New York Times: Indian Heart Surgeon Took Talents Home On May 18, 2003 By AMY WALDMAN




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Indian Heart Surgeon Took Talents Home


-New York Times



Taken out of context, it looks like Naresh Trehan is playing a video game. He stares intently into a console at a three-dimensional image, his feet pressing on pedals, his hands maneuvering levers.

But in this case, context is everything. On a television screen several feet from Dr. Trehan, a heart, embedded in gelatinous tissue and blood, throbs insistently. Several feet farther still, lies the body that is home to the heart, on which Dr. Trehan is, at this moment, operating.

He moves a lever, and on the screen, a robot's claw lifts the internal mammary artery, soon to be joined with the coronary artery in a single bypass. Dr. Trehan is providing the brainpower by remote control. Two robotic arms with tiny hands, inserted through two small incisions in the torso, and a tiny camera inserted through a third, are doing the work.

When he moves the controls inches, the robots move micromillimeters, with more precision and steadiness than the human hand.

''Like going to the moon,'' Dr. Trehan said of the procedure.

Minimally invasive robotically controlled cardiac surgery is the latest frontier in heart surgery. It is slowly catching on in the United States, as doctors and industry work to bring the cost down and the clinical value up. But this is India, where those who can afford it have been accustomed to going abroad for state-of-the-art care, often provided by Indian doctors who have migrated themselves. Dr. Trehan was one of them. He went to the United States in 1969, and by the mid-1980's was earning over $1.5 million a year as a Manhattan heart surgeon.

But then he did what few Indian doctors do: he came back, prompted largely by the Indians who kept showing up on his operating table and asking why they could not get the same quality of care back home. He was driven, he said, by ''a certain amount of arrogance -- a kind of national pride.''

''I could do things better than most of my American counterparts,'' he said.

He decided against practicing in an established hospital and found an industrialist to finance his vision of a private heart institute and research center in New Delhi.The Escorts Heart Institute and Research Center opened in 1988. Today it is among the largest of its kind in the world, with 325 beds, 9 operating theaters and satellite operating rooms in five cities -- although that means little in a nation of a billion people.

At 56, Dr. Trehan may be the most prominent heart surgeon in the country. He has won just about every award India gives for citizenship and service. He has operated on almost every major political figure or businessman and he counts many of them as friends.

Everyone wants him. One man, accused of helping to bilk the Delhi Development Authority in a land scheme, has petitioned the court to have Dr. Trehan perform his heart bypass.

Escorts also draws Indians and others from abroad to New Delhi, by bringing the most advanced technologies and techniques here. It is only the second place in Asia, after Japan, to perform robotic surgery. It has done about 50 robotic surgeries since December, moving cautiously because the procedure is costly and the technology still evolving.

On some fronts, Dr. Trehan has far outstripped the West. Most American cardiac surgeons still hesitate to perform ''beating heart'' surgery, which does not require stopping the heart or using a heart-lung machine. The procedure reduces trauma to the body but is challenging to perform. Escorts has done about 10,000 beating heart surgeries, including 4,000 last year alone, putting it in the top tier worldwide for this procedure.

The center devotes 10 percent of its income to free care for the poor and subsidizes care for government employees, members of the military and retirees. Staff members in its mobile echocardiogram van see 100,000 villagers a year.

Dr. Trehan said that when he returned to India, after almost two decades abroad, with his wife, Madhu, and two daughters, he found that ethics and family values that shaped his youth had been corroded. Corruption was everywhere; prominent families were at each others' throats over money. The things he held dear, which he found absent in America, were disappearing in India, too.

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