

The MMA government in 2005 announced plans to establish 300-bed Peshawar Institute of Cardiology (PIC). Dr Mohammad Hafizullah and Dr Riaz Anwar remained project director and deputy project director, respectively, of the PIC till 2015.

The PIC is not yet functional due to multiple reasons but lack of adequate funds caused the delay even though the building was completed in 2017.

Prof Dr Zahid Aslam Awan, head of cardiology department HMC, Prof Shehzad Akbar, a surgeon serving as Medical Director HMC, and Sahibzada Mohammad Saeed, Chairman Board of Governors (BoG) HMC - played a role in bringing Dr Aasim home and facilitating him in setting up the state-of-the-art cardiac surgery unit despite limited resources.

The majority of patients operated in the cardiac surgery department HMC is poor and are provided treatment free or nearly free or by availing the Sehat Sahulat Card.

Those close to Dr Aasim told The News that he has strictly been following Western standards by ensuring minimally invasive AVR surgery and VSR+CABG surgery. His work was widely appreciated in a recent international conference in the Netherlands. He was the only delegate invited from Pakistan to the conference.

He was given prime time to make his presentations. Two of his posters were displayed on the digital screen till conclusion of the conference along with other high standard international presentations.

The unit at HMC is not less than a blessing for the needy heart patients as a fully paid open heart surgery is done in less than USD3000, including all the services fee, disposables and hospital expenses.

According to officials, in Europe, elsewhere and even in China the minimum cost of the procedure is USD15000. However, the patients requiring cardiac surgery have to wait till February 2021as Dr Aasim alone has to conduct surgery.

Despite limited resources, the unit has maintained its standard and excluding the high risk cases the mortality rate is around one percent in open heart surgeries for elective open heart cases. In such cases, the mortality rate of about 2.5 percent is acceptable by any standards as these are high risk.

In emergency cases like VSR+CABG, 40 percent mortality is acceptable internationally.

In the minimally invasive AVR group, HMC’s cardiac surgery unit has zero mortality.

“Almost 18 cases done without any mortality or major complications Alhamdolillah,” remarked an official when asked for figures concerning mortality and morbidity in the unit. Pleading anonymity, he said their mortality and morbidity was much better than all local institutions.

In December 2018 at a conference held in Rawalpindi, a known hospital presented their data of VSR+CABG (ventricular septal rupture + coronary artery bypass grafting) for 10 years. They had operated upon only 20 high risk patients with 60 percent mortality.

In comparison, HMC’s cardiac surgery unit did more than 12 cases in VSR+CABG in short time of period with less than 30 percent mortality. Internationally, mortality up to 40 percent is reported in this group.

When a high risk patient had diarrhea after taking bad food and died, the doctors developed controlled food supply policy in the HMC cardiac surgery unit.

Recently when the government shut down the cardiovascular surgery department in LRH allegedly due to high mortality, the unit in HMC was the only facility in KP that attracted most cardiac patients. It added to workload of Dr Aasim and his team. The department in LRH was recently restarted but it will take time to restore the patients’ trust.

The HMC administration and its BoG need to plan for the unit’s expansion and hire dedicated surgical trainee doctors to make them good cardiac surgeons along with nursing and paramedical staff. They have a skilled and down to earth cardiac surgeon willing to train people.

The department needs additional equipment and instruments with uninterrupted supply of cardiac surgery disposables to ensure quality of procedures.

This correspondent tried to seek comments of Dr Aasim, but he is always stated to be busy and unwilling to seek publicity through the media. A cardiologist noted that there are no properly trained cardiac anesthesiologists, nurses and paramedical staff. Besides, he said there was a lack of dedicated doctors willing to undergo tough training to become cardiac surgeons and cardiac anesthesiologists/intensivists.

Pleading anonymity, he said Dr Aasim had operated on one high risk foreigner belonging to the African country, Mali. “The patient was diagnosed with coronary artery disease in Mali and went to Morocco where he couldn’t afford the high risk CABG. He came to Pakistan for Tabligh, got chest pain in Peshawar and was brought to the cardiology department of HMC. He remained under supervision of noted cardiologist Prof Zahid Aslam Awan who asked Dr Aasim if he could do his CABG.”

After clearance from the patient’s embassy and foreign ministry, Dr Aasim operated upon him free of cost. An Afridi Tablighi family took care of him in Peshawar. The patient later went to Lahore to get his artificial leg repaired. After full recovery, the patient came to Peshawar to consult Dr Aasim and obtain a fitness letter to fly back to Mali. The cardiologist recalled that the grateful patient had tears in his eyes when he thanked Dr Aasim and his team and the people of Peshawar and Pakistan for taking care of him. “The patient said he had left Mali in the name of Allah to die in his way or to be taken into the right hands for treatment as he knew he couldn’t afford the cost of open heart surgery,” he added.