Monday, August 21, 2017

Off-Pump (Beating Heart) versus On-Pump Coronary Artery Bypass Surgery

Below is a discussion of a follow-up article published in the New England Journal of Medicine by Dr. Grover and colleagues, showing favorable results for conventional coronary artery bypass over off-pump beating heart coronary bypass surgery. The same Veterans Affairs 2009 study showed similar results at one year.

No doubt, there are select times when the beating heart approach is preferred, for example, when the aorta is calcified. Most surgeons' experience, including mine, is that the conventional coronary artery bypass approach allows for more precise sewing and better protection of the heart. This would explain why the technique of beating heart coronary bypass surgery continues to drop in the U.S. to fewer than 20% of cases. I suspect it will now be used fewer than 10% of cases.

This article may have other implications. Some surgeons tout off-pump as "better" or "safer," usually under the umbrella of "less-invasive." Understandably, patients desire safer, less-invasive procedures, with quicker recoveries. In many areas of heart surgery, techniques have been developed to yield these desired results, such as trans-catheter valve procedures and aortic stents. But for patients who require multi-vessel coronary artery bypass surgery, this long-term study suggests that the beating heart technique may not be better than the conventional approach.

The most important thing for patients is to discuss all options with their surgeons. There are surgeons who have mastered a particular technique that may yield better outcomes than reported in research studies. Many excellent surgeons continue to develop better ways to improve the safety and outcomes for our patients. Ask your surgeon for his/her experience and results, no matter the technique. Patients should also research public report cards on surgeons and seek a second opinion whenever possible.

I'm grateful to our academic leaders such as Dr. Fred Grover and I'm proud to be part of the Society of Thoracic Surgeons, for their hard to improve the health and safety of our patients.


Newer method of open-heart surgery carries more risks, study finds

The older method of doing open-heart surgery, in which the heart is stopped and a pump circulates blood through the body, leads to higher survival rates than a newer method of operating while the heart is beating, which doesn't require use of the pump, according to a new study. Why it matters: Coronary-artery bypass surgery is…

Wednesday, March 22, 2017

Team Matters

Thanks to the miracle of modern technology, I'm posting this blog from 35,000 feet up over this beautiful country of ours. I'm traveling to attend a course on minimally invasive mitral valve repair in California.

One of my favorite movies is "Up in the Air" with George Clooney. In the film, he loves being in flight, traveling across the country for his job. There is a certain serenity, a time to reflect. I agree. I find it very relaxing, one of the few times I am completely alone with my thoughts, while enjoying the view of God's work below.

Tonight, my thoughts are with my team. At the center of that team are four special women who I have had the privilege of working with for as long as I can remember --Mindy Snyder, Carol Shannon, RN, Pam Olivieri, and Lisa Garloff.

Mindy is our practice manager. Mindy is the heart and soul of our practice. Carol is one of the most experienced and talented cardiothoracic surgery nurse in the country with 35 years of experience! Pam is our office scheduler who manages thousands of patient appointments every year, somehow keeping up with emergencies and constant changes. Lisa is our O.R. scheduler, who ensures that every patient that goes to the operating room is ready and safe to proceed.

Together, they are the core of our practice. They work so hard and rarely get the recognition that they deserve.  I know that whatever success I may have enjoyed over these past 25 years, it is largely due to my team --the entire team-- exemplified by these four amazing professionals. To me, it's more than just a team, it feels like family.

Indeed, what separates our cardiothoracic team at Lehigh Valley Health Network is that we are a family. All of our surgeons, physician assistants, nurses, and staff are truly special. Patients sense this when they come to our office and when they are cared for in our operating rooms and our intensive care units.

Yes, I've been fortunate to travel far and wide for my career, as I am doing tonight. And in all my travels, I know, I'm the luckiest surgeon in the world to have the finest team at home.

"The way a team plays as a whole determines its success. You may have the greatest bunch of individual stars in the world, but if they don't play together, the club won't be worth a dime." --Babe Ruth