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August 20, 2008 > At the Heart of Minimally Invasive Surgery

At the Heart of Minimally Invasive Surgery

New "Clampless" Beating Heart Surgery Maximizes Patient Outcomes

From brain surgery to hip replacement, Washington Hospital has for years been increasing the availability locally to cutting edge minimally invasive surgical options.

Now recent advances in medical technology have taken the treatment of coronary artery disease (CAD) to the next level with a procedure called Beating Heart, or "Off-Pump," Bypass Surgery.

The risks of heart disease

According to the American Heart Association, Coronary Heart Disease is the leading cause of death in the United States. Furthermore, about 310,000 people a year die of coronary attack in an Emergency Department or without being hospitalized.

Given these statistics alone, it's worthwhile to learn more about the disease and the next level of treatment.

The human heart has three main coronary arteries through which blood flows, but when a patient suffers from CAD these passageways become narrowed or blocked by a gradual buildup of cholesterol within the artery wall.

Cholesterol is both naturally produced in the body's cells and ingested in the form of animal fats, such as red meat and eggs.

Given enough buildup of cholesterol, called atherosclerotic plaque or simply "plaque," blood flow to the heart becomes restricted and the heart muscle supplied by that vessel doesn't receive enough blood.

While symptom patterns of coronary artery disease may vary from patient to patient, common signs of CAD include:
* Chest pain and/or discomfort that feels like a heaviness beneath the breastbone, accompanied by neck, jaw or arm discomfort
* Sweating, shortness of breath or nausea known as angina
* Exacerbation of symptoms caused by stress or physical exertion (but may also occur at rest or while sleeping)

Women tend to report atypical symptoms such as a hot or burning sensation, as well as tenderness to the touch in the back, shoulders, arms or jaw. Many times they don't have any chest discomfort, which is why they must be particularly vigilant about warning signs.

Protecting the heart

If the blood supply to the blockage is not corrected rapidly, a patient will develop a heart attack, which means the area of the heart muscle not receiving adequate blood flow will turn into scar tissue and become unable to pump. The result is an overall weakening in the heart's ability to pump blood.

Depending upon symptoms, often a patient's physician will diagnose coronary artery blockages using a technique called catheterization. Bypass surgery may then be required to protect the heart by preventing heart attacks, improving angina symptoms and improving the heart's ability to pump.

During traditional surgery to treat coronary artery disease (CAD) surgeons must use a heart-lung machine to stop a patient's heart, which can lead to unwanted complications in certain patient populations.

Fortunately, a new type of surgery utilizes advancements in medical technology to perform what is known as Clampless Beating Heart, or "Clampless Off-Pump," Bypass surgery, making it possible to perform this same surgery while the heart continues to beat.

A new approach

"Clampless Beating Heart Surgery enables me to perform multiple bypass grafts at the same time while also minimizing the rate of stroke and decreasing the risk of other cardiac complications," says Dr. Sang Lee, a Washington Hospital Medical Staff thoracic surgeon. "The benefits of this technology are even more significant for particular high-risk patient populations."

Studies have shown that women, the elderly, those with diabetes, dialysis patients and patients with aortic disease or poor left ventricular function typically have poorer outcomes following bypass surgery.

By eliminating the need for a partial occluding clamp - used to create a bloodless field while the surgeon repairs the artery after removal of blockages - Dr. Lee can eliminate the element of traditional bypass surgery responsible for certain adverse clinical consequences.

Clampless Beating Heart Surgery, in contrast to traditional bypass surgery, also allows the surgeon to:
* Minimize the potential for neuropsychological deficits and cardiac complications
* Increase the likelihood of a shorter length of stay in the hospital
* Decrease the risk of dangerous tearing of the artery, called aortic dissection
* Minimize damage to the inner lining of the blood vessel, decreasing the chances of a blood clot forming in the future
* Reduce the amount of aortic manipulation that can lead to cerebral injury

"This procedure allows us to improve patients' outcomes, which is the most important part of what we're doing," Dr. Lee says. "This is just another facet of the high quality of care patients can access."

Comprehensive Cardiac Care

From leading edge diagnostic equipment and interventional services, to the latest in surgical procedures and cardiac rehabilitation, Washington Hospital's multi-million dollar Heart Program provides patients with a full continuum of high quality care.

Washington Hospital provides services ranging from heart disease screening and prevention and all types of non-invasive testing to the most sophisticated of cardiac, valvular and vascular surgeries.

To learn more about the program, including cardiac rehabilitation, visit, click on "Services & Programs" and select "Heart Program" from the drop-down menu.

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