Department Name

Minimally Invasive Surgery:

As in many other areas of surgery the field of cardiovascular surgery continues to explore ways to make surgery safer and "less invasive" to patients. This includes the use of smaller incisions for valve operations ("Minimally invasive valve techniques") and coronary artery bypass (The "MIDCAB"or "Minimally Invasive Direct Coronary Artery Bypass"). Although minimally invasive surgery is technically more demanding to perform, patients express satisfaction with the limited incisions and, in general, are able to leave the hospital a day earlier than with conventional techniques.

Another recent advance has been the effort to avoid the use of the cardiopulmonary bypass machine for coronary artery bypass surgery when it is not necessary. Newer stabilizing devices facilitate the elevation of the heart to expose vessels on the back of the heart, enabling surgeons to operate on a "beating heart." (fig.1). Although several prospective studies have shown that "Off pump" surgery can be performed safely, the surgical community is still awaiting the completion of several large, randomized studies that should tell us whether "Off pump" surgery is really better than traditional bypass surgery. In fact, The University of Florida is presently conducting a prospective, randomized study comparing patients undergoing coronary artery bypass surgery with the cardiopulmonary bypass machine to patients undergoing coronary artery bypass on a beating heart. If you are scheduled for surgery you can ask your surgeon whether you might be a candidate for one of these newer techniques.

The Maze Operation

Atrial fibrillation is an abnormal heart rhythm characterized by rapid and chaotic depolarization of atrial tissue in the upper chambers of the heart. When these impulses are conducted to the lower ventricles patients can suffer from low blood pressure. The "Maze" operation was developed by Dr. James Cox several years ago to eliminate atrial fibrillation by creating surgical lines of ablation on the atria, which prevent this abnormal rhythm from propagating. The Maze operation has been performed with great success at several major cardiovascular centers. However, the extensive surgery required to actually "cut and sew" back together the surgical lines of ablation limited the widespread application of this operation. More recently, newer energy sources have been utilized to create lines of ablation and have shortened operating times and made the maze operation safer. As over two million Americans have atrial fibrillation, many patients could benefit from the maze operation. Patients with a history of atrial fibrillation undergoing cardiac surgery are candidates for this procedure and should consult with their surgeon to see if it is appropriate for them.

Stent Graft Technology for Thoracic Aortic Aneurysms.

The Division of Thoracic and Cardiovascular Surgery at the University of Florida is a major referral center for thoracic aortic aneurysms and dissections in the southeastern United States. Our Thoracic surgeons operate on over one hundred of these patients each year and see many other patients in consultation. Although stent-grafts have been employed for several years for abdominal aortic aneurysms, there are still no commercially available stent-grafts for the thoracic aorta. Experience with stent-grafts in the thoracic aorta is limited, however the patients that have undergone stent-grafting did not have to have incisions in their chest or have their "ribs spread." These patients generally tolerated their operation well with less difficulty than patients undergoing surgery with conventional techniques (Figure 1). In the near future we will begin enrolling patients in a trial for a new thoracic stent graft. If you have a thoracic aortic aneurysm and are scheduled to undergo surgery, consult with your doctor to see if you are a candidate for this technique.

   
Figure 2. Thoracic aortic aneurysm (a) treated with a thoracic aortic stent graft (b).