Artificial Intelligence (AI) is rapidly transforming the landscape of cardiac surgery, offering unprecedented opportunities for precision, planning, and patient care. As robotic surgeries become more prevalent, AI integration is enhancing diagnostic accuracy, surgical outcomes, and post-operative monitoring. Dr. Swarup Swaraj Pal, a Consultant CVTS and Transplant/MICS Surgeon at Dr L H Hiranandani Hospital, Mumbai, shared his insights on the current state and future prospects of AI in cardiac procedures. In a recent interaction with Healthcare Radius, an ITP Media Group publication, Dr. Pal delved into the benefits, challenges, and ethical considerations of this groundbreaking technology.
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How has the integration of AI transformed robotic surgery in cardiac procedures?
By using AI and 3D models of images of cardiac lesions, surgeons can plan better. All complex procedures are run through, in the mind, and then performed. This gives better results and enhances the safety profile of complex surgeries.
How AI has improved patient outcomes in cardiac surgeries?
AI enhances diagnostic accuracy in interpreting various cardiac images, such as CT scans, MRIs, and echocardiograms. AI and language models streamline medical record documentation, automate administrative tasks, and improve operational efficiency, enabling us to focus more on direct patient care. In surgeries this results in better surgical outcomes. For example, a complex lesion with abnormal drainage is determined and the connections and distances measured pre op. During surgery we know exactly how to do the intra cardiac repair and plan the subsequent steps. Another example is that a bicuspid calcified aortic stenosis patient is analyzed by AI and we know preoperatively if the patient needs a root enlargement or the chances of a conduction block while decalcifying the annulus.
What are the future prospects for AI-enhanced robotic surgery in cardiology?
In the future, AI will help us with cardiac imaging, 3 dimensional [3D] reconstruction, electrocardiography, continuous bedside monitoring, analyzing the ICU parameters of the admitted patient by the doctor at remote locations , better patient monitoring by wearable devices, analyzing the genetic pedigree in rare cardiac lesions and much much more. The future holds great promise.
How can AI be used to identify patients at high risk for complications during cardiac surgery?
AI was used to predict mortality, postoperative length of stay, and complications following cardiac surgeries. It can also improve clinicians’ medical decisions by providing better preoperative risk assessment, stratification, and prognostication. AI can detect elevated pulmonary pressures, determine the cardiac output and thus guide us about a stormy post-operative course. It can guide us as to which ionotropes to use and detect arrythmias as well. By calculation, multiple scoring systems and combining them, it can tell us where the patient may get stuck and which system or end organ needs more preservation.
What are the challenges and limitations of using AI in cardiac surgery?
Cost and availability and high end machinery are the limiting features. A 3D cardiac imprint may cost 2-2.5 lakhs in our setting. If we invest in this, the patient is not left with any money to undergo the surgical procedure. Also, the high end machinery and hybrid OT set up needed is not possible in smaller set ups and tier -2 cities.
What are the ethical considerations associated with using AI for predictive analytics in surgery?
It starts with the consent of the patient, the predictions and their sensitivity of AI, addressing the high risk factors and explaining it to the patient, their acceptability and legal issues if things go south if it was not predicted in the first place. Also data privacy and respecting patient’s right to share is important.
How can we ensure the transparency and accountability of AI algorithms used in surgical procedures?
We can ensure transparency by being honest with the patient and explaining each high risk variable to the surgical candidate. With respect to accountability, there is an AI governance committee which regularly reviews the AI performance by incident reporting and formulating response plans. AI tools also work under the purview of ISO and FDA guidelines.
What future trends and challenges do you foresee in the integration of AI into cardiac surgery?
The future will see AI driven patient specific care, voice assisted surgery and 3D navigation tools being employed. There will be AI powered autonomous robots and AI driven recommendations for surgical decisions. AI enabled monitoring in the ICU as well as remote patient monitoring will be feasible. A surgeon on vacation will be able to check on his post operative patients in real time!
The challenge would be to ensure a safe playing field wherein the surgeon understands the AI’s thinking process and balances the AI insights with human clinical judgement. Developing guidelines for AI integration in cardiac surgery will be a challenge considering the difficult nature of cardiac surgery sans any second chance. Preventing virus attacks / hackers and protecting sensitive patient data fed into the AI processor will be required. Liability, accountability and continuous monitoring and evaluation and evolution are foreseeable challenges in the future.
In short AI could be a game changer, but needs to be handled with care, curiosity and precision.
