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Many exciting advances have made surgery on the chest and heart safer, less morbid, and minimally invasive. I will try to keep this page updated frequently.
Heart transplantation, first performed in 1967, is today a safe and effective treatment for terminal heart failure. There's just one problem...not enough donor hearts to go around. So what do scientists come up with? ....use a PIG'S HEART !!!
Pigs (or any animal for that matter) have proteins called antigens that are distinct from human antigens. When implanted, a pig's heart will be immediately "REJECTED" by man's immune system, which will recognize it as 'foreign'.
By an ingenious technique, genetic engineering of pig hearts to replace their antigens with human antigens is today possible. This would prevent the rejection response, and allow safe transplantation.
Pigs are chosen for many reasons...their hearts resemble the human's in structure, they are easy to grow, no ethical issues are associated with their slaughter...
Dr.Christian Barnaard, who performed the first heart transplant in South Africa, jokingly commented that the time may soon come when the average American millionaire would have "HIS MERCEDES IN HIS GARAGE, AND HIS PERSONALIZED PIG IN HIS BACKYARD"!!!!
Coronary bypass is the most frequently performed heart operation. A novel technique, popularized by the work of DR.VALAVANUR SUBRAMANIAN of Lennox Hill hospital, New York, enables the performance of this complex operation through a two-inch long incision of the chest wall. The heart-lung machine is dispensed with. The morbidity of the surgery is minimal, and patients are discharged from hospital earlier, with lesser pain and discomfort. Though applicable only to a select group of patients now, the technique and expertise are expanding, and with further technological improvements, the scope of the so called MICAS may well widen to encompass most patients ! Want to know more??? Visit the MIDCAB forum page
In keeping with the trend towards minimal invasion and lesser patient morbidity and hospital stay, thoracoscopic surgery has advanced tremendously in its application. It is essentially surgery performed through "key-holes" in the chest, through which specially designed instruments are passed. The surgeon controls them by viewing the operative field through a telescope inserted through one of the holes. Though earlier used only for clipping patent ductus arteriosus (PDA), it is now used even for lung removal and operations on the food-pipe (esophagus) and pleura. It is especially useful in patients with emphysema, and the very young infant, where conventional surgery causes breathing difficulty.
The CPB machine temporarily replaces the patient's heart and lung during surgery, and allows safe operation on these organs. Institution of heart-lung bypass by catheters inserted percutaneously, without surgical incisions, has allowed surgery, and angioplasty (PTCA) to be performed with greater safety, especially in critically ill patients. Outcome of near fatal heart attacks has improved with development of this technique, since it allows stabilisation during the time taken to transfer the patient to the operating suite.
Many patients need heart transplantation, but since donor hearts are hard to come by, some other method of supporting them in the meantime is needed. Ventricular assist devices are artificial machines that support the heart's function, temporarily. The usual devices are bulky, need external power sources, and are inserted at an operation. A new device, the ABIOMED 2000, is based on Archimedes' screw principle. A rapidly rotating screw on the tip of a catheter is positioned within the heart's pumping chamber (the ventricle) and augments its function. It allows the heart to rest, and maybe recover its functional reserves. This device is still experimental, and can be inserted via just a needle stick in the groin !!