TAVR: Most exciting innovations in heart care

TAVR Heart Procedure Called “Transformative” for Your Aortic Valve

A minimally invasive technique for aortic valve replacement has emerged as one of the most exciting innovations in heart care in decades.

Transcatheter aortic valve replacement (TAVR) allows doctors to insert a prosthetic valve inside a damaged valve in the cath lab. It’s a lifesaving option for patients with severe aortic stenosis (AS), for whom surgery is considered too risky. But it’s not yet ready for everyone.

Treatment: Laser surgery for heart problems?

Transmyocardial revascularization or TMR is a therapeutic procedure that uses a laser beam to create small holes in the heart muscle (myocardium) of the left ventricle. TMR may be recommended for patients with chest pain (angina) that does not react to medication or who are ineligible for other treatments such as coronary artery bypass graft (CABG) surgery.

It may also be employed as an adjunct to minimally invasive CABG surgery to increase the procedure's effectiveness. Studies have shown that TMR reduces the severity of symptoms and increases a patient’s capability for exercise. However, TMR is not a cure for coronary artery disease, and there is no confirmation that it can offer people a longer life.

The risk of complications is low, but all surgeries carry at least a small risk of complications, these complications could include the following

• Return of the angina

• Damage to the mitral valve (located between the left atrium and the left ventricle)

• Heart failure

• Arrhythmia (an abnormal heart rhythm)

• Damage to the great vessels (the aorta and/or the pulmonary artery or the coronary
arteries)

• Hypotension (low blood pressure)

• Cardiac tamponade (a dangerous accumulation of blood in the sac around the heart)

• Heart attack

Surgery a Way of Getting Rid of Obesity

Obesity is a growing problem among children and teens these days. The condition gives way to a number of other health problems.

The children and teens suffering from obesity face problems while performing physical activities leading to joint problems. The other disease that occurs due to obesity are troubled metabolism, disturbed glucose level, hypertension, type 2 diabetes, nonalcoholic fatty liver disease, sleep apnea and gastro esophageal reflux disease.

The most difficult one is treating morbid obesity. The people suffering from this form of obesity have to access even better die, exercise and medicines. While some feel that surgery as the effective way of treating the condition.

As per an article, "a recent meta-analysis has bolstered the sense that bariatric surgery is a good solution for morbid obesity in adolescents, since patients seem to keep weight off and concomitant metabolic conditions resolve”.

The advancement in medical field has resulted in developing various bariatric surgeries, out of them one is Rouxen-Y gastric bypass that is performed on teenagers. The surgery results in weight loss. The other forms of surgeries are gastric sleeve operation, gastric banding, an intragastric balloon, or a gastric stimulator.

Since the year 1990, many people have undergone bariatric surgery, this form of treatment has become very popular, but there are certain criteria’s that patients should match with so as to carry out the surgery.

Though there has been surgical ways of getting rid of obesity, but there are various medical based journals that oppose these surgeries, while the non medical ones encourage undergoing such surgeries.

source: newstonight

Cataract surgery more likely for people with celiac disease?

People with celiac disease may find they are more likely to need cataract surgery in the future, according to a new study.

Research conducted at the Karolinska University Hospital in Stockholm and featured in the American Journal of Epidemiology, highlighted that vitamin deficiencies which are prevalent in people with celiac disease are associated with cataract formation.

Over the course of the study, the researchers established that there were 397 cataracts cases among 100,000 people with celiac disease each year, compared to 311 cases among the general population.

However, the researchers pointed out that rather than celiac disease causing cataracts, the two conditions could share common risk factors.

The link could also be due to lower intake of certain antioxidants and vitamins which are associated with a reduced risk of cataracts.

According to the Celiac Disease Foundation, celiac disease is an autoimmune disease which affects around one in 133 people.

source: spirehealthcare

Types of cosmetic surgery procedures?

Cosmetic surgery is performed to make progress on your appearance and self-esteem. Cosmetic surgery involves reshaping parts of the body that are or else functioning properly.

Cosmetic Surgery includes:

• Botox
• Blepharoplasty (Eyelid Surgery)
• Breast Augmentation
• Breast Lift
• Breast Reduction
• Breast Implant Replacement/Removal
• Brow Lift
• Buttock Augmentation (Butt Enlargement)
• Buttock Lift
• Chemical Peel
• Dermabrasion
• Endoscopy (Keyhole Plastic Surgery)
• Face Lift
• Facial Implant
• Injectable Fillers
• Radiesse
• Restylane
• Juvederm
• Endermologie
• Thermage
• Sclerotherapy
• Facial Scar Revision
• Forehead Lift
• Arm Lift
• Gynecomastia ( Male Breast Tissue ) Reduction
• Hair Replacement
• Intense Pulsed Light Treatment
• Laser Hair Removal
• Laser Vein treatment
• Laser Skin Resurfacing
• Labiaplasty
• Liposuction
• Mentoplasty ( Chin Surgery )
• Chin Reduction
• Microdermabrasion ( Skin Rejuvenation )
• Neck Lift
• Otoplasty ( Ear Surgery )
• Rhinoplasty (Nosejob Surgery)
• Rhytidectomy ( Face Surgery )
• Thighplasty ( Thigh Lift )
• Thread Lift
• Tummy Tuck

Sticking plaster that can repair damaged hearts using cells

Healthy heart tissue grows on carbon-fibre patch as thin as human hair

A sticking plaster to heal damaged hearts has been created by scientists.

Packed full of healthy heart cells, it could be used to shore up areas damaged by heart attacks, cutting the odds of further ill health.

This would improve the quality of life of some of the 100,000-plus Britons who have heart attacks each year by averting a second attack and preventing potentially deadly heart failure, in which the organ struggles to pump blood round the body.

More than 750,000 people live with heart failure in the UK alone.

For many, everyday tasks such as eating, dressing and getting out of bed leave them breathless and exhausted.

Treatments range from drugs to transplants but with up to 40 per cent of those affected dying within a year of diagnosis, heart failure has a worse survival rate than many cancers.

To create the inch-long patch – which is as thin as a human hair and resembles a black sticking plaster – the U.S. researchers first built a scaffold of extra-thin carbon fibres.

In experiments in a dish, healthy heart muscle, nerve and other cells ‘crawled’ on to the framework, repairing damage to the heart.

In other words, it was able to bring regions of the heart left ‘dead’ by heart attack back to life, the journal Acta Biomaterialia reports.

David Stout, the study’s lead author, said: ‘This whole idea is to put something where dead tissue is to help regenerate it, so that eventually you have a healthy heart.’

Other materials were not as successful. The researchers believe the carbon fibres worked because they conduct electricity well.

The first animal tests will take place this year but it is likely to be ten to 15 years before the plasters are routinely used to patch human hearts.

Researcher Thomas Webster of Brown University, Rhode Island, told the Daily Mail: ‘When someone has a heart attack, part of the heart dies. The heart compensates for that, placing it under more strain.

Breakthrough: The inch-long patches of carbon fibre can bring regions of the heart left 'dead' by heart attack back to life

'What we wanted to do was develop a material that could be inserted wherever the damage is, maybe through a catheter or small tube, so that new, healthy tissue can grow on top of it.’

While it would be best to insert the device soon after a heart attack, it may still help if it is put in up to several years later, Dr Webster added.

The approach is one of several being explored around the world.

The British Heart Foundation wants to raise £50million within five years to fund research into repairing hearts.

The charity is pursuing the idea of heart patches as well as pills to trick the organ into healing itself, and injections of stem cells.

Launching the appeal earlier this year, Professor Peter Weissberg, the BHF’s medical director, said: ‘The biggest issue that still eludes us is how to help people once their heart has been damaged by a heart attack.

‘Scientifically, mending human hearts is an achievable goal and we really could make recovering from a heart attack as simple as getting over a broken leg.’

source: dailymail

New Technique For Severe Asthma Sufferers

Surgery Uses Heat To Enlarge The Airway And Help Breathing, But Long-Term Effects Unknown

NEW HAVEN —— A surgical procedure that shrinks muscle tissue in the windpipe is offering hope for people with severe asthma.

There has been frustratingly limited treatment for asthma, a chronic condition in which restricted airflow causes breathing problems. "That's it," said Dr. Geoffrey Chupp, pointing to bags of inhaler devices in the corner of his office.

Chupp, who is director of the Yale Center for Asthma and Airways Disease, said the new procedure, known as bronchial thermoplasty, is the first to directly go to the root of the problem — the lungs.

The treatment is being offered at Yale-New Haven Hospital as part of a Phase IV study being conducted on the procedure. The FDA approved the procedure in April 2010 with the proviso that follow-up studies be done for five years to examine its long-term safety.

The procedure involves inserting a bronchoscope into the airway through the mouth or nose. Once it reaches specific points of the airway, a device known as the Alair Bronchial Thermoplasty System attached at the end of the scope expands to make contact with the interior walls. It then delivers radio-frequency waves for 10 seconds at a time. The heat essentially melts off some of the smooth muscle tissue.

In asthmatics, the thick layer of muscle tissue is responsible for the constriction of the airway, leading to asthma attacks.

It took 10 years of study for the FDA to approve the treatment, which was developed by the company Asthmatx. Although asthma specialists say the development of a device and surgical procedure for the condition could be a major breakthrough, there are still some concerns about it.

Dr. Norman Edelman, chief medical officer for the American Lung Association, agreed that the procedure appears to be effective but cautioned that there's still a lot more to learn about it.

"The short-term effects appear to be positive, but we don't know the long-term effects," he said. Like any surgical procedure, it has risks, he said, but for now it's suitable only for people with severe asthma. If an asthmatic can control his or her condition with medications, they should stay with that remedy.

At Hartford Hospital, Dr. James Pope, who specializes in pulmonary disease, calls himself a "hopeful skeptic" about the treatment. Considering how serious a physiological change the surgery causes, he said his hospital is waiting to see the results of the study on long-term effects before deciding whether to offer it to patients.

"It's a totally novel and fascinating way to treat asthma," he said. "But if we do this to the airway, what does it do to it 10 years from now? We don't know."

Typically, the entire procedure is done in three sessions about one month apart. One of the downsides is that after each session, the patient's asthma worsens. Conditions return to normal in one to seven days, and then steadily improve, Chupp said. That's why the sessions are scheduled one month apart; doing it all at once could be too much for the patient.

For each session, the surgery takes about an hour, plus two to four hours of post-surgery observation.

Chupp said that it's unlikely that patients will improve to the point that they can do away with their inhalers. But it appears to control symptoms enough so that their quality of life significantly improves. One of his patients, he said, completed the procedure six months ago and the improvements in his condition still have not leveled off. He still carries an inhaler, but he now can play a game of basketball without frequent breaks and is able to get his heart rate to a higher level on the treadmill.

The procedure can cost up to $20,000, and it's not automatically covered by insurance companies.

"What happens with this kind of new technology is that there's always some resistance from the insurance companies," Chupp said. He added, though, that sometimes insurers can be convinced to cover it after consulting the doctors.

source: courant

Gastric bypass encourages heart health in teens

Gastric bypass surgery for obese teens may be even more effective at reducing the risk of cardiovascular disease than it is for adults who undergo the same procedure, according to a recent study from the School of Medicine led by bariatric surgeon John Morton.

The study involved 99 adult patients and 33 adolescents who underwent gastric bypass at Stanford between 2004 and 2010. The adults in this group were, on average, 44.4 years old and had a body mass index (BMI) of 52.3, while the adolescents were, on average, 17 years old and had a BMI of 52.7. BMIs more than 25 are considered obese; these patients were described as “severely overweight.”

Although both groups lost approximately the same amount of weight after their surgery, the teenage patients had a greater improvement in several biochemical markers thought to be predictive of heart problems. Some of the markers the researchers tracked include cholesterol levels, diabetes status and blood pressure. The teenage group showed higher levels of “good” cholesterol and sharper drops in fasting glucose — slower drops are an indicator of diabetes.

By some counts, one in three adults and one in five adolescents are considered obese. Such excess weight can lead to conditions including high blood pressure, diabetes, heart disease and shortened life span. Surgery is often the last resort for these obese patients.

SOURCE: stanforddaily

Bariatric Surgery Can Improve Memory and Concentration

An excessive amount of body fat leads to obesity. “Overweight” refers to an excessive amount of body weight that includes muscle, bone, fat, and water. As a rule women have more fat than men.

When a person weighs 20 percent or more than his or her ideal body weight, in that case the person’s weight posesa real health risk. Obesity becomes “morbid” when it significantly increases the risk of one or more obesity-related health conditions or serious diseases (also called co-morbidities).

Obesity is more than a cosmetic problem now days. It has become a health related problem which may cause diseases like Type 2 Diabetes, High BP, heart disease, Depression, Sleep apnea, Infertility, Urinary stress incontinence, Menstrual irregularities, Emotional suffering, Laziness and memory loss.An obese or a morbid obese person can lose weight through various treatment options like Non surgical weight loss programs, Traditional open weight loss surgery or Minimally invasive or laparoscopic weight loss surgery or Bariatric Surgery.

John Gunstad, an associate professor in Kent State University’s Department of Psychology, and a team of researchers recently discovered a link between weight loss and improved memory and concentration. The study shows that bariatric surgery patients exhibited improved memory function 12 weeks after their operations.

The findings will be published in an upcoming issue of Surgery for Obesity and Related Diseases, the Official Journal of the American Society for Metabolic and Bariatric Surgery. The research report is also available online here.

The cost of Bariatric surgery averages around $17,000. Insurance is available for some because weight loss is proven to reduce risk of diabetes, hypertension, sleep apnoea, reflux, high cholesterol and joint pain. In India the Cost of Weight Loss Surgery is about 6000 to 7500 US Dollars.

Gunstad said that the initial idea came from his clinical work, “I was working at Brown Medical School in Rhode Island at the time and had the chance to work with a large number of people who were looking to lose weight through either behavioral means or weight loss surgery.” \

Gunstad said he kept noticing that these patients would make similar mistakes. “As a neuro-psychologist who is focused on how the brain functions, I look for these little mental errors all the time,” Gunstad explained.

This research team studied 150 participants (109 bariatric surgery patients and 41 obese control subjects) at Cornell Medical College and Weill Columbia University Medical Center, both in New York City, and the Neuropsychiatric Research Institute in Fargo, N.D. Many bariatric surgery patients exhibited impaired performance on cognitive testing, according to the study’s report.

source: medindia

Bypass Surgery Best for Some Heart Failure Patients

Over an average of five years of follow-up, the researchers found that patients who underwent bypass surgery reduced their risk of dying 14 percent compared with patients on medications alone. However, that reduction was not statistically significant, the researchers noted.

Bypass surgery did, however, significantly reduce the risk of dying from cardiovascular disease by 19 percent and the risk of death from any cause and hospitalization for heart disease by 26 percent, Velazquez said.

Going over the data, the researchers found that 55 patients who were supposed to have bypass surgery did not actually get the procedure, and 100 patients assigned to medication alone ended up having a bypass operation.

When the researchers straightened out these discrepancies, they found bypass surgery actually reduced the risk of dying from any cause by 30 percent to 50 percent compared with medication alone.

This finding comes with some caveats: there were more risks from bypass surgery than from medication alone. And, the survival benefit of bypass surgery only kicked in two years after the procedure, the researchers noted.

Two-thirds of the 6 million people in the United States with heart failure have clogged coronary arteries, the researchers said. Given the improvements in medical therapy, whether the risks of bypass surgery are worth it has not been clear, the researchers added.

Bypass surgery involves taking healthy arteries and veins from other parts of the body and using them to re-route blood around the blockages, to restore blood flow and normal heart function. It has been unclear whether the risks of bypass surgery were worth taking, given recent lifesaving advances in medical therapy.

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, said that "the benefits and risks of coronary-artery bypass surgery in patients with chronic symptomatic heart failure have been uncertain and the results of the STICH trial have been eagerly awaited."

"These important new findings suggest that surgical revascularization should be considered for patients with heart failure and coronary-artery disease," he said.

In addition to these findings, the STICH researchers used data from the trial to look at whether imaging could identify patients most likely to benefit from bypass surgery. Scans were given to 601 of the patients in the trial.

After almost five years of follow-up, the researchers found that scans did not provide any clue to how effective bypass surgery would be for each patient.

However, these scans, which can identify viable heart tissue, were able to predict long-term survival. In fact, patients with living heart tissue were 40 percent more likely to survive, compared with patients with irreversible heart damage, the researchers found.

source: health.usnews

Nipple Sensation Might be Lost After Breast Reduction Surgery

Breast reduction/loss of sensation

That depends on the how the surgery is done and the skill of the surgeon, but most of the time, no, the sensation in the nipple is not lost. There is always that risk, however and when the surgeon has you sign the consent for the surgery, they will explain that possibility to you.

The Anatomy of Nipple Sensation
All sensation is based upon nerve connectivity, and in particular, a certain set of nerves called the fourth intercostal nerve branch provides sensation to the nipple. These nerves extend from the chest wall to the nipple and if any of them are severed or damaged - or if their blood supply is cut off - the result may be diminished nipple sensation.

Surgeons must use careful techniques in order to avoid damaging this nerve branch and to promote proper healing and nipple sensitivity. Depending on the specific type of breast surgery being performed, some methods are better at preserving nerves than others. The following are a few cases in which permanent sensation loss may occur, along with techniques surgeons can use to help preserve feeling.

With Breast Augmentation
With breast augmentation, the nerves below the nipple are not typically cut, but can be damaged or stretched when the surgeon maneuvers the implant inside the breast. This is particularly true in cases where larger breast implants are used. While there is some debate about incision location and implant placement affecting post-operative nipple sensitivity, the strongest evidence supports the size of the implant as being the major determining factor in sensation loss.

Essentially, the larger the implant placed in the breast pocket, the more pressure that the implant puts on the nerves and tissue within that pocket. If there is a large implant and a smaller breast pocket, the risk is even greater.

There has also been evidence that placing breast implants under the pectoral muscles preserves sensation more than sub-glandular placement. This may be because, when the implant is under the muscle, it places less pressure on the fourth intercostal nerve branch. Choosing a moderately sized implant and placing the implant below the muscle may help reduce the risk of sensation loss.

With Breast Reduction
Unlike breast augmentation, breast reduction carries significantly more risk for decreased nipple sensation. This is because the nerves may need to be cut in order to sufficiently remove enough breast tissue. In more extreme cases, a plastic surgeon may need to remove the nipple entirely to reposition it. Called a free nipple graft, this method allows the surgeon to remove more tissue, but it severs the blood supply and nerves, almost guaranteeing loss of nipple sensation.

The more common pedicle method of breast reduction in Seattle is a much better way to preserve nipple sensation. Instead of completely severing the nipple from the nerves and surrounding tissue, the surgeon will leave the nipple attached to a section of tissue called a "pedicle" that contains the milk ducts, nerves, and blood supply. Because the nerves remain intact, it is far less likely that patients will permanently and fully lose sensation.

With Breast Lift
Breast lifts are often very similar to breast reduction, in that the nipple may need to be moved, increasing the chances of nerve damage and stretching. Some surgeries will sever the nerves, requiring months of healing for the nerves to (hopefully) regenerate and sensation to return. Typically, the more dramatic the lift and the more the nipple needs to be moved, the greater the patient's chances of losing nipple sensation. However, in many cases, the surgeon can use a similar technique to the pedicle method to maintain the nerve connection to the nipple when performing the breast lift.

What You Can Do
All breast surgeries usually result in temporary sensation loss, since incisions can damage surface nerves. However, these nerves typically grow back, returning sensation over a period of about 3 to 6 months on average.

In general, if you are concerned about nipple sensation when considering breast surgery, discuss your options with your plastic surgeon. He or she can advise you about certain methods that may be right for you.

Board certified plastic surgeon Dr. Wandra Miles specializes in Seattle breast reconstruction surgery. Dr. Miles also performs breast augmentation, breast lift, liposuction, tummy tuck (abdominoplasty) and face lifts. Her office is located in Seattle, Washington and serves Tacoma, Bellevue and Olympia. Dr. Miles also spends time in Ketchikan, Alaska consulting with patients.

Article source: ezinearticles

New Open Heart Surgery Keeps Patient Awake During Surgery

In Health Watch:Surgeons in India have performed open-heart surgery on a patient who was wide awake throughout the entire procedure.Kendis Gibson explains why this kind of surgery could be the wave of the future.Staying awake for heart surgery isn't for the "faint of heart" but Catholic priest Father Bolmax Periera was excited.

Fr. Periera says, 'maybe I will be able to see my own heart.'A sheet actually shielded Father Periera from seeing the surgery, but he was able to sense doctors pushing and pulling inside his chest cavity.An epidural injection into his spine prevented him from feeling any pain below his neck.One of the advantages of keeping a patient conscious during heart surgery is that it gives doctors an early warning sign of any problems.

Dr. Allan Stewart says, 'sometimes when we have people asleep it takes several hours for them to wake up if they had a stroke during the operation it's too late. We've lost that window to intervene on them.Surgeons at the Fortis hospital in Bangalore replaced a defective heart valve in Father Periera's chest.They stopped his heart and his breathing -- a machine took over his blood circulation.During the whole procedure, he was able to speak to his doctors - at one point he even asked for a pillow.Dr. Vivek Jawali says, 'they are very comfortable on the table.

I did not even put any music on his ears. He was listening to what we were talking about.'Fr. Periera, 'One thing I head them say is, "This is the heart." So I knew my heart was wide open.'But doctors here in the United States say there are major drawbacks to the procedure - especially if something does go wrong during the surgery and doctors have to put in a breathing tube during a crisis.Dr. Stewart says, 'to institute that In the middle of a heart lung operation would increase the risk of infection, would increase the psychological trauma.'Still, because he didn't have to recover from general anesthesia, Father Periera was able to start his recovery shortly after surgery.

Doctors in the U.S. also routinely insert a probe down the throat to monitor the progress of open-heart surgery.They say it would be very uncomfortable to have a tube sitting in a patient's throat while he or she was awake.

source: keyc

Best surgeon for your prostate cancer op?

It's a delicate operation that can leave men impotent and incontinent - so who do the experts turn to?

Around 36,000 men a year are diagnosed with cancer of the prostate, making it the most common male cancer in Britain.

It’s also among the most feared, not least because two of the key measures to tackle it — surgery to remove the prostate (radical prostatectomy) or radiotherapy — can leave men incontinent and impotent.

Nerve-sparing prostatectomy, in which the gland is removed with minimal damage to the nerves which control erections, may be possible when the cancer is low grade and hasn’t spread.

But the ­downside of this ­procedure is it reduces the chance of ­completely clearing the cancer.

‘Some men say forget about the nerves, it’s much more important you take out all of the tumour,’ says Edward Rowe, a ­urologist at Southmead Hospital, Bristol.

‘Other men say their quality of life will be zero if they lose their potency and they would rather be dead than that.’

Men in Britain are not routinely screened for prostate cancer, partly because the ­technique for doing this, the PSA (prostate-­specific antigen) blood test, which measures the protein produced by the ­prostate, is unreliable.

Some men with prostate cancer don’t have a raised PSA level, and two-thirds of men with a raised PSA don’t have prostate ­cancer — just an infection or an enlarged prostate, which comes with ageing.

Prostate cancers are slow growing, and the lack of scientific consensus in this field means it can be difficult for surgeons to decide whether to ­operate or ­simply ­regularly monitor the patient until it grows.

This paves the way for both over-treatment and under-treatment — with some men having radical ­treatment for a prostate cancer that’s never going to harm them and others under-treated for a more aggressive disease because the ­surgery is difficult and the results might be worse than the cancer itself.

Radical prostatectomy can be carried out by open surgery or by keyhole — either by a surgeon directly, or a surgeon using robotic technology.

Although consultants will argue in favour of the benefits of their own chosen method, there is no ­scientific evidence, as yet, to prove the ­superiority of one approach over another.

So where surgery is ­recommended, finding a top-notch ­surgeon is more important than being swayed by technology — or the lack of it.

So what’s the surest way of lining up the country’s best surgeons? We’ve hunted down the UK’s top ten ­outstanding prostate cancer surgeons.

We’ve turned the spotlight on urologists, even though radiologists and oncologists play an equally important role in prostate cancer treatment. This is because ­urologists are the treatment ­gatekeepers who make the ­diagnoses and will then refer patients to other specialists where necessary.

We felt those best placed to tip the top would be urologists themselves, so we canvassed 40 of them from around the country and asked: ‘If your own nearest and dearest required prostate cancer surgery, to whom would you refer them and why?’ Each nominated five fellow ­surgeons.

Those who got the most votes from their peers made it into the Daily Mail’s top ranking.

This is a guide, not a scientific study — there are many superb and highly skilled urologists all over the country who didn’t make it into our top ten, but who spend every day of their working lives giving their patients the best possible odds of beating their cancer.

All of those in our listing work in the NHS, although the majority do private work as well.

PROF DAVID NEAL

Addenbrooke’s Hospital, Cambridge

A very able surgeon technically, who ­handles tissues beautifully.

In surgery, he won’t make three ­incisions when one will do and he cares about his patients.

He’s a ­scientist, and made the ­transition from open to robotic ­surgery — and has immense experience with it.

His standards are extremely high and he can be relied upon to give a unbiased view of the best ­treatment for patients.

DAVID GILLATT

Southmead Hospital, Bristol

He has done huge numbers of open ­prostatectomies, but switched to robotics a couple of years ago.

He has consistently been a leader in the field and is very highly regarded for his technical work.

He’s down-to-earth, his patients love him and he knows his subject inside out.

PROF NOEL CLARKE

The Christie NHS Foundation Trust, Manchester

at the top of his game, with very good operating skills.

He’s also a good communicator, too, who does open and robotic surgery.

Very involved in research and considers all treatment options.

Some of his patients are recruited on to trials he’s involved in.

There’s lots of ­evidence to show patients on trials do better, as they are very carefully monitored under strict guidelines and benefit from getting more time with specialists.

JOHN B. ANDERSON

Royal Hallamshire Hospital, Sheffield

One of the big beasts of open prostate ­surgery, he is ­excellent technically, a good communicator and not motivated by money.

He’s a realist about what can and can’t be done.

He can be counted on for a ­balanced view on treatment options, pitching information at the right level for each patient.


Top class: Professor Prokar Dasgupta

Top class: Professor Prokar Dasgupta

PROF PROKAR DASGUPTA

Guy’s & St. Thomas’ Hospital NHS Foundation Trust, London

A top-class technician with wide-ranging knowledge, who would give a very balanced view.

He was the leader of robotic prostatectomy in Britain and has trained many of those starting in robotics.

He would give patients a good and honest opinion on treatment options without pushing anything.

Click Here For More...

source: dailymail

Heart Valve Provides Life-Saving Alternative to Open-Heart Surgery

VANCOUVER, BRITISH COLUMBIA - According to recent study result published in the New England Journal of Medicine (NEJM), a new aortic heart valve replacement procedure, called trans-catheter aortic-valve implantation (TAVI) has shown to be a viable life-saving option for patients who are unable to undergo open heart surgery.

The study, which is part of the Partner Trial (Placement of AoRTic TraNscathetER Valve), compared the health outcomes of patients who underwent TAVI using the investigational Edwards SAPIEN trans catheter valve to those who received standard therapy. All patients in the study had severe aortic stenosis and were considered not to be suitable candidates for surgery. The conclusions stated that TAVI, as compared with standard therapy, significantly reduced the rates of death for these patients.

Severe aortic steno-sis is a progressive and life-threatening disease, and patients who do not undergo surgical valve replacement of their diseased aortic valve have no effective treatment option to prevent or delay their disease progression. Without treatment, previous studies indicate 50 per cent of patients will not survive more than two to three years.

Heart valve replacement surgery usually requires a long incision in the center of the chest to enable surgeons to expose the heart, which is temporarily stopped while the valve is replaced and sutured in place. A heart-lung bypass machine is used to keep the patient's blood circulating until the heart function is restored. Using the TAVI procedure, the Edwards SAPIEN valve (a collapsible aortic heart valve) can be inserted in two ways: through a small incision in the ribs (trans-apical) or threaded up to the patient's heart through the circulatory system using a catheter inserted in the patient's groin (trans-femoral). The NEJM study focused on the trans-femoral procedure.

In 2005 a team of specialists at the Heart Centre in St. Paul's Hospital, Vancouver, BC (one of the partner sites in the trial) and University of British Columbia, were the first world's first to successfully perform trans arterial procedures (pioneered by the St. Paul's Heart Center team) and the world's first to successfully perform a trans apical aortic valve replacement. The Heart Center began with 17 procedures in 2005 and have now done over 200 trans femoral procedures and over 150 trans apical. The team has also trained over 50 other programs around the world, with over 10,000 procedures now done worldwide.

"The world-renowned research and clinical innovation in the Heart Centre at St. Paul's Hospital continue to position British Columbia as a leader in cardiac sciences," says Hon. Kevin Falcon, Minister of Health Services.

"The research and cardiac services at St. Paul's have a rich 50-year history of excellence, and I'm confident this tradition – and breakthrough improvements to patient care -- will continue through St. Paul's Hospital's leading contributions and collaborations with BC's health authorities, Cardiac Services BC, universities and other research partners."

St. Paul's world-renowned interventional cardiologist, Dr. John Webb is co-author of the study and a member of the executive committee for the trial's design. He was also the first interventional cardiologist in North America to perform a successful per cutaneous aortic valve replacement.

"The results from the trial to date are very encouraging," says Dr. Webb, McLeod Family Professor in Valvular Heart Disease Intervention at the University of British Columbia. "We hope that this will eventually become a standard treatment option. Not only is it less invasive than traditional open-heart surgery, but this procedure provides patients who are not candidates for surgery with an option that has so far proven to have better health outcomes than standard treatment."

At St. Paul's Hospital, the procedure is currently provided on compassionate grounds for patients who are too frail to survive open-heart valve replacement surgery.

These findings were presented at the Transcatheter Cardiovascular Therapeutics (TCT) 2010 scientific symposium held in Washington, DC, this week.

source: marketwire

Bypass surgery is better than angioplasty for severe heart disease

A major new study on 1,800 patients with heart disease has found that coronary artery bypass grafts (CABG) are superior to angioplasty and stenting in the long run. New findings presented at a Geneva meeting of the European Assn. for Cardio-Thoracic Surgery show that patients who received angioplasty and a stent to hold arteries open were 28% more likely to suffer from a major adverse cardiovascular event, such as stroke or heart attack, were 46% more likely to require a second procedure to reopen the blocked blood vessels and were 22% more likley to die.

Given that cardiovascular surgeons have suspected the benefits of bypass for a long time, the question is why angioplasty is so much more popular. An estimated 1.3 million Americans will undergo angioplasty this year, compared with 448,000 who will have CABG, according to the National Center for Health Statistics. True, angioplasty is cheaper than bypass -- at least initially -- and is easier on the patient, who is typically hospitalized only overnight and can go back to work in a couple of days. But given the benefits of CABG, why do so many opt for angioplasty?

One reason is convenience. Many arterial blockages are discovered through angiography, in which a catheter is inserted through a blood vessel in the groin and threaded to the site of the suspected blockage. When a blackage is discovered, said Dr. Stephen Lahey, a cardiac surgeon at Maimonides Medical Center in Brooklyn and a professor of medicine at SUNY Downstate, the patient is typically asked whether the cardiologist should just go ahead and perform angioplasty because the patient is already on the table. "The natural tendency is to opt for something that is [more convenient], far less invasive and doesn't hurt as much," he said. "But is that the right thing, or good for the patient? Sometimes, we have to say I know you want [angioplasty], but that really isn't the right thing for you."

That situation "takes away the opportunity for informed consent," added Dr. Michael J. Mack, medical director of cardiovascular services and director of transplantation for Medical City Dallas Hospital, a co-author of the new report. "The patient is lying on the table, recommendations are being made, and there is no real opportunity to gather all the facts. There is now a trend toward stopping, having an objective conversation with the patient, the cardiologist and a surgeon."

Moreover, added Dr. John Conte, associate director of the division of cardiac surgery at Johns Hopkins Hospital in Baltimore, the cardiologist will often say, "If you don't do well, we can always give you surgery later." But, he added, "if people will do better with surgery the first time, why put them through the added risk?" A major conclusion of the new study is that, before angiography, the patient should meet with a team containing both a cardiologist and a surgeon who will present them with all the pros and cons of both procedures. "That paradigm [of a team approach] is already established in oncology. Why can't we do it in cardiology.... It's absolutely amazing that the federal government and payers don't insist on it."

The final question, and perhaps the easiest to answer, is why bypass proved better. "Coronary bypass treats most of the current and future blockages of a vessel. Stenting treats a single lesion," said Dr. Richard Guyton, chief of cardiothoracic surgery at the Emory University School of Medicine. "If there is one severe lesion [blockage] and five emerging lesions, stenting treats the existing lesion and the emerging ones are still there." Because bypass replaces a much longer section of artery, it takes care of the emerging lesions as well. Most recurrent heart attacks are not caused by a re-blockage at the site of the angioplasty, he said, but by the sudden closure of an artery caused by a ruptured plaque from another site. "That's the reason there is a difference in outcome between the two procedures."

All the researchers agreed, however, that there was one time when angioplasty was not only preferred but absolutely necessary -- when a patient had a heart attack caused by the sudden blockage of an artery. In such situations, time is of the essence, and angioplasty is the fastest way to reopen the artery and save the patient's life.

-- Thomas H. Maugh II

source: Los Angeles Times

Great Features of Next Generation Knee Replacement Surgeries

When former Prime Minister of India Atal Bihari Vajpayee underwent a knee replacement surgery a decade ago, India was introduced to artificial knee implants in a big way.

Vajpayee had to undergo a surgery with a big cut, not only on the skin, but also on a large chunk of his muscles and ligaments. And Vajpayee’s implants are also likely to wear out in another five years or so. But Rajshree Mohan, (55), has a different story.

Suffering from knee problems for more than three years, she could not bend her knees without wincing in pain. On Tuesday, Rajshri (name changed) got a knee-replacement with two firsts—she became the first Mumbaikar to get an implant made of a better metal alloy, and the surgery used blocks tailor-made specifically for her.

Vajpayee’s surgery was a painful affair and he had to wait a year to get the second implant. Now, thanks to a combination of technology and surgical techniques, a patient can go home the next day after getting implants in both knees in one go. Joint replacement surgeon Dr Adam Mullaji for example, speaks of the ‘quad-sparing’ technique, where the main muscles of the quadracep are completely spared. “There is a small incision on the skin and hardly any pain. Patients can bend and straighten the leg right away and walk without support the same day,’’ he says.

Here are some features of the next generation of knee replacement surgeries, where techniques or skills used in an implant have brought a revolution to painless walking, or kneeling for that matter, published by TOI.

Tailor-made for each patient

Apatient wanting a knee replacement can now get the knee cut in such a way, that the new knee (the implant) fits exactly to the bone. With the help of patient-specific cutting blocks, a patient’s joint bone is cut so it is exactly the inside shape of the implant knee and the implant fits like building blocks. With the help of the MRI, a 3 dimensional image of the joint is transferred to a computer software which marks the bone image at places where it needs to be cut. A block is then made, which when fitted at the joint during surgery, saves all measurements and the bone can be directly sawed through the gap in the block.

The drawback is that the technique to make the blocks is available only in the US, so surgeons in India have to send the images there and wait for almost a month before doing the surgery. Dr Alfred Tria, a professor and designer surgeon of the technique, said it helps eliminate around 22 steps during the surgery. “Every block has a gap through which the blade can be inserted and the bone is cut. When the implant knee is then put, it fits right in the bone,’’ he said. A knee replacement with this technique would cost an Indian patient around Rs 1.10 lakh.

Improved knee rotation flexibility

Getting a knee replacement so far meant that post-surgery, one could bend the knee only backward and forward, and slightly to the side. But it is now possible to achieve complete movement of the knee with better rotations. City doctors say while knee replacement was earlier an option of the old, the age group of those coming in for a replacement has gone down by a decade. “We now get patients around 50 to 55 years of age, who, after the replacements, want to continue with all physical activities,” said Dr Sanjeev Jain, orthopaedic surgeon, L H Hiranandani Hospital. In the conventional method, the cruciate ligament, one of the major ligaments which supports the bones in the joint, is cut to reach the bone.

“But now, we can reach the bone from another side, saving the cruciate ligament. Besides, less bone needs to be cut up,” said Dr Jain, adding the plastic in a normal implant wears out, so the implant fails after a few years. “In the rotating platform, plastic wear-out is comparatively less as there is enough contact area between the plastic and metal,” he said. As the ligament supports the bone, the new implant too gets support from the ligament which enables the patient have better joint movement,” explains Dr Jain.

Longer lasting material for implants

Earlier, most implants lasted for 15 to 20 years. Now, with patients getting younger, implants are getting better with some able to last even up to 30 years. Cobalt-chromium and titanium alloy, earlier used in the knee joint implants, are now being replaced by oxidized zirconium, a material which lasts longer. “The cobaltchromium alloy is like stainless steel. Even if we use utensils with special care, they are bound to wear out after a few years. Similarly by rubbing against each other and the ligaments, thechrome-cobalt knee joint too wears out after some years,’’ explains Dr Sanjay Agarwala, head of orthopedics in P D Hinduja Hospital.

Apart from the friction of the metal, the bone itself gets worn by the alloy implant, say doctors. The oxidized zirconium alloy on the other hand, is harder and smoother by nature, which makes it resistant to abrasions. “For patients allergic to metals, or are likely to develop allergy, the oxidized zirconium alloy is much better as the patient’s immunity system is able to tolerate the new implant,’’ said Dr Agarwala.

source: TOI