New Techniques in Cardiovascular Surgery

Modern cardiac surgery owes its existence to technology as all other fields of medicine. Cardiac surgery with its various surgeries requires artificial valves, fabric grafts, Heart-Lung machine and its components and disposables, along with various other technological innovations in the ICU and in anaesthesia for successful outcomes.

Further advances are needed to miniaturise the incisions and to perform the most difficult type of surgeries i.e. Aortic Surgeries, Aneurysm Repairs, Aortic Dissections that can take upwards of 6-8 hours to perform. This requires the use of deep Hypothermia (cooling the patient down to 18C) and stopping the circulation completely – Circulatory Arrest, without causing any brain or other organ damage. This has been possible due to technological innovations and evolution of new techniques in the field. We have started understanding the physiology of the human body better, thereby are able to make machines that can help improve outcomes in cardiac surgery. Robotic heart surgery, involving the use of robots, use of Anastomotic Devices for Coronary Artery Anastomoses, stabilisers, are all examples of technology allowing us to perform heart surgeries with smaller incisions, better accuracy and better results. Robotic surgery as applied to cardiac surgery is still developing, due to the restricted access in the chest and the difficulty in handling fine sutures while stitching the heart.

The most challenging aspects of heart surgery are surgeries in new-borns and small children with birth defects. These babies are sometimes prematurely born and weigh less than 2kg, needing complex surgeries to correct their heart defects. This is an entirely different specialty and needs a completely different training as well as dedicated surgeons, Anaesthetists, Perfusionists and nurses to make the surgeries successful.

The advent of Percutaneous Valve replacements using TAVI – Trans Apical or Femoral Aortic ValveImplants, valves, is an example of superb innovations to make sutureless valve replacements possible. These valves are crimped to a size of our groin arteries so that they can be introduced without an incision and then expanded once the valve is near the Heart. This technique of crimping and re-expansion is a direct application of space technology and involves the use of a self-expanding alloy called Nitinol. Currently, these valves are approved for use in patients >80 years age who are too ill to have a surgical valve replacement. Similarly, is a technology called a Mitraclip that is used to fix a leaking Mitral Calve without a cut on the body.

The future will include Gene Therapy and the use of Stem Cells injected in specific areas of the heart as treatment at a cellular level, without the use of conventional surgery.

Dr Manoj Pradhan,
Senior Consultant,
CVTS Surgery,
SL Raheja Hospital-A Fortis

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