The Heart of the Matter: Advances in Cardiac Care
By Larry Schwingel / February 1, 2017

The human heart is a muscle about the size of a small fist, yet it delivers the biggest of impacts. This incredible organ, with chambers and valves working in unison, pumps blood that is rich in oxygen and nutrients to all bodily tissues. It is our veritable lifeline of existence. Chambers contract to push blood through our vascular system and valves move blood efficiently in the proper direction-an amazing feat occurring about 100,000 times daily.

If the heart falters or fails, primary organs suffer. Last year, according to the American Heart Association, heart disease caused more than 17 million deaths. More people succumb to it than from all forms of cancer combined. In the United States, it is the leading cause of death, striking one person every 43 seconds. That is a grim statistic, but thanks to advances in cardiac care treatment and new surgical techniques, a longer, healthier lifestyle is possible.

The most common forms of heart disease are coronary artery disease, heart failure, and arrhythmia, with coronary artery disease (a blockage of the coronary arteries) the most common. Some diseases affect the heart muscle and heart valves, while some affect the heart's electrical system and coronary arteries. The greatest problem-they all have the potential to disrupt the heart's pumping action.

Dr. Alexander Justicz, chief of cardiac surgery at Holy Cross Hospital in Fort Lauderdale, had this to say about coronary disease: "The major risk factors remain the same (high blood pressure, diabetes, stress, high cholesterol, hypertension, smoking and family history), but what is changing are new surgical methods that provide far better outcomes for people with heart disease."

The cardiovascular and thoracic surgeon said that sophisticated imaging is an integral part of the surgical preparation. "Various modalities of cardiac imaging can tell us precisely where the problem areas are," he said. "The CT, MRI, and Transesophageal Echocardiography (high-frequency sound waves for detailed pictures of the heart and arteries) are pretty standard."

According to Dr. Justicz, one of the most important roles cardiologists play is determining a pro-active sequence of diagnostic modalities for proper treatment. "Cardiologists are able to break down the nuances of the testing and variability of the testing, and this definitely helps the cardiac surgery team," he said.

Advances in treatment
Historically, arrhythmia (irregular heartbeat) has been controlled by anti-coagulates, but drugs are not always the answer. Surgeons now have the option of ablation-a technique where a catheter balloon is guided to the blood vessels, destroying cells that interfere with the heart's natural rhythm. "In a traditional ablation, heat is used to destroy faulty cells, while cryoablation uses a cooling agent to freeze cells," Dr. Justicz said. "This new technique offers greater stability of the catheter and minimizes the damage to surrounding healthy cells."

Atrial fibrillation-a problem where the heart's two small upper chambers beat too fast and don't pump enough oxygen and nutrients throughout the body, is a problem affecting nearly 2.5 million people. AFib can be diagnosed by an ECG (electrocardiogram) recording. A common surgical procedure is the Cox-Maze technique. During the procedure, a series of safe and effective "scars" are made that permanently block the electrical signals that trigger the irregular heartbeat. Most patients will not need blood thinners or other medications post-op. "Cox-Maze is an organized set of burns to reconstruct a normal rhythm, and it's minimally invasive," Dr. Justicz said.

The Lariat Suture Delivery Device (LSDD) protects patients with AFib from developing a stroke. When out of normal rhythm, blood can pool in the heart and create blood clots. If clots travel to the brain, a stroke is very possible. Blood thinners prevent formations, but some have side effects not everyone can tolerate. With the Lariat, an electro physiologist uses a catheter to guide a lasso-like loop over the appendage, closes it off and prevents the blood from pooling-thus reducing the risk of stroke.

Another less invasive surgery for heart valve disease is Trans-Catheter Aortic Valve Replacement (TAVR). It's a great option for people who need a valve replacement but fall into the high-risk open-heart surgery category. This procedure involves inserting a catheter into the groin (femoral artery) and guiding it to the heart's chambers using advanced imaging techniques. Through the catheter, a collapsed tissue heart valve is guided into position and placed directly inside the diseased aortic valve. Once the new valve is in place, a balloon is inflated that deploys a valve. No opening of the chest is required.

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