Advances in Diagnostic and Surgical Techniques

Ten years ago cardiac surgeons operated on patients using certain basic techniques that did not necessarily take into account each individual’s, age, health or structural differences. Today, individualized cardiac care begins in the diagnostic stage and carries through to a variety of therapeutic options. One size does not fit all.

"The biggest change is that every step has been refined," says Craig Saunders, M.D., Chairman of Cardiothoracic Surgery for the Saint Barnabas Health Care System. "Now each procedure is tailor-made for the individual. The options are so much greater. It is the difference between the Little League player who swings at anything regardless of the pitch and the Major League player who can hit a slider or a curve ball with different techniques."

Diagnostics Play Important Role in Plan of Care

By using advanced diagnostic techniques, cardiac surgeons are more familiar with the internal structure of the patient than ever before. Tests, such as the transesophageal echocardiogram, which are performed before surgery, provide the surgeon with structural and functional information about the patient’s valves and heart muscles. Knowing medical details, such as the thickness of the patient’s muscles, helps the surgeon create the best surgical and postoperative plan of care.

"Everyone is different and the disease is different depending on the patient," says Dr. Saunders. "Our ability to individualize treatment has, in large part, resulted in dramatic improvements in cardiac outcomes for HEART HOSPITAL patients of the Saint Barnabas Health Care System."

Treatment Options Grow "The choices for cardiac surgery have grown in leaps and bounds in just the last five years," says Dr. Saunders. One example is the use of "beating heart surgery" for coronary bypass operations, eliminating the use of a heart and lung machine for some patients. When patients undergo a coronary bypass operation, they are generally put on what cardiologists call "the pump," which serves as an artificial heart while surgeons graft a blood vessel (or blood vessels in double, triple or quadruple bypasses) around the blockage. There is risk and trauma associated with this procedure in which the patient's heart is actually not beating for several hours. Post-operative lung, brain, and kidney problems can occur. HEART HOSPITAL surgeons use a less invasive method: coronary artery bypass grafting without cardiopulmonary bypass (a.k.a. off-pump CABG), or, "beating heart surgery." Here, surgeons work directly on the heart without having to break the breastbone to open the chest cavity. Lower death and serious complication rates and shorter lengths of stay have been associated with this less invasive method. "To sew a small vessel on the heart is a little thing, but getting there is a big thing," says Dr. Saunders. "Breaking the breastbone is a traumatic procedure for the patient and it takes time to heal. Whenever possible, we avoid doing so. Beating heart surgery eliminates the need to break the breastbone, reduces blood loss and has a less detrimental effect on brain and kidney function."

The Future of Cardiac Surgery

With the use of advanced robotics, cardiac surgeons can perform procedures without the surgeon’s hands ever entering the patient’s chest. Currently, HEART HOSPITAL surgeons employ robotics for some techniques and Dr. Saunders expects to use them in the future for operations on heart valves and eventually multiple bypasses. The da Vinci Robot System gives the cardiac surgeon the control, range of motion and 3-D visualization that is characteristic of open-chest surgery.

Dr. Saunders also predicts an increase in both alternative medicine techniques to supplement post-operative care, and a focus on the prevention of heart disease with the help of future DNA studies. To be a cardiac surgeon, says Dr. Saunders, is to embrace change.

"There is an old saying: ‘What you did yesterday is no longer good enough today,’" he relates. "You have to continually change, update and innovate. I enjoy being out there on the edge. I have no fear of change."

To reach The HEART HOSPITAL of New Jersey, please call (973) 322-2131.