Maryland Heart Center

Minimally Invasive Coronary Bypass Surgery

What New Advances are Being Made at the Maryland Heart Center?

Minimally Invasive Coronary Bypass Surgery

Maryland Heart Center cardiac surgeons are constantly looking for ways to improve surgical techniques to reduce side effects and improve outcomes for all patients. Some new advances include:

Optical Coherence Tomography (OCT) -- The University of Maryland Medical Center is using a new technique -- known as Optical Coherence Tomography -- that uses infrared light to determine the quality of the blood vessels used to create bypass grafts during coronary artery bypass surgery. This technique also provides important feedback to the surgical team about the quality of the connection between the vein and the coronary artery.

Endoscopic Vein Harvesting -- Traditionally, a long leg incision is necessary to obtain the saphenous vein for grafting to the heart. After coronary bypass surgery, patients often have more pain associated with the leg incision than the chest incision. We are addressing this problem. In most cases, we remove the saphenous vein with an endoscope, which requires a much shorter incision. This technique, known as endoscopic vein harvesting, is a videoscopic technique that is much less invasive than the traditional method. In addition to reducing post-surgical pain and scarring, it helps speed recovery time as well.

New Heart-Lung Bypass Machine -- The Maryland Heart Center is one of several sites enrolled in a trial of a smaller bypass machine. This device markedly reduces the requirement for adding salt solution to the patient during surgery, minimizing hemodilution and avoiding the need for blood transfusions. The overall surface area in contact with the bloodstream during bypass is only 15 percent of that in a traditional bypass machine. As a result, inflammation and its adverse consequences are reduced.

National Trial Involving Gene Therapy for the Saphenous (Leg) Vein -- In this study of DNA therapy, doctors treat the vein with a piece of DNA to block the expression of a bad gene and to prvent thickening of the vein. This technique allows the vein to remain open longer, thus helping to reduce the need for additional bypass surgery.

Trial Investigating Blood Clotting Issues Associated With Off-Pump Coronary Bypass -- In selected patients that undergo off-pump coronary bypass surgery, we will be investigating the safety and efficacy of an FDA approved drug, called Aprotinin, which was designed to prevent excessive bleeding. All patients will receive either the drug or a placebo and then have a thorough evaluation of their clotting system and an analysis of the bypass grafts using a noninvasive CT scan. The results of this trial will contribute greatly to our understanding of this crucial issue in this growing technique.

Laser Revascularization (Transmyocardial Laser Revascularization) -- This procedure treats patients with coronary artery disease and angina who are not candidates for coronary artery bypass surgery or angioplasty. The procedure stimulates the heart muscle and is effective in controlling pain. The laser is used to create holes in the heart through a small incision. It can be used alone or with coronary artery bypass.

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