Title : Strategic use of emerging surgical technologies for cost-effective management of complex cardiovascular and thoracic diseases

The landscape of cardiothoracic surgery is rapidly evolving, driven by the need to achieve superior clinical outcomes while ensuring cost-effectiveness. Among the most transformative advances are OffPump Coronary Artery Bypass (OPCAB) surgery for high-risk cardiac patients and Uniportal VideoAssisted Thoracoscopic Surgery (UVATS) for complex thoracic diseases. This keynote presents a comprehensive perspective based on over two decades of clinical experience, highlighting how the strategic adoption of these techniques can significantly improve both immediate and long-term outcomes.

OPCAB has become a cornerstone in the management of high-risk coronary artery disease, particularly in patients presenting with acute myocardial infarction (AMI), ongoing ischemia, and ischemic heart failure with severely reduced left ventricular ejection fraction. Our experience of more than 7500 OPCAB including more than 3,000 OPCAB procedures in very high-risk patients—including over 20 critical patients undergoing ongoing cardiopulmonary resuscitation (CPR) following hemodynamic collapse— demonstrates the robustness of appropriate timely surgical interventions . Additionally, patients with severely compromised ventricular function, with ejection fractions as low as 15–20%, have been successfully managed using OPCAB techniques.

Avoidance of cardiopulmonary bypass in these vulnerable populations has consistently resulted in reduced perioperative morbidity, improved hemodynamic stability, and lower incidence of complications such as renal dysfunction, neurological events, and systemic inflammatory response. Over a follow-up period spanning more than two decades, our data show remarkable improvement in both immediate survival and long-term functional outcomes. Patients benefit from shorter intensive care stays, faster recovery, and reduced overall treatment costs, making OPCAB a highly effective and economically sustainable strategy in treating complex cardiac patients with critical coronary artery disease.

In parallel, the evolution of Uniportal VATS has redefined the surgical management of thoracic diseases. Over the past decade, our experience with more than 600 uniportal VATS procedures for complex thoracic problems has demonstrated its applicability across a wide range of complex thoracic conditions, including decortications for infectious lung diseases, Bullectomies for Giant bullous lung disease including patients waiting for Bilateral lung transplant , mediastinal tumors, ruptured hydatid cysts, and advanced thoracic malignancies. The modified uniportal approach, utilizing a single small 3 cm incision with enhanced visualization techniques, allows precise dissection even in cases with dense adhesions and complex anatomy with zero conversion to open thoracotomy.

Our results indicate that UVATS significantly improves perioperative outcomes, with early extubation, minimal postoperative pain, rapid mobilization, and reduced hospital stay. Importantly, the technique has shown excellent long-term outcomes comparable to, or better than, conventional open thoracotomy, while minimizing surgical trauma. The reduced need for intensive postoperative care and quicker return to daily activities translate into substantial cost savings for both patients and healthcare systems.

The combined strategic application of OPCAB and UVATS exemplifies a paradigm shift toward minimally invasive, high-impact surgical care. These technologies not only expand the boundaries of what is surgically feasible in high-risk and complex cases but also ensure that such care remains accessible and cost-effective.

This keynote will emphasize that the future of cardiothoracic surgery lies in the judicious integration of innovation with experience, ultimately delivering safer, more efficient, and economically sustainable care to patients worldwide.

Deepak Puri is presently Chairman Cardiovascular Thoracic Surgery at Paras Health , a chain of 8 Suoerspecialty Hospitals across 5 states of India . He is also Founder Chairman of Cardiomersion, a global Organization  promoting integrated approach to comprehensive cardiac care since 2011. He takes keen  interest in Off Pump Coronary Revascularisation in high risk acute MI and Ischemic Heart Failure , Minimally invasive cardiac surgery and Regenerative Therapy and Uniportal Video assisted Thoracoscopic Surgery  with 87 publications in reputed National and International Journals including a chapter in a Book. Having presented more than 125  talks in conferences across the globe, he been invited faculty in several International conferences and organized more than 200 workshops as well as more than 20   International Conferences promoting an integrated approach, innovative techniques, promoting new technologies and exchanging skills with experts across the globe. He has worked as Assistant professor in Post Graduate Institute of Medical Education and Research Chandigarh, Additional Director CTVS at Fortis Healthcare, Senior Director CTVS at Max Healthcare and has been visiting surgeon at University of Maryland Baltimore, Swedish hospital Seattle as well as Leipzig Heart Center Germany, Shanghai Pulmonary Hospital , University of Pittsburg USA.