Innovations in Heart Surgery

Todd K. Rosengart, MD, Professor and Chief of the Division of Cardiothoracic Surgery, discusses some of the latest innovations in heart surgery available at Stony Brook’s Heart Center.

What are some of the current trends in heart surgery?

There are several major trends, with one of the most important—and certainly one of the most exciting—being advances in minimally invasive procedures. Not only do they benefit patients in a number of ways, including lower risk of complications, smaller incisions, and shorter hospital stays, but they also show clear medical benefits with better overall patient outcomes. These can be measured by factors such as fewer repeat surgeries, fewer rehospitalizations, and lower mortality rates. In addition, because of these shorter hospital stays and reduced medical needs, costs are significantly lower. The fact that minimally invasive procedures produce better outcomes at lower costs with no sacrifice of quality make them highly desirable by patients, doctors, and insurers alike.

Stony Brook is on the leading edge of this trend by offering minimally invasive aortic and mitral valve replacement and repair surgeries. Done traditionally, valve surgery is a major procedure that involves opening the patient’s sternum to gain access to the heart. The minimally invasive approach typically uses a two-inch incision in the rib cage, resulting in less trauma to the body, less inflammation, and fewer complications. Recovery time is measured in days, not weeks. And, after the procedure, the patient’s comfort is improved, both physically and psychologically.

What is Stony Brook’s expertise in these new procedures?

Currently, only about 20 percent of heart programs nationwide have the capabilities and the expertise to perform minimally invasive valve repair and replacement. Doctors in our division were on the leading edge of training for this procedure, and perform approximately 300 aortic or mitral valve replacements or repairs annually. This number is important because in healthcare, high volumes correlate with high quality. On Long Island, Stony Brook University Medical Center is a leader in offering these services. This is good news because it means people can receive the most advanced procedures in their own community, without having to travel into Manhattan or to another state or deal with unfamiliar doctors and institutions.

Who are candidates for minimally invasive valve procedures?

Because this minimally invasive approach carries less risk than traditional open surgery, a wider pool of candidates can undergo valve repair or replacement. For example, people who are overweight, elderly, or who have certain pre-existing conditions typically are considered high risk surgical patients. Often, these patients may not tolerate invasive procedures, long periods under anesthesia, or lengthy surgeries. With minimally invasive procedures, these factors become less of an issue. In addition, the psychological aspects of the procedure should not be discounted. Most patients would do anything to avoid having their chests opened for valve surgery. Knowing that 90 percent of the cases require a two-inch incision or less that usually leaves no visible scar makes them much more apt to consent to surgery, which in turn dramatically improves their quality of life and, in some cases, saves it.

What else distinguishes Stony Brook’s Heart Center?

The Stony Brook University Heart Center continues to pursue advances in minimally invasive valve procedures. Next up: Replacing heart valves with no chest incision. Called percutaneous valve replacement, this procedure is accomplished by passing a collapsed artificial valve through an entry point in the upper leg, much as conventional cardiac catheterizations are performed today. Right now, Stony Brook is completing a multimillion dollar project to build two new operating rooms that will allow surgeons and cardiologists to perform this new technique so we can continue to bring the latest innovations in medical science to our patients.

For additional information about Stony Brook University Heart Center, please call (631) 44-HEART (444-3278).

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