When a Bengaluru government hospital makes high-end heart surgery look ordinary

For many Indians, ‘advanced heart surgery’ still evokes a familiar image: a sleek private hospital, cutting-edge technology, and bills large enough to devastate family finances. Public hospitals, by contrast, are often associated with overcrowding, long waits, and basic care. High-end cardiac procedures — especially minimally invasive ones — are widely assumed to belong to the private sector.

That assumption deserves reconsideration.

In Bengaluru, the State-run Sri Jayadeva Institute of Cardiovascular Sciences and Research has built a cardiac surgery programme that challenges this stereotype. At its core is Right Vertical Infra-Axillary Thoracotomy (RVIAT), a minimally invasive ‘keyhole’ technique typically associated with elite global centres. The real story is not just that Jayadeva performs RVIAT but that it has made it routine in a government setting, using standard instruments, for hundreds of largely poor patients without straining public resources.

RVIAT changes how surgeons access the heart. Instead of splitting the breastbone (sternotomy), the surgeon operates through a small incision under the right arm between the ribs. The sternum remains intact, and the scar is hidden in the underarm crease. For patients—especially young women—this reduces visible scarring, pain, and recovery time. Clinically, it also translates to shorter ICU stays, fewer wound complications, and faster mobilisation—outcomes that matter as much for system efficiency as for patient comfort.

The technique itself is not new. Centres in Switzerland, China, and elsewhere demonstrated that axillary approaches can be safe and effective for congenital and selected adult procedures. But they also highlighted a limitation: from a small incision, the heart lies deep within the chest, making access to structures like the aorta technically demanding—particularly in adults. Many hospitals overcame this using specialised long instruments or robotic systems, options often out of reach for public institutions.

At Jayadeva, Rajesh Kishan Rao and his team approached the problem differently: instead of bringing expensive tools to the heart, they brought the heart closer to the surgeon. Their ‘traction technique’ for aortic cannulation involves placing sutures on the aorta, looping them, and applying controlled traction to lift the heart and great vessels closer to the incision. This simple innovation converts a deep, narrow field into a workable space using standard instruments, transforming a complex procedure into a reproducible one.

The scale of implementation is striking. Rajesh at Jayadeva has performed around 700 keyhole procedures within a total of more than 3,000 cardiac surgeries—numbers large enough to assess safety and reproducibility. Importantly, over 95% of these minimally invasive surgeries are provided free to below-poverty-line patients, supported by Karnataka state funding and schemes like Ayushman Bharat. Comparable procedures in the private sector often cost Rs 5–7 lakh. For patients from districts such as Koppal, Raichur, or Ballari, this difference determines whether treatment is accessible at all.

The benefits operate at two levels. For patients, RVIAT means less pain, fewer complications, shorter hospital stays, and quicker return to routine. For a daily-wage worker, earlier discharge can prevent financial collapse; for a young woman, a hidden scar can avoid lifelong social stigma. At the system level, improved recovery reduces ICU occupancy, transfusion needs, and overall resource consumption, allowing more patients to be treated within the same budget—an essential consideration in a resource-limited public system.

This model challenges the assumption that innovation and quality are exclusive to private healthcare. Jayadeva has not only implemented RVIAT successfully but also hosted what was described as the world’s first dedicated summit on transaxillary cardiac surgery, attracting national and international experts. Interestingly, visiting faculty were as interested in questions of training, logistics, and scalability as in surgical technique.

How does a public institution sustain such volumes? How are surgeons trained? What funding and policy frameworks enable this? These are precisely the questions policymakers should be asking.

At the same time, such success highlights systemic vulnerabilities. Programmes like this often depend on a small group of highly skilled individuals and a strong institutional culture. They risk becoming ‘islands of excellence’ within a broader system of uneven care. Over-reliance on key personnel makes them fragile in the face of burnout or leadership change. Moreover, celebrating isolated successes can distract from the harder task of strengthening the wider health system—district hospitals, anaesthesia services, nursing capacity, and referral networks.

Scaling minimally invasive cardiac surgery in the public sector will require deliberate policy action. Training programmes must expose young cardiothoracic surgeons to these techniques within public institutions, not just private fellowships. Governments need to support centres of excellence while ensuring rigorous outcome tracking, appropriate case selection, and accountability. Professional bodies must define standards to ensure that the push toward minimally invasive approaches does not compromise safety.

The lesson from Bengaluru is not that every district hospital should adopt RVIAT immediately. Rather, it shows that with sustained public funding, institutional vision, and context-sensitive innovation, government hospitals can deliver care that matches global standards. In a debate often framed as public versus private, Jayadeva offers a more useful question: not who owns the hospital, but what enables high-quality, accessible care for those who need it most.

(The writer is a Hyderabad-based consultant neurologist)