Diseases of heart are complex, success depends on innovation: Payal Agrawal, Structural Heart Division Abbott

The pandemic has had unprecedented effects on the healthcare system globally, and in India. Like with other diseases, cardiac care has also been affected.

Congenital Heart Disease (CHD) refers to a problem with the heart’s structure that is present at birth. Such defects are not rare; more than 200,000 children are estimated to be born with congenital heart disease in India every year and this poses a tremendous challenge for the families, society, and health care system. Majorly, CHDs could be a hole in the heart or an abnormal blood flow owing to improperly formed valves and more. In an exclusive conversation with Financial Express Online Payal Agrawal, GM & Country Head, Structural Heart Division Abbott talked about paediatric cardiac care services for CHD and more. Excerpts:

What has been the impact of the pandemic on the utilization of paediatric cardiac care services especially when India has been struggling for decades with the largest population of congenital heart disease in the world? 

India has a large population of babies born with congenital heart defects. Over the years, our country has worked steadily on capacity building for quality pediatric cardiac care. Dedicated pediatric units delivering high-quality care are present in many large cities, and some tier-2 cities. Awareness and diagnostic facilities are better than before. This has enabled timely referrals for patients from smaller towns to the larger cities for the treatment of neonates with heart conditions.

The pandemic has had unprecedented effects on the healthcare system globally, and in India. Like with other diseases, cardiac care has also been affected. Transportation to neonatal centres has been difficult. There is also fear amongst parents to visit hospitals in locations outside their immediate area. Today, hospitals and infrastructure are better equipped to handle non-COVID related issues and it is extremely important for people to understand that treatment should not be delayed. Time is a critical factor for cardiovascular patients in general, and babies in particular.

What percentage of children in India are born with a rare heart disorder in India? How do you think the innovative technologies are helping in providing minimally invasive treatment and improving patient outcomes?   

It is estimated that approximately 240,000 children are born in India each year with congenital heart defects. Of these, one-fifth would need early intervention to survive the first year of life. Common issues include ventricular septal defect (a hole in the wall or septum that divides the heart’s lower chambers or ventricles), atrial septal defect (a hole in the wall or septum that divides the upper chambers or atria of the heart), tetralogy of Fallot, a condition caused by a combination of four heart defects that affect the structure of the heart, PDA or patent ductus arteriosus, an opening between two blood vessels leading from the heart, amongst others.

The rising prevalence of congenital heart disease has led to the rise in adoption of minimally invasive procedures due to better imaging technology. The need is to develop therapies that have immediate impact with long-term benefits to reduce the risks of life-threatening complications and allow physicians to treat the youngest and tiniest patients. Our broad portfolio to correct structural heart defects includes breakthrough, minimally invasive and life-saving pediatric devices as alternatives to current standards of care.

You have recently launched a new device in India, the Amplatzer Piccolo™ Occluder  for Treatment of Premature Babies and New-borns with a Life-threatening Opening in Their Hearts? How do you think it is different from other devices available for treating congenital heart diseases?

This is the world’s first medical device that can be implanted in the tiniest babies (weighing as little as 700 gms) using a minimally invasive procedure to treat patent ductus arteriosus, or PDA. The device, even smaller than a small pea, now offers hope to premature infants and newborns who need corrective treatment, and who may be non-responsive to medicine and are at high risk to undergo corrective surgery.

One of the most common congenital heart defects occurring in premature babies, PDA is a potentially life-threatening opening between two blood vessels leading from the heart. This channel, which is present in normally developing fetuses, is important prior to birth to allow oxygen-rich blood from the mother to circulate throughout the fetus’ body. For most infants, the pathway, or duct, seals itself shortly after birth. In some cases, primarily in babies born prematurely, the PDA fails to spontaneously close, which can make it difficult for babies to breathe normally due to increased blood flow to the lungs. PDA accounts for up to 10% of all congenital heart disease.

The device is a self-expanding, wire mesh device that is inserted through a small incision in the leg and guided through vessels to the heart, where it is placed to seal the opening in the heart. It is designed to allow the physician to insert it through the aortic or pulmonary artery, as well as to retrieve and redeploy the device for optimal placement. Because the device is deployed in a minimally invasive procedure, many of the premature babies who are critically ill in the neonatal intensive care unit are able to be weaned from artificial respirator support soon after the procedure.

Payal Agrawal, GM & Country Head, Structural Heart Division Abbott

It is said that this device can cure heart defects in children below 1 year of age including premature infants weighing even less than one kilogram? Can you share about a successful case study of Piccolo implant?

One of the first implants in India was done on a tiny infant, born at 27 weeks in Edappal, whose birth weight was just 960 gms. An echocardiogram revealed he had PDA, and he was intubated for almost a month. That’s when the baby’s treating physician decided that Abbott’s device was the best solution for the baby and decided to move forward with the implant. Post the implant, the baby could be extubated, put on some weight and is on his way to better health now. It is gratifying to see that through our devices, children like this baby have a chance at a normal life.

How do you see Abbott contributing towards strengthening the treatment modalities when it comes to heart diseases in the coming years?

Diseases of the heart are complex, and success depends on innovation that brings to reality treatment options for patients. We are committed to this challenge and aim to create new technologies that redefine possibilities for people’s lives by changing the way cardiovascular disease is treated. We are present across the continuum of cardiovascular care — from diagnosis to treatment to management – with comprehensive solutions to tackle cardiovascular disease from every angle. We offer tools that give doctors new insights, such as a test that can help predict future cardiac events years before they occur and imaging that can improve treatment planning and care delivery. We’ve developed science-based nutrition that helps improve outcomes for people who undergo cardiovascular procedures. In many markets around the world, we offer a portfolio of medicines that treat a variety of cardiac conditions.

We focus on innovative technologies that can improve the way clinicians treat people with vascular diseases, irregular heartbeats and diseases of the heart’s valves and other structures. Abbott is at the forefront of medtech, advancing digital health technologies that put more control in people’s hands and helps them be more engaged in their own care. We are driving a future where medical devices are smaller, faster, connected, predictive and fit seamlessly into people’s lives — connecting patients and their doctors beyond the four walls of the clinic and enabling them to make accurate, timely and informed health decisions.