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Heart surgery was considered to be the last frontier in the development of modern surgery. Since its inception in the 1960s, tremendous progress has been made in many fronts of this highly specialized field of surgery.1 What was once thought as unthinkable to operate on the fragile beating heart, surgical procedures on the heart are among the most common operations done in this country today. This is due to the high prevalence of cardiovascular disease and the remarkable safety that has been developed in modern heart surgery. For example, the risk of dying from coronary artery bypass surgery at the
I have had the opportunity to contribute to the risk reduction of heart surgery through clinical and laboratory research. I have delineated the risk stratification and management of high risk patients such as the elderly (octogenarian)2,3,4, the patients with kidney failure5, liver failure6, and blood disorders.7 Innovative techniques and medicines have been tested in my laboratory and subsequently applied in our current management of our patients in the operating room by improving the protection of the heart during surgery.8,9 On-going work is being done to reduce the need for blood transfusion during surgery10, and to streamline hospital care after surgery to allow the patients to go home to their families expeditiously.11
Through the dedicated work of numerous scientists and physicians, modern heart surgery is providing significant benefits with minimal risks to over four hundred thousands of patients in this country annually. As we move onto the next millennium, the next giant step forward is to minimize the trauma and the risks of heart surgery. A number of advanced techniques have been developed to allow the patients to recover more expeditiously, return to their normal daily activities and the workplace. Toward this endeavor, I am collaborating with other scientists and industries on the investigation of new techniques that may allow heart surgery to be done without the traditional large chest wound12, and to avoid the use of the heart-lung machine that is responsible for so much of the morbidities associated with heart surgery.
Most recently, I have developed a program of "Off-Pump" or "beating heart" coronary bypass surgery. With the proper instrumentation and monitoring, coronary bypass surgery can be done without the use of the heart-lung pump in 55% of our cases. We find that this new approach of beating heart surgery is critical for the elderly, and the patients with major organ dysfunction, such as emphysema, asthma, kidney failure, and previous history of strokes. Our new program has allowed our patients to recover expeditiously, with lower chance of blood transfusion requirement, being able to come off the respirator soon after surgery, with less lung and neurologic complications, shorter hospital stays, and regain their normal level of activities at home earlier.
Toward the same goal of reducing the trauma of surgery, the "Endoscopic Vein Harvest" technique has been adopted in our program. The saphenous vein along the leg is often used for coronary bypass surgery. Traditionally, a long incision is made along the length of the inner leg to remove the vein. In this new endoscopic technique, only two small puncture wounds are required to remove the entire vein in the thigh. In addition to the cosmetic advantage, this minimally invasive approach is beneficial for patients with wound healing problems such as those on steroid or are diabetic.
I have initiated a new program for Laser transmyocardial revascularization (TMR). TMR is a new procedure approved by the Federal Drug Administration to treat patients with advanced coronary disease that can no longer be treated adequately with medicine, angioplasty or bypass surgery. TMR creates new channels in the heart muscle to provide new blood flow to alleviate angina or chest pain symptoms.
The latest development in valve surgery has been incorporated into our program by employing the "Heartport" or "Port-Access" technique. Only a 3 inch incision is made on the right chest rather than opening the entire sternum or breastbone as in the traditional method. The surgery is facilitated through specialized endoscopic instruments, and we have utilized this advanced technique successfully in aortic and mitral valve surgery. Patient satisfaction is enormous because of minimal wound discomfort. Patients are able to drive, swim, and carry out other major activities within days after surgery, instead of waiting for three to six months for the breastbone to heal.
Lastly, I have initiated a project in designing innovative treatments for advanced heart failure. I have performed a new procedure known as the "heart reduction surgery" or the "Batista" operation on a dozen patients, with good long term benefits on the selected individuals. The U.S. Genome Project is expected to provide major breakthroughs in various fields of medicine as we move onto the next century. I am investigating the possibility of using gene therapy in treating advanced heart failure. We are Investigating into the genetic expression of bypass grafts with hopes of prolonging their longevity. A number of innovative surgical techniques and instruments are being tested in our laboratory to enhance the safety of the new minimally invasive approach, such as the use of laser welding of blood vessels. Clinical research on our patients is always ongoing to improve the quality of care and patient satisfaction.
