Navigation Links
For one Stanford doctor, the beat goes on during open-heart surgery

In a Stanford Hospital surgery room on a recent afternoon, heart surgeon Kai Ihnken demonstrated how he repositions the beating heart while it's still inside the chest of a 78-year-old man undergoing triple bypass surgery. The surgeon reached into the chest, lifted the beating heart out, then craned his neck to the side, just so, searching for the right spot on the back of the heart to attach the next vessel.

Ihnken, MD, clinical assistant professor of cardiothoracic surgery at the Stanford University School of Medicine, was using an innovative technique called "beating-heart" surgery for coronary bypass. It replaces the more conventional use of a heart-lung machine, which allows for stopping the heart during surgery.

"It's very, very technically demanding," said Ihnken discussing the challenge of working on a still-beating heart shortly before he stepped into surgery to do so. "Surgeons don't want to put up with the stress. But it's so beneficial for the patient."

Despite its reputation as a technically tricky procedure, beating-heart surgery has garnered renewed attention recently as the trend toward less-invasive methods of heart surgery grows stronger.

"We need to be researching this," said Robert Robbins, MD, chair of the cardiothoracic surgery department at the School of Medicine, who hired Ihnken this summer to lead investigations into the potential benefits of less-invasive surgeries such as beating-heart and robotic heart surgery. "We need to make it available to our patients."

Currently, most heart surgeons use the more conventional method of putting a patient on a heart-lung machine, aka "the pump," for bypass surgeries. The pump lets the surgeon stop the heart by keeping blood circulating throughout the body, which keeps the patient alive, while the doctor sews on new vessels. It's easier for surgeons to perform because they have a stable target. The heart is not moving.

In beating-heart surgeries - currentl y used in about 22 percent of U.S. bypass procedures - a surgeon's ability to stitch vessels onto a moving, blood-filled heart replaces the need for the heart-lung machine. A stabilizer, a small device with a suction cup attached, is used to minimize the motion of the heart where the stitching is done.

The hesitancy of most surgeons to switch to beating-heart surgery is, in part, due to the overall success of the heart-lung machine over the past 40 years. In other words, if it ain't broke, why fix it?

But proponents of beating-heart surgery, such as Ihnken, point to the risks associated with conventional bypass surgery, including blood loss, stroke and kidney failure. Because the body doesn't have the added stress of being put on a heart-lung machine, beating-heart surgery can reduce these risks, and does so particularly well among such high-risk groups as the elderly and, surprisingly, women, Ihnken said.

"For reasons not well-understood, women don't do as well during bypass as men," Ihnken said. "Women have double the mortality rates following bypass."

Besides his own positive experiences with the technique, Ihnken points to a recent report in the new journal Innovations, which presents an analysis by an international group of doctors of more than 150 previous studies of the procedure. It found that the beating-heart technique is as safe as conventional heart surgery, with fewer complications and lower costs. The consensus report, based on randomized controlled trials and retrospective studies, concluded that when complications such as blood loss, stroke, kidney failure and irregular heart beats were considered, beating-heart surgery had a definite advantage over conventional bypass.

"Beating-heart surgery is an advance in cardiac surgery because it provides a better result for patients," said John Puskas, chief of cardiothoracic surgery at Emory Crawford Long Hospital, Atlanta, and one of the 12 authors of the paper.

Still, scientific evidence does not yet conclusively show its benefits, said Robbins, addding that he wants to see more research done before he's convinced.

"It's just so difficult," explained Robbins, who first used the procedure when it was developed a decade ago and now uses it only occasionally. "I don't have the time to devote to it. You need to do it often to be good at it."

Which is exactly what Ihnken plans to do. He's completed more than 130 of the surgeries and does all his bypass work off-pump. "I really want to build Stanford as an off-pump center," he said, before scrubbing up for surgery on that afternoon earlier this year. "I want patients sent here from everywhere."

Ihnken would spend the next three-and-a-half hours intricately stitching new blood vessels onto the beating heart of his patient. When he lifted the heart out of the chest, a tricky step in the beating-heart procedure, the doctors and nurses and technologists in the room turned suddenly quiet. The beat, beat, beat of the heart monitor filled the air. Ihnken, head tilted, found the spot he was searching for on the heart's backside and, finally, looked up.

"Everything OK out there?" Ihnken asked the anesthesiologist breaking the tense silence.

"Really stable, really stable," the anesthesiologist answered. "He's tolerating it really, really well."


'"/>

Source:Stanford University Medical Center


Related biology news :

1. Same mutation aided evolution in many fish species, Stanford study finds
2. First real-time view of developing neurons reveals surprises, say Stanford researchers
3. Stem cells from brain transformed to produce insulin at Stanford
4. Stanford gut check shows diversity of intestinal ecosystem
5. Young Blood Revives Aging Muscles, Stanford Researchers Find
6. Stem cell training program to make its Stanford debut
7. Gene therapy for muscular dystrophy fixes frail muscle cells in animal model, Stanford study finds
8. Sooner is better with cochlear implants, Stanford scientist shows
9. Learning to love bacteria: Stanford scientist highlights bugs benefits
10. Stanford study of owls finds link in brain between sight and sound
11. Stanford/Packard scientists data-mining technique strikes genetic gold
Post Your Comments:
*Name:
*Comment:
*Email:


(Date:4/11/2017)... , Apr. 11, 2017 Research and ... Market 2017-2021" report to their offering. ... The global eye tracking market to grow at a ... report, Global Eye Tracking Market 2017-2021, has been prepared based on ... covers the market landscape and its growth prospects over the coming ...
(Date:4/11/2017)... Florida , April 11, 2017 ... a security technology company, announces the appointment of independent Directors ... Bendheim to its Board of Directors, furthering the company,s ... ... of NXT-ID, we look forward to their guidance and benefiting ...
(Date:4/5/2017)... , April 5, 2017  The Allen Institute for ... Cell Explorer: a one-of-a-kind portal and dynamic digital window ... imaging data, the first application of deep learning to ... stem cell lines and a growing suite of powerful ... for these and future publicly available resources created and ...
Breaking Biology News(10 mins):
(Date:8/15/2017)... ... August 15, 2017 , ... Pittcon is pleased to ... and scientific instruments. This year’s symposium, organized by the Pittcon 2018 program chair, ... Bioanalytical Applications.” This dynamic presentation will discuss novel ionization processes, high throughput IMS-MS ...
(Date:8/15/2017)... ... August 15, 2017 , ... Coffea arabica accounts for 70 ... factors. During this educational webinar, participants will learn about the importance of genomics ... better understanding of how genomics is important for coffee breeding improvement. , Attendees ...
(Date:8/14/2017)... NY (PRWEB) , ... August 14, 2017 , ... ... Clinical Trials event, which will take place on September 6, 2017 at the ... Karlin, MD , Head of Experimental Medicine, Informatics, and Regulatory Strategy, Pfizer Innovative Research ...
(Date:8/11/2017)... Wauwatosa, WI (PRWEB) , ... August 11, 2017 ... ... transparency in food production, and, in particular, more natural alternatives to synthetic ingredients,” ... and innovation of Third Wave, with the established manufacturing presence and know-how of ...
Breaking Biology Technology: