Future Trends in Cardiac Surgery

Exciting new technologies on the cardiac surgical horizon at Saint Francis Hospital and Medical Center:

  1. Hybrid Coronary Revascularization: Cardiologists and cardiac surgeons working collaboratively to offer patients the best advantages of stenting and coronary bypass surgery in an integrated, minimally invasive strategy. In this approach, a robotically mediated, minimally invasive bypass of the left anterior descending coronary artery is performed using the left internal mammary artery which confers the best long-term durability of any currently available modality with a typical patency rates of this conduit of over 90% for 10- to -20 years post-operatively. This is performed without a median sternotomy and without cardiopulmonary bypass. Shortly thereafter, the patient undergoes stenting of either the right or circumflex coronary arteries. Such an approach permits the patient to have a short post – operative convalescence and excellent long-term outcomes using both minimally invasive surgical and stenting techniques. Within the very near future, the entire procedure will be able to be carried out in one session, instead of the current staged approach, in dedicated hybrid ORs, incorporating the full surgical capabilities of an operating room and the full imaging and interventional capabilities of the cath lab. New anastamotic devices will permit the surgeon to attach the bypass grafts to the target vessels on the heart more rapidly and hopefully more accurately than is possible via the conventional hand sawn techniques.

  2. Percutaneous Valve Replacement Technology: An emerging technology that will most likely result in a substantial paradigm shift to the approach of valvular pathology, a percutaneous, rather than surgical approach to aortic valve replacement and mitral valve repair. These technologies are currently undergoing clinical trials and if successful, should be available clinically in the next 3-5 years. St Francis is actively preparing for this technology by developing teams of cardiologists and cardiac surgeons proficient in these techniques and building new Hybrid ORs that will facilitate this exciting emerging technology in our community.

  3. Heart Assist Devices and Comprehensive Congestive Heart Failure Program: Saint Francis Hospital has always been a leader in the management of congestive heart failure. Unfortunately, because of the substantial discrepancy between demand and supply of heart transplants, mechanical devices are increasingly utilized to support the failing heart on a long-term basis. In collaboration with Massachusetts General Hospital, Saint Francis is embarking upon a state-of-the-art heart-assist device program allowing for both bridging to transplantation and long-term destination therapy in which the patient will have a permanent heart-assist device implanted. In addition, we are implementing a multi-disciplinary shock team to comprehensively address patients presenting to the hospital in shock. In these cases, an expeditious approach is mandatory in quickly incorporating aggressive pharmacologic management with judicious implantation of heart assist devices to address these critically ill patients and impact their high mortality rates.