Cutting Edge: Attacking Heart Disease. Heart Surgery. Minimally Invasive Procedures.

Aortic Valve ReplacementWith over a third of Americans afflicted with cardiovascular diseases of some kind, many of us may be on the verge of needing some type of heart surgery or may know someone who may be needing heart surgery. Cutting Edge: Attacking Heart Disease, is a medical special report produced by Gannett Broadcasting, airing across America that explores new and innovative, procedures and treatments that are helping us fight heart disease. One area of rapid advancement is minimally invasive heart surgery procedures that are taking the place of open heart surgery. These new techniques have less scaring and faster recovery rates. With host Julie Nelson and leading cardiology surgeons from major medical centers, we learn why these minimally invasive techniques are considered cutting edge.

What are minimally invasive techniques?

Rakesh Suri, M.D., Cardiovascular Surgeon at the Mayo Clinic in Minnesota says “heart surgery in general is becoming more miniaturized, becoming more minimally invasive, that’s utilizing both robotic and catheter-based technology. Robotic surgery and cardiac surgery is still in its infancy. The da Vinci  is really an extension of our own hands and eyes for that matter. We are able to utilize 4 instruments including the camera all at once. Using those two technologies, high definition imaging and robotic telemanipulation, we are able to perform the same operations that we would traditionally by putting our hands in the middle of the patient’s chest, outside of the chest now, through small incisions that are the size of the fingertip. So that’s why it’s cutting edge for both surgeons and patients. That translates then into improve patient outcomes, patients get to the floor earlier, they leave the hospital earlier.”

Minimally Invasive Aortic Valve Replacement
Julie Nelson points out that the replacing of the aortic valve, keeps oxygenated blood flowing from the heart to the aorta,
almost always requires open-heart surgery. But a new cutting-edge surgical technique might change the procedure forever.

Hersh Maniar, M.D., Cardiac Surgeon, Washington University at Barnes-Jewish Hospital says ” Transaortic valve replacement is a groundbreaking procedure because it offers a gentle therapy to many elderly and frail patients who have aortic stenosis and who are not candidates for traditional aortic valve replacement. For many patient it leads to easier recoveries and less pain. You want to do this in such a way that the patient can have the breathing tube out that afternoon and have a short hospital stay. Typically in a range of four to five days. This is what we have seen with the trans-catheter valve programs so far.”
Alan Zajarias, M.D. Cardiac Surgeon, Washington University at Barnes Jewish Hospital says “it’s a game changer because it improves survival, improve symptoms, patients seemed to live better.”

We learn that without opening a patient’s chest, doctors are able to replace aortic valves. To do this, they use the trans-catheter valve technique which involves inserting a new valve made of cow heart tissue and a small wire mesh expandable stent, into a catheter. The catheter is then inserted into the leg or below the left breast and threaded to the site of the bad valve using x-ray guidance. The new value with the stent is released from the catheter and inflated with a balloon which opens the stent. Then inside the stent the new valve starts working.

Julie explains that this procedure allows patients to avoid the use of cardio pulmonary bypass or being on a heart lung machine. For elderly patients this is key because some 100,000 receive new aortic valves every year. 30,000 more require a replacement valve. For the elderly, the risks of open-heart surgery may be too great, so trans-catheter in valve replacement can dramatically improve their lives.
The procedure is still in clinical trials and it’s not yet been approved by the FDA.  But physicians look forward to some day being able to offer this to patients on a wide scale. (Update 11-2-2011 Sapien Transcatheter Aortic Heart Valve Gains FDA Approval)

Less Invasive Stent Procedure to Un-Clogged Arteries
Julie explains that one serious problem related to heart disease is clogged arteries.  One procedure that restores blood flow to clogged arteries is called coronary angioplasty.  Its goal is to reduce or eliminate a patient’s chest pain or shortness of breath.
An interventional radiologist inserts a very small balloon attached to a thin catheter into a blood vessel through a small nick the skin. The catheter is threaded under x-ray guidance to the site of the blocked artery. The balloon is inflated to open the artery.

Angioplasty is often combined with the placement of a small wire mesh stent to help prop the artery open and decrease the chance of narrowing again.  Stents have often been inserted into patient’s legs making recovery more difficult.
Carmello Panetta, M.D. Cardiologist, Healtheast Heart Care, Minnesota does a stent procedure that is often less invasive.

Dr. Panetta says “I perform cardiac catheterizations looking at the heart, specifically the heart vessels, where they feed the heart and where there are blockages. I work with cardiothoracic surgeons and the rest of the team to define whether or not bypass surgery, stenting or medical therapy is the best option for people who come in with unstable angina or stable angina.”

Dr. Pineda explains his less invasive stent procedure. “The idea is that I put a tube into the wrist. I use ultrasound to locate the artery and a small tube which can be as small as 1.3 mm diameter, allows me to place the catheter back up to where the heart is and then I inject iodine-based dyes and then take x-rays…and image the vessels…a shadow from the inside of the vessel will light up.  And where there is a narrowing, you will see the dye suddenly disappear and then open up again. And that will reflect atherosclerosis or buildup of plaque.

Going through the wrists allows the patients to sit up right away, and be able to walk around. It’s a good procedure to go forward with.”

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