Minimally Invasive Heart Surgery: Splitting The Breastbone Isn't Always Necessary
At one point, a heart surgical procedure required opening your chest. Technology’s now made it possible in some cases to avoid open heart surgery in favor of minimally invasive procedures that are actually better for some patients.
Dr. Brian Lima is a cardiac and thoracic surgeon with Baylor University Medical Center. He'll participate in a panel discussion on cardiovascular health hosted by Sam as part of Baylor’s Head to Toe Health Series Thursday (2/9/17) at noon at Hamon Hall in the AT&T Performing Arts Center.
What are some minimally invasive approaches to heart surgery: "There is something as simple as just a valve crimped on to a catheter that can be deployed using an artery – like an artery in the groin – without having to make an incision. There are also scenarios where we can go through the ribcage, between the ribs, on the side of the chest with much smaller incisions. There’s even robotic-assisted approaches using that same kind of approach through the ribs."
How doctors decide: "It sort of depends on what the valve issue is, which valve it is and what’s best for the specific patient."
For example: "The main pumping chamber of the heart has to get the blood to the rest of the body and the passage way is the aortic valve. That valve over time can become what we call stenotic or tight. Calcium can build up and the heart has to work progressively harder to get that blood through this narrowing opening. When it gets so narrow that symptoms occur – shortness of breath, fainting spells, chest pain – the valve needs to be replaced. Years ago, that meant open heart surgery. Then we progressed to going just halfway – what’s called a mini-sternotomy: Go between the ribs on the front of the chest. In recent years, you can actually have an aortic valve prosthesis crimped on to a catheter and have it put in like you’re getting a catheterization."
Advantages over open heart surgery: "That drastically cuts down on the length of a surgery, the trauma to a patient. There’s a faster recovery And if the measurements and the approach is appropriate for a given patient, it’s revolutionized aortic valve surgery."
Candidates for this type of surgery: "Where this technology started is in what we call high risk or inoperable patients, which are predominantly elderly folks with other medical issues. As the success with that has evolved, we’re extending this technology to further down, lower risk profile people. Currently, if you’re intermediate risk, meaning you’re not quite inoperable or high risk, as judged by the heart team (team of heart specialists) and the risk scores that we have, you can also be a candidate for this catheter-based aortic valve replacement."
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