Minimally Invasive Coronary Bypass Surgery
By Giovanni Ciuffo, M.D.

Minimally Invasive Coronary Surgery techniques have changed the way we cure cure coronary artery disease. In spite of all the exciting progress in the field of interventional cardiology (stents and angioplasties), many patients are best treated with coronary bypass surgery to enjoy a durable and reliable solution to their problems and a much better quality of life. One of my favorite analogies about choosing the right options in heart disease comes from the field of dentistry. If you have a toothache and a literally rotten tooth you might consider two basic choices…….

CHOICE #1: The DIY Cheap Way Out.

You might decide to go to the local drug store and get yourself some strong toothache medication to feel better for a while. Unfortunately, we all know what happens next. This remedy won’t last too long and chances are that you will end up losing your tooth and/or experiencing the misery of a tooth abscess.

CHOICE #2: The Permanent Fix

….OR you might decide to see what a dentist can do to help. Chances are that our good dentist will recommend a root canal. It goes without saying that none of us particularly enjoys the prospect of needle sticks and gruesome drilling in the dentist’s office. We can expect, though, to save our tooth and get a crown on it. Bottom line: the pain is gone, the tooth is saved and we are happy again. That’s more like it!!

Let’s go back to coronary disease. A lot more than a tooth is at stake but a great deal of patients are still in denial and will try any easy way out rather than facing their condition. Some of them are unsuccessfully treated with medical therapy and/or stents and show up again with the same or more chest pain, shortness of breath, profound weakness or even worse…a heart attack and/or a much weaker heart. In many cases these same patients subject themselves to a radical, often exaggerated decrease in their physical and social activity to avoid their symptoms of chest pain, palpitations or shortness of breath. Some others get more and more stents in spite of the fact that they are obviously not working for them. I recall the extreme example of a 58-year old coronary patient with multiple stents saying, and I quote: “I’m fine. I only get chest pain when I walk!!” I heard once this line: “Insanity is doing the same thing over and over again, expecting a different outcome each time”.

All coronary patients should be strongly encouraged to consult with a heart surgeon and get a balanced view of their options in the treatment of their disease. It is not unusual to see patients that had been insisting on non-surgical therapies that are not working and can eventually cause more problems and effectively take their quality of life away. I am always amazed by how little information is offered to patients and their families when they are “shopping” for their best options. You should always feel free to ask as many questions as you like to your primary care physician and to the heart specialist about your choices in treatment. Our low-impact and minimally invasive techniques in coronary bypass surgery have dramatically improved our results and have shortened the recovery time. The overwhelming majority of coronary patients in my service return to their homes two-three days after their surgery. Even frail and older patients can enjoy these excellent results and get their “permanent fix” instead of the “DIY cheap way out”

What is a Coronary Artery Bypass? Coronary bypass surgery is one of the most frequently performed surgical procedures in the U.S.. To put it in plain plumbing terms, this procedure deals with badly clogged pipes (the coronary arteries). We connect a new pipe (a bypass) between the aorta (the equivalent of the main water supply) and the coronary artery segment downstream from the blockage (the “clogged pipe”). This bypass serves the purpose of bringing back a normal flow of oxygenated blood to the portion of heart muscle supplied by the blocked coronary artery (see picture below).

The traditional way to perform this operation involved the use of a heart-lung machine and a midline incision through the breast bone (median sternotomy). A more recent development that has revolutionized the way we perform this procedure is the beating heart surgery technique. In other words, we are now able to perform a coronary artery bypass while the heart is beating, with no need for a heart-lung machine. In expert hands, this technique allows excellent results and a shorter and less complicated postoperative course, especially in the older and higher risk patient population. By avoiding the use of the heart-lung machine, we are also able to perform a much less invasive procedure. Clinical studies are beginning to show that this technique is associated to much less bleeding and very few patients require transfusions. It is better tolerated by the lungs and kidneys, which is a great advantage in patients with emphysema and/or renal insufficiency. It might also be beneficial in patients that have carotid artery disease (bad circulation to the brain). For all these reasons, it is my personal preference to use this technique in the overwhelming majority of my coronary patients. The operation is carried out by connecting the aorta to a small opening in the segment of coronary artery beyond the blockage. The connection is created with saphenous veins harvested from the leg, mammary arteries from the chest wall, radial arteries from the forearm or other arteries from the abdomen (see picture).

Which grafts? The first coronary artery bypasses were performed only with leg veins. In the 70’s the internal mammary artery (IMA) was introduced in clinical practice. It was soon discovered that the routine use of this artery for bypass can guarantee long term results that are far superior to using only leg veins. Numerous clinical studies have in fact shown that even after 10 years over 96% of the IMA grafts are still open and function well. The use of the IMA to bypass the coronary artery that feeds the front of the heart has been proven to give our patients the greatest survival advantage over any other intervention in contemporary medicine. This the reason why the left IMA is now considered the graft of first choice all over the world, often in association with other grafts if more than one bypass is necessary. The excellent results we observed with the use of the IMA lead us to believe that the preferential use of more arterial grafts instead of veins might improve the duration and quality of the beneficial effects of the bypass operation. In addition to both IMA’s (right and left), other arterial grafts such as the radial arteries from the forearm, the right gastroepiploic artery from the stomach, the inferior epigastric artery from the abdominal wall, etc. have been successfully used. It is again important to point out that every patient gets an individual evaluation to decide which particular procedure and grafts suit him or her best.

MIDCAB stands for Minimally Invasive Direct Coronary Artery Bypass. This technique truly represents the ultimate minimally invasive technique in the field of heart surgery because it is carried out through a small incision AND does not require the use of the heart-lung machine. This operation is performed on the beating heart and instead of the traditional big midline incision, a 3″ long transverse incision is all that is necessary to access the heart. The incision is right on the skin fold underneath the left breast to insure an invisible scar.

The Left Internal Mammary Artery is harvested from the chest wall and prepared for connection to the blocked coronary in the front of the heart.

A mechanical stabilizer (that two-pronged fork) is used to immobilize the portion of the heart surface where the blocked coronary vessel is and allow the surgeon to connect the left internal mammary artery to it. The wound is then closed with plastic surgery techniques and the scar will be effectively hidden in the skin fold underneath the left breast. This approach can basically afford our patients a scarless and often painless operation

After this minimally invasive operation, our patients experience minimal pain with a small surgical scar and can often go home within the next 48 hours with a left internal mammary artery graft. Once again, this mammary graft is by far the best life insurance that modern medicine can offer to coronary patients!!! Ask your cardiologist about it. It is important to remember, though, that each patient needs to get an individual evaluation by the heart surgeon in order to decide if he or she is a suitable candidate for this procedure.

Visit us for more information and surgical pictures about Dr. Ciuffo and his revolutionary Minimally Invasive Heart Surgery techniques.

Minimally Invasive Coronary Bypass Surgery is routinely available to Dr.Ciuffo’s patients. His accomplishments stem from an entire career dedicated to the development and improvement of these techniques. Dr. Ciuffo speaks fluent Italian and Spanish. He currently runs a busy Cardiothoracic Surgery practice at Mount Sinai Hospital in Manhattan, where he cares for numerous patients coming from the Tri-State Area and the rest of the country.

Giovanni B. Ciuffo, MD is board certified by the American Board of Surgery and the American Board of Thoracic Surgery. He is a member of the New York Society of Thoracic Surgeons. His current academic and clinical activity is entirely devoted to the surgical therapy of coronary, valvular and thoracic aortic disease with the most advanced bloodless, minimally invasive and beating heart surgery techniques.

He serves as cardiovascular surgeon and consultant in the Hospital Liaison Committee for the Jehovah’s Witnesses for his expertise in bloodless surgery techniques and strategies. He is often invited to teach and demonstrate his minimally invasive techniques in European and American cardiac surgery centers. He is often an invited speaker to meetings and conventions of medical and civic associations and the author of a health column on America Oggi, a daily Italian language newspaper in the U.S.

Dr. Ciuffo lives in Queens, NY with his wife and his two children.

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While it is true that the overall number of plastic surgery procedures performed in the past few years is up, and the number of men as a percentage of this total is increased, women still far outnumber male patients by about 10:1 for most practices. While male plastic surgery procedures are somewhat different from woman’s, their motivations for undergoing plastic surgery are also different.

While both men and women undergo plastic surgery to look physically better, you have to dig beyond this obvious level to understand what their true motivations are. The desired physical concerns or desired changes are just a reflection of their unspoken concerns. Generally speaking, most women undergo plastic surgery for internal self-image motivations. They want to fell better about themselves. Correcting a physical flaw is one approach to self-improvement. (and perhaps the easiest?) Whether it is a tummy tuck to look better in clothes or t have their eyes done to look more refreshed, plastic surgery for women is mainly about improving themselves and is not necessarily for others. I hear this over and over…’my husband says I look fine the way I am’…or…’my friends say I look fine’. But yet, women want to have the surgery anyway…because they to effect an internal self-image change. Men, conversely, often undergo plastic surgery because they want things. Whether it be to have more women, sex, money or power…it most always deep down is motivated by a desire for external or more tangible things. As a plastic surgerycorollary to ‘Men are Venus, Women are from Mars’…Women do things for themselves, Men usually do things for somebody else. or other external raesons.

The male plastic surgery patient is also different from the female patient in other ways as well. They often do not prefer to undergo radical procedures that make a drastic change in appearance, have less pain tolerance, follow postoperatve instructions less carefully, do not want a prolonged physical or social recovery, and can be more vocal about the outcome of the surgery. (or they are at least more vocal) Much of this has to do with the general greater impatience of men who want to get to the final result quickly…and usually more discretely. This is why smaller more subtle procedures for men are often better, even if the result is not as significant. Men get no accolades, and certainly little support, in society for suffering through a plastic surgery recovery. And the aging of men is generally better accepted in all societies. Women, conversely, garner more empathy if they are suffering to look more ‘beautiful’. In fact, our society expects them to do so.

The handling of the male plastic surgery patient, I have found, is quite different from a female patient. Because of the male mentality, some plastic surgeons do not enjoy working with men. They often require more time and patience than most female patients. And the expectations of the younger male are often higher than for the older male. The young ‘narcisistic’ male patient can be the most demanding and the most likely to require revisional surgery to achieve a mutually satisfactory result.

Dr Barry Eppley is a private plastic surgeon who practices at his hospital-based medspa locations at Clarian Health in Indianapolis. To learn more about the latest trends in plastic surgery, go to his daily blog, http://www.exploreplasticsurgery.com .

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In this video, Dr. Kreuzer conducts an anterior hip replacement surgery using an Arch Table to manipulate the hip out of its socket. One viewer of this video commented “Anterior is the way to go especially if your young like me 37 yrs old Avascular Necrosis. Pain is gone hardest thing for me is just coming down stairs but once i get that i will be ok. Already doing everyday things couldn’t do before surgery. Feel so much better and recovery time is quicker than the posterior approach no disconnecting muscles.”

Medical students are reportedly choosing not to specialize in gynecology due to the high cost of malpractice insurance. Litigation has caused the insurance premiums to rise, which has led to many leaving their ObGyn job. In the meantime, the number of positions is expected to grow faster than average between now and 2014 due to population growth. This had led to fewer health care options in many states for women. As a result, the average salary for practicing gynecologists is expected to raise considerably and the job outlook is expected to be be strong.

The American Medical Association reported in 1995 that about 5.5% of people held jobs as obstetricians and gynecologists that worked in hospitals and clinics in the United States, according to the Bureau of Labor Statistics. Employment opportunities for physicians that specialize in obstetrics or gynecology are expected to grow by about 14% through 2016. OBGYNs will find more job openings in rural or underserved urban areas. OBGYNs earned an average annual salary of $195,580 to $284,000 in 2008, according to Salary.com.

As our population ages and the need for health care grows the current physician shortage in the US is expected to intensify. Several factors are impacting this problem, the shrinking economy, the aging population and finally the impending health care “reform”.

Physician Shortage:

American Academy of Family Physicians suggests there will be a shortage of 40,000 primary care doctors (Family Practice jobs, Internal Medicine jobs, Gynecology job and Obstetric job) by 2020. Added to this shortage is the fact that the number of medical students choosing primary care as a profession has already dropped by 51.8% since 1997, and that currently only 2% of medical school graduates choose primary care as a career.

Aging Population:

The US population is aging. From 2010 and 2035, all age groups 70 and above will increase over 95%. Although for most other specialties this means there will be a greater demand for all health care services, this would be less so the case for that care of pregnancy and birth were it not for the mini baby boom. Further, it is estimated that as many as one-third of today’s older practicing physicians will retire by 2020.

Stock Market Decline:

The recent stock market decline has impacted older physicians’ decisions. Some physicians are postponing retirement because of the economy’s impact on their retirement savings. But even a three- to five-year delay won’t address the impending loss of experienced physicians.

Health Insurance Reform:

The final uncertainty is the outcome of national health reform. If the reform actually works in increasing the enrollment into health care insurance programs then when combined with the long term the aging population and these increased numbers should push demand for services and therefore cost higher. However, no one yet knows what will happen to reimbursement rates from Medicare and this new program. The question is will there be rate a cut of reimbursement rates for different procedures by Medicare and this new program that may ultimately decrease the income of all specialties.

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Source: http://www.articlealley.com/article_1374104_36.html

For many people, snoring may seem like a fairly minor issue in their lives. After all, something that is experienced by so many people around the world cannot possibly be all that serious, they suppose, so it seems a waste to consider such treatments as snoring surgery.

The truth is that snoring can have a number of negative effects on a person’s life, as well as the lives of those close to them. And even more severe is the fact that snoring is sometimes not the problem in and of itself, but rather a symptom of a more severe problem, such as sleep apnea. Snoring surgery may not only be the right choice to improve the quality of your sleep, and the sleep of those around you, but also may be the right choice because of a greater health risk.

Snoring surgery may not be the only solution for you. Obviously, it would be a wise choice to consult a doctor before you decide to go with a surgical procedure, as there may be other treatments available which would be able to give you the positive results you need without the extra costs and hassle associated with a surgical procedure. These treatments may include simple things such as nasal strips. In fact, it may even be as simple as sleeping in a different position or losing a bit of weight, both of which can yield remarkable results in stopping your snoring. Consulting a doctor will also give you a chance to find out if your snoring is caused by simple things such as nasal congestion, or more severe causes such as a deviated septum or sleep apnea.

Once you have consulted a doctor, if you still feel that snoring surgery is the right choice for you, then you have a few options which are open to you. Each option works in different ways, and as such varies in effectiveness depending on the cause of your snoring. One of the simplest and easiest methods is a procedure that is known as Somnoplasty. Somnoplasty uses a specific frequency of radio waves to, over time, correct blocked airways. This will reduce snoring, as well as potentially reducing or eliminating the threat of an obstructive sleep apnea. The advantages of this method are obvious, as there is no real surgical procedure involved. However, the time frame is a bit longer than one might expect from some other methods.

Other types of snoring surgery are, obviously, more invasive than the Somnoplasty treatment. However, they may be necessary, as Somnoplasty is not effective in cases where the cause of snoring is within the nasal passages. For instance, direct nasal surgery would be required in order to fix snoring that is caused by a deviated septum, and other similar sorts of nasal blockages. Again, the specific type of snoring surgery you use should be decided based on advice from a medical professional, as they will be able to inform you of how effective you can expect each different method to be in your case.

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Source: http://www.articlealley.com/article_71200_23.html