Minimally invasive approach during coronary artery bypass grafting surgery is safe and effective

New research shows that a minimally invasive approach used during coronary artery bypass grafting surgery is safe and effective, despite previous studies that linked endoscopic vein harvesting to a higher mortality rate. The research, published in the August 1, 2012 edition of The Journal of the American Medical Association, was an observational study of more than 235,000 patients included in The Society of Thoracic Surgeons National Database who underwent CABG surgery at 934 participating surgical centers. Investigators compared the three-year outcomes of patients undergoing EVH to the outcomes of patients undergoing the more invasive open vein harvesting (OVH) procedure and found no difference in mortality rates. "This study should alleviate concerns of patients and surgeons raised by past studies, and confirms the superiority of the EVH technique in terms of infection and wound complication rates that makes the minimally invasive approach the preferred method," said senior author Peter K. Smith, MD, Professor and Chief of Cardiovascular and Thoracic Surgery at Duke University in Durham, N.C.

Heart surgeons-in-training benefit from hands-on homework (Canada)

Residents in cardiac surgery who receive extra training on a take-home simulator do a better job once they get into the operating room, Dr. Buu-Khanh Lam today told the Canadian Cardiovascular Congress 2011, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society. Dr. Lam and a multidisciplinary surgical team developed a kit – containing sutures, forceps, and miniature tubing – that can be taken home by trainees to practice a highly technical operation called microvascular anastomosis. The procedure, which involves joining two arteries together, is the "bread and butter" of coronary artery bypass surgery and is performed hundreds of thousands of times a year in North America, says Dr. Lam, director of surgical undergraduate education at the University of Ottawa and director of the University of Ottawa Heart Institute Valve Clinic

England has best heart surgeons in Europe: report

For the first time comprehensive data on cardiac surgery across 23 countries has been compared. Patients in the NHS in England and Wales were 25 per cent more likely to survive their operation and recovered faster than the European average, the report found. It means around 250 more patients survive surgery each year because their operations were in England or Wales - Telegraph

Statins before surgery can lower heart-attack risk (USA)

Cardiologists at the University of Florida's medical college have found that giving patients cholesterol-lowering statins before surgery and other invasive procedures can cut their risk of heart attacks, death and other complications by almost half, according to a new report in the Journal of the American College of Cardiology. "The magnitude of benefit we found in terms of reducing mortality, post-procedure myocardial infarctions and reduction in atrial fibrillation after bypass surgery is really quite large," said Dr. David Winchester, a cardiologist at UF's College of Medicine. "If you look at some of the other interventions we use, such as using beta blockers before surgery, you don't get nearly the kind of benefit that we are seeing with using statins prior to procedures. That is very surprising." They found that patients who took the therapy before surgery had a 43 percent lower risk of heart attack and 46 percent lower risk of atrial fibrillation. Post-surgery death rates were lower by 34 percent. Beneficial effects were seen when statins were administered as little as one day before surgery

Hospital suspends heart surgery after child deaths (UK)

An Oxford hospital has suspended child cardiac surgery pending the results of an external investigation into the deaths of four children over the past three months. Twenty six children are awaiting heart surgery at the hospital. Those who need urgent treatment will be offered operations elsewhere. A hospital statement said the four children had been "very sick." It read: "Paediatric cardiac surgery outcomes are nationally validated and the data is published. Oxford has been within normal outcome ranges." The statement added that it was "right that we take a pause while we look in to the individual cases, to see if there is anything to learn from them." The four children had congenital heart problems and had been receiving care at the hospital before their operations." - Reuters

Heart surgery to sideline Newfoundland and Labrador premier for weeks (Canada)

Newfoundland and Labrador Premier Danny Williams will be sidelined from three to 12 weeks because of heart surgery he'll undergo at an undisclosed location in the United States, says acting premier Kathy Dunderdale. Williams travelled to the U.S. Monday on the advice of his doctors after weeks of consultations, Dunderdale said. "I'm not going into the details of the premier's condition," she told reporters at a news conference in St. John's Tuesday morning. "Any heart surgery is serious, however, his prognosis is very, very good." Dunderdale said the surgery would happen this week, but refused to provide specifics on the day or where Williams is being treated, other than to say he has "gone to a renowned expert in the procedure that he needs to have done." She also wouldn't say whether Williams could have had the procedure performed in the province or elsewhere in Canada

Surgery on beating heart thanks to robotic helping hand

"If you've been waiting for the day to arrive when computers actually start performing surgery, that moment might soon be upon us. A French team has developed a computerized 3D model that allows surgeons to use robotics to operate on a beating heart, according to a report in The International Journal of Robotics Research, published by SAGE. The robotic technology predicts the movement of the heart as it beats, enabling the surgical tools to move in concert with each beat. It means that the surgeon can perform a procedure as if the heart was stationary. This development could be very important for millions of patients who require less invasive surgical heart procedures, where stopping the heart from beating would cause unnecessary risk. Rogério Richa, Philippe Poignet and Chao Liu from France's Montpellier Laboratory of Informatics, Robotics, and Microelectronics developed a three-dimensional computerized model that tracks the motion of the heart's surface as it beats. In addition to the heart, this model also accounts for the movement of a patient's chest wall during breathing. Known as the "thin-plate spline deformable model", this new computerized approach allows the robotic arm to continually adjust to heart and chest movements during surgery" - EurekAlert

Kryptonite glue helps breastbone heal after surgery (Canada)

A glue that rapidly bonds with bone can speed up recovery of the breastbone after surgeons intentionally break it during open-heart surgery, researchers in Calgary have found. As part of a pilot study, cardiac surgeon Dr. Paul Fedak of Foothills Medical Centre and the University of Calgary used the adhesive polymer, called Kryptonite, on more than 20 patients. "If we can change what people are doing to benefit patients around the world and this really does change the standard of care, then I know we've done something really significant with this work, and that would be the ultimate goal," said Fedak. The new adhesive heals the breastbone in hours, instead of weeks, after surgery, without sticking to surrounding tissues. Patients reported far less pain and discomfort after surgery and did not need as much strong pain medication, such as narcotics, the team found. - CBC

Anytime is good for heart surgery

"The October issue of the journal Anesthesiology contains a study reviewing potential adverse effects associated with the timing of a patient's heart surgery; but based on this study, there is no bad time of the day or week or year to have elective coronary artery bypass graft surgery. Research indicates that sleep deficits, natural body rhythm disturbances, and prolonged duty all reduce performance of drivers and pilots. This study's authors tested the theory that the same adverse effects may impact hospital personnel performance. Hospital personnel often work off-hours and pull long shifts. The study investigators thus expected surgical outcomes to be worse at the end of the day and at the end of the week when personnel are likely most fatigued. Similarly, outcomes might be worse in July when new resident physician trainees, fresh out of medical school or newly promoted to perform more demanding duties, start working"

Doctors invent 'egg whisk' to help heart pump blood during surgery (UK)

"Doctors have pioneered a revolutionary 'egg whisk' to help the heart pump blood round the body during life-saving operations. The device, which rotates faster than a high-speed food blender, could revolutionise surgery to unblock arteries and reduce the risk of organ failure during heart surgery. The ground-breaking procedure involves passing the miniature fold-up whisk through the body and next to the heart. It is then used to clear blocked arteries or to keep blood pumping around the body during heart surgery and so reducing the risk of cardiac arrest or other organ failure, the Times reported. It is inserted via a catheter through the groin shortly before angioplasty - the technique used to mechanically widen an obstructed or blocked blood vessel. It then folds out to form a plastic cage encasing two eight mm blades which can rotate at a speeds of 12,000rpm"

Deaths prompt heart patient alert (UK)

A hospital has recalled 14 people who have had heart valve surgery after three patients died from an infection. Nottingham University Hospitals NHS Trust contacted the patients, who all underwent the procedure at the Trent Cardiac Centre at the City Hospital. A trust spokesman said the three who died were among eight patients who had the surgery who went on to develop the skin infection staphylococcal. He said the other 14 were at low risk but had been recalled as a precaution - BBC

$5m to avert heart wait-list deaths (New Zealand)

"Auckland and Northland patients needing state-paid heart surgery have been assured waiting times will shorten following a $5 million boost. Health Minister Tony Ryall announced the cash yesterday after audits at Auckland City Hospital revealed that 141 patients had in May been waiting too long for surgery. The maximum wait under clinical guidelines ranges from two weeks to three months, depending on each patient's condition. Yesterday, the hospital promised to cut waiting times to a maximum of three months by October 31." - NZ Herald

Drinking in week before surgery a bad idea, doctors say

Drinking alcohol during the week before heart surgery multiplies the risk of delirium by six times, a study done at St. Paul's Hospital in Vancouver suggests. Delirium can include agitation, confusion and hallucinations. It may last days or weeks and can delay discharge from hospital or even increase the risk of complications and dying after surgery. Delirium is distressing for family members and increases the burden of care on nursing staff. Previous research has shown that it occurs more frequently in patients who are chronic drinkers and elderly. But in the current study, age was not a risk factor and merely drinking in the week before surgery increased the risk. The study, published in the B.C. Medical Journal, was conducted by six local physicians and a medical student. It was based on the charts of 38 patients who were admitted to St. Paul's for open heart bypass and/or valve surgery over a two-week period - Star Phoenix

Video: open heart surgery at the Wellcome Institute (UK)

An audience of 200 people gather to watch a surgeon perform open heart surgery live:

Dubai Heart Centre's free surgeries save 100 children

"Over a 100 children have got a new lease of life, thanks to free heart surgeries at Dubai Heart Centre in
 Dubai Hospital. At a ceremony held on Thursday to celebrate the success of a campaign launched with a team of Swedish experts, officials at Dubai Heart Centre said they had conducted 120 heart surgeries since the launch of the campaign 
in 2007. Consultant cardiac surgeon and director of the centre Dr Obaid Al Jassim said the surgeries were conducted during a phased programme organised in association with the Swedish team. The Department of Health and Medical Services had launched the campaign after realising the need for paediatric congenital heart surgery facilities in the UAE. Many children born with congenital heart diseases in the UAE have been forced to seek treatment abroad. Usually conducted in various phases, these surgeries cost over Dh300,000, including
travel expenses in some countries. 'Sometimes this can go up to Dh500,000 if
it is a complicated case,' 
said Dr Jassim. He said that the initiative meant for citizens and residents from different emirates also benefited some children from Saudi Arabia, Yemen, and Bahrain, some of whom were in critical condition requiring
 urgent intervention. Many children, whose lives were saved through the initiative, were present at the programme. Meanwhile, a Dubai-based healthcare group also launched a similar initiative to offer free and subsidised congenital heart surgeries for children born in
poor families. Dr Moopen's Group recently announced the 'Save Little Hearts' campaign in Dubai to mobilise resources for conducting these surgeries at MIMS Cardiac Centre, the group's high-tech cardiac facility in
 Kerala, India"

Researcher develops method to combat congenital heart disease in children

Alison Marsden, an assistant mechanical and aerospace engineering professor at the University of California at San Diego, has developed a unique set of computer modeling tools that are expected to enhance pediatric surgeons' ability to perform heart surgery on children. Marsden's work focuses on designing and using simulation tools to provide a way of testing new surgery designs on the computer before trying them on patients, much like, for example, engineers use computer codes to test new designs for airplanes or automobiles. Source - Journal of Thoracic and Cardiovascular Surgery

Anxiety does not up risk of post-surgery delirium

Older patients often suffer delirium after heart surgery, but this seems to be unrelated to pre-surgery anxiety and depression, according to a new study. "Delirium is a common psychiatric complication after cardiac surgery," note Dr. Koen Milisen, of Katholieke Universiteit Leuven, Belgium, and colleagues. "Special attention" must be paid to delirium after heart surgery, because the syndrome is associated with poor outcomes, including higher rates of post-surgery complications, longer hospital stay, and higher death rates, they say. In a long-term study involving 104 elderly patients admitted for heart surgery, Milisen's team found that 27 patients, or 26 percent, suffered postoperative delirium for a median of 2 days - Source: Journal of the American Geriatrics Society, December 2008.

British team lead stem cell heart surgery that could end need for transplants

A major advance in treatment for millions of heart patients has been heralded by revolutionary stem cell surgery, developed by a British-based team of scientists. The researchers at Imperial College London are perfecting a technique to rebuild a heart severely damaged and scarred by disease or cardiac arrest. They have discovered a way to extract, grow in the laboratory and then graft on a patient's own muscle-building cells which then can be used to patch up the heart and increase its pumping power. Eventually it could end the need for transplants, revolutionise heart surgery and reduce the 238,000 lives lost every year to heart disease, the UK's biggest killer. What is more, it could increase the quality of life for the million or so people who suffer a heart attack every year. The world-leading research, which is being led by the American Professor Michael Schneider, was last night awarded The Medical Futures Innovation Award, otherwise known as a medical Oscar. Dr Nicholas Boon, President of the British Cardiovascular Society and one of the judges for the awards, said: "This could transform the care for patients who have had heart attacks or have heart disease. "Because the cell therapy uses a patient's own cells, it negates the risks or complications associated with other treatment options such as rejection linked to transplantation." - Telegraph

Octogenarians can be good candidates for heart surgery

"Patients 80 years and older who are in overall good health are perfectly able to withstand open-heart surgery, according to the latest study of Dr. Kevin Lachapelle of the McGill University Health Centre. His findings were presented in Toronto during the 2008 Canadian Cardiovascular Congress. 'Age should not be a reason for doctors to rule out the possibility of heart surgery for their octogenarian patients," explained Dr. Lachapelle. 'If patients with heart problems are otherwise in good health, this surgery can significantly improve their quality of life'" - EurekAlert