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The Evolution of Heart Surgery
When people think about heart surgery, it is usually the idea of “open heart surgery.” This surgery is considered invasive. It not only includes a large incision in the chest, but also, the heart is stopped and the patient is put on a heart-lung machine during the procedure.
In the last two decades, great advances have been made in the field of minimally invasive procedures. Treating the heart is no exception. Minimally invasive procedures involve small incisions, through which surgeons can use a camera and robotic surgical tools that allow for greater precision.
Open surgery versus minimally invasive
Heart disease is the leading cause of death for men and women in the United States. Today, there are about 500,000 open heart surgeries performed each year. It is most often used for complicated procedures, such as coronary artery bypass, or complex procedures to the aorta or the heart itself. These procedures usually involve a hospital stay of a week or more and a lengthy recovery time.
Minimally invasive procedures have proven effective for coronary bypass, valve surgery, or repairing aneurysms. When compared to open heart surgery, it is less disruptive to the body, meaning there is less pain and scarring. There is also a smaller risk of infection and bleeding. Finally, it typically results in a shorter hospital stay and quicker recovery. As a result, it is always better to do the less invasive procedure whenever possible.
For valve issues, minimally invasive procedures allow cardiac surgeons to either replace a valve entirely or do a repair. It is always best to try to retain the healthy part of the valve through repair rather than replacing it.
The heart is responsible for supplying blood to the whole body, including all the organs. But the only blood vessels that supply the heart with the oxygen and nutrients it needs are the coronary arteries. If an obstruction stops the blood from flowing through them, there needs to be another way to the heart. This is where bypass surgery comes in. In this procedure, surgeons take the patient’s blood vessels, veins, or arteries, and create a new pathway to “bypass” the area that is blocked.
Which procedure will be used
Many factors are considered to determine which type of procedure is right for each patient for the best possible outcome. Factors in the decision are the available data developed by physicians and researchers based on actual results. Other deciding factors include the patient’s anatomy and the extent of disease.
I like to think of it as doing home renovations. You would not want to destroy your entire house and start from scratch if you could avoid it. The same goes for surgery. If you can do something easier, faster, and better, with the same or improved outcome for a patient, minimally invasive procedures typically have a major advantage.
Medicine, open heart surgery, and minimally invasive procedures are all tools to try to manage patients with heart disease.
Coronary artery disease is almost exclusively found in first world countries. For the most part, people have heart disease as a result of lifestyle choices. The fact is there are many actions people can take to prevent heart disease, such as not smoking, getting regular exercise, managing weight and cholesterol, and having a diet low in saturated fats.
While heart disease remains the leading cause of death, life expectancy has been extended as medicine and technology have improved. However, it is important to remember that the longer people live, the higher their chances are for having a heart condition.
Luckily, the progress we have made has almost made open heart surgery an archaic form of treating heart disease. As we move forward, technology will continue to move toward less invasive techniques.
What the future holds
As a cardiac electrophysiologist, I work with the heart’s electrical system. In this area, there are innovations and new technologies that are making treatments faster and smarter, ultimately resulting in better care and outcomes for our patients.
For instance, new wireless devices are now available for those who require pacemakers and defibrillators. This “leadless” technology means that we can keep hearts beating easier and more effectively. It is also worth noting that the technology used to perform electrical surgeries is always improving.
If you have heart disease, take comfort in knowing there are many ways we can help you. Learn more about our services here.
Antony Chu, MD
Dr. Antony Chu is the director of complex ablations within the arrhythmia services section of the Lifespan Cardiovascular Institute and an assistant professor of medicine in the department of medicine at The Warren Alpert Medical School of Brown University. His research interests focus on atrial arrhythmias and their management.