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Commentary |
by Maria
Degois-Sainz
President, Cardiac Surgery
Guidant |
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What is Minimally Invasive Cardiac Surgery?
What is “minimally invasive cardiac surgery”? I think the best way to approach this question is from the perspective of the patient, as a healthcare consumer.
With recent advancements in medical technology, every patient rightly expects to receive the latest methods of care that combine the least procedural invasiveness, fewest acute and long-term complications, and best long-term outcomes. From this perspective, minimally invasive cardiac surgery is the treatment of coronary artery disease in the manner least burdensome to the patient.
Angioplasty claimed fame as a patient-friendly procedure: thirty minutes in a cath lab setting, groin puncture, and back home tomorrow. Now, drug eluting stents promise fewer repeat interventions, a seemingly one-stop cure-all for coronary artery disease. Meanwhile, cardiac surgery procedures are much more frightening to patients, who think of massive surgery with the heart stopped, a large visible scar, and long recovery times.
Information and education are crucial to ensure that patients and physicians know the options available and understand the pros and cons as they relate to invasiveness, complications, and outcomes for cardiac surgery procedures. We should not assume that the data is known: the story needs to be actively told. Telling the story requires time and commitment.
Procedural invasiveness is easier to measure than complications and long-term outcomes, and not all patients are equal. Data is out there, and it is very important. But what is best for a 40 year-old male with a simple de novo lesion in the circumflex may not be best for a 55 year-old diabetic female with triple vessel disease. The best solution may require the cardiologist and surgeon to partner in patient assessment and/or hybrid procedures.
Innovations in minimally invasive cardiac surgery reduce procedural invasiveness, decrease complications and improve patient outcomes. New technologies available today – including beating heart tools, post-operative atrial fibrillation wires, and devices to facilitate proximal anastomoses like Guidant’s Heartstring – reduce the invasiveness of cardiac surgery, and others on the horizon, including automatic anastomotic devices and endoscopic tools, will further advance surgery towards sternal-sparing procedures. It is important for surgeons to learn and adopt these new technologies to deliver the best procedure for patients in the future.
The influence of the patient will increase over time, in the choice of procedure, the devices used and medications prescribed. As increasingly well-informed customers for their health, we cannot ignore them.
In the end, the patient wants what is best for her… and isn’t that what physicians and the medical industry want, too?
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