Current Trends in Cardiac surgery
Dr. Vijit K. Cherian, Consultant Cardiothoracic Surgeon, Lakeshore Hospital
A lot has happened in the field of cardiac surgery in the past fifty years. From a period when the ability to treat cardiovascular disorders seemed impossible in the 1950s, to the possibility of salvaging high risk end-stage heart failure patients in the present era, the future holds even greater promise to the many unanswered problems of diseases of the heart.
Coronary Artery Disease
Beating Heart Surgery/Off-Pump CABG:The advent of beating heart coronary artery bypass grafting has reduced morbidity and hospital stay. It has extended the limits of surgical revascularization especially in patients with severe left ventricular dysfunction, calcific aorta, renal dysfunction and those with chronic obstructive pulmonary disease (COPD).
Nontransplant surgery for heart failure: In the era of nonavailability
of organ donors, it has become imperitive to look for alternatives to heart transplantation. Some of the techniques that can be used in these patients are:
High risk coronary artery bypass grafting n Mitral valve repair
Surgical ventricular restoration n Mechanical blood pumps
Valvular heart disease
Surgery for atrial fibrillation:Chronic atrial fibrillation either alone
or in combination with concomitant mitral valve disease can be
treated surgically especially when in medical management fails to yield results. Surgically pathways in the atria (upper chambers of the heart) can be interrupted. This can be done either by cut-andsew techniques or by using ablation.
Bioprosthetic valves:There is a higher usage of valves made from animal tissues especially from porcine (pig tissue) and bovine (cow tissue). The main indications for the usage of these valves is:
Age of patient > 60 years -- Inability to take anticoagulation
Women in child bearing age -- Limited life expectancy -- Those
wanting an active lifestyle.
Mitral Valve Repair:The technique of preserving the mitral valve is possibly the best option for a patient , where this is possible.
The future of heart valve replacements is tissue engineered
heart valves. The future for cardiac surgery is minimally invasive
cardiac surgery, robotic surgery, the use of anastamotic devices and newer valves and the use of advanced imaging techniques for assessment of cardiac disorders.