Medical Care

When coronary arteries (the arteries that deliver blood to your heart) become blocked, we may perform surgery to give blood a new pathway to the heart. During coronary artery bypass graft surgery (also called CABG, or “cabbage”), a blood vessel is removed or redirected from one area of the body and placed around the area or areas of narrowing to bypass the blockages.  This allows blood flow to be restored to the heart muscle. This vessel is called a graft. With more than 500,000 performed each year heart bypass surgery is among the most common operations performed in the US.

On-Pump CABG

During the traditional “on-pump” surgery, a heart-lung bypass machine takes over the work of the heart and lungs. This allows the heart to be completely at rest while the surgeon performs the bypass surgery. The heart-lung machine also helps your body receive the oxygen and blood flow it needs during the surgery. The on-pump operation is the most common CABG surgery.

Off-Pump CABG

Off-pump or beating heart bypass surgery allows surgeons to perform surgery while the heart is still beating. The heart-lung machine is not used. Advanced operating equipment is used to stabilize/hold portions of the heart and bypass the blocked artery. Meanwhile, the rest of the heart keeps pumping and circulating blood to the body.

Hybrid revascularization is a combination of coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) performed either during the same procedure or in a staged approach. Percutaneous coronary intervention is used to restore blood flow to the heart’s muscle after arteries become narrowed or blocked. The treatment is minimally invasive and relies on thin tubes called catheters. A catheter is inserted into an artery in the wrist or leg, and then threaded to the heart. We use contrast dye and X-rays to guide our work. This imaging procedure is called an angiogram and is a type of cardiac catheterization.

Aortic Arch Repair is indicated for aneurysmal (a balloon-like dilation) disease of the aortic arch.  Aortic arch procedures require temporary interruption of the blood flow to the blood vessels that supply the brain. The aortic arch is replaced with a synthetic tube that is attached to normal segments of the ascending and descending thoracic aorta. The arch blood vessels (brachiocephalic, left carotid, and left subclavian arteries) that supply the brain among other organs are reconnected to the synthetic graft with a separate synthetic tube that has three branches (trifurcation graft). While all these connections are being created, this novel technique allows for insertion of catheters in the individual arch blood vessels for perfusion of the brain with blood (selective cerebral perfusion).

When the wall of a blood vessel weakens, a balloon-like dilation called an aneurysm sometimes develops. This happens most often in the abdominal aorta, an essential blood vessel that supplies blood to your legs. For this surgery, a large incision in the abdomen is made to expose the aorta. Once the abdomen is open, a graft can be used to repair the aneurysm.

In this procedure, a stent graft (a fabric tube supported by metal wire stents that reinforces the weak spot in the aorta) is inserted into the aneurysm through small incisions in the groin.

Pericardiectomy is a procedure done on the sac around the heart. A surgeon cuts away this sac or a large part of this sac. This allows the heart to move freely. The most common reason for performing a pericardiectomy is constrictive pericarditis, a condition in which the pericardium has become stiff and calcified.

A pericardial window is a procedure done on the sac around the heart. Surgically removing a small part of the sac allows the effusion to drain continuously into the peritoneum or chest.

Endocarditis is an infection of the endocardium, which is the inner lining of your heart chambers and heart valves.

Surgical treatment of infective endocarditis is performed to:

• Removal all infected tissue
• Drain abscesses (collection of pus)
• Repair the heart tissue
• Repair or replace the affected valve

A left ventricular assist device (LVAD) is a pump that is used for patients who have reached end-stage heart failure. We surgically implant the LVAD, a battery-operated mechanical pump, which then helps the left ventricle (main pumping chamber of the heart) pump blood to the rest of the body. The job of the LVAD is to help your weakened left ventricle pump blood. Unlike in the past, LVAD devices are now portable. This means you can return home with the LVAD and continue your normal activities while waiting for a heart to become available.

Epicardial lead placement is required for cardiac resynchronization therapy (CRT) which reduces symptom and mortality among patients with heart failure and left bundle branch block. Epicardial Lead Placement is usually placed by catheterization. Patients are referred for surgery because of failed coronary sinus left ventricular lead implantation.

Pulmonary endarterectomy is an operation to remove old blood clots from the pulmonary arteries in the lungs. Pulmonary endarterectomy is a major operation involving a heart-lung bypass machine. The surgeon will make an incision in the sternum and then opens the pulmonary arteries to remove the artery lining to clear the obstructions.

Esophagectomy is the main surgical treatment for esophageal cancer. It is done either to remove the cancer or to relieve symptoms. During an open esophagectomy, the surgeon removes all or part of the esophagus (food pipe) through an incision in the neck, chest, or abdomen. The esophagus is replaced using another organ, most commonly the stomach but occasionally the small or large intestine.

Your esophagus (food pipe) is the tube that carries food and liquids, including saliva, from your mouth to your stomach when you swallow. Esophageal cancer (cancer of your esophagus) can make it hard to swallow. This is called dysphagia. An esophageal stent is a tube placed in your esophagus to keep open a blocked area. The tube helps you swallow solids and liquids.

Extrapleural pneumonectomy is a surgical treatment for malignant pleural mesothelioma (MPM). In an extrapleural pneumonectomy (EPP), the surgeon removes the diseased lung, part of the pericardium, (membrane covering the heart), part of the diaphragm (muscle between the lungs and the abdomen), and part of the parietal pleura (membrane lining the chest).

Minimally invasive procedures for conditions of the lungs, pleura (lining of the lungs), and mediastinum (partition between the lungs). Compared to surgery performed through a long, open-chest incision, minimally invasive lung surgery provides several benefits for patients, including:

• Faster recovery and return to normal activities
• Shorter hospital stays
• Less pain
• Little scarring
• Minimal blood loss
• No cutting of the ribs or breastbone/sternum.

Video-Assisted Lobectomy or VATS is a less invasive surgical approach for early-stage lung cancer. A lobectomy removes a section of the lung. This technique reduces a patient’s hospital stay and the patient experiences a quicker recovery with less pain after surgery as compared with the traditional incision into the chest wall (thoracotomy).

This surgery is performed to remove all or part of a lung for lung cancer.  An incision is made on one side of your chest (thorax) during a procedure called a thoracotomy. Surgery that uses this approach avoids areas in the chest that contain the heart and the spinal cord.

CyberKnife Robotic Radiosurgery System is used to provide a non-invasive alternative to surgery for the treatment of both cancerous and non-cancerous tumors. Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. The CyberKnife System is the world’s first and only robotic radiosurgery system designed to treat tumors throughout the body non-invasively. It provides a pain-free, non-surgical option for patients who have inoperable or surgically complex tumors, or who may want an alternative to surgery.

The da Vinci® Robotic Surgery system is the least invasive approach for surgical removal of primary malignant, metastatic, and benign lesions of the peripheral and central lung. The da Vinci robot is used for precise anatomical resection as well as complete mediastinal lymph node dissection. This approach provides effective treatment without the need for a formal thoracotomy (open) or an access thoracotomy (VATS).

Bloodless surgery refers to the use of no donated blood during and after the surgery. People refuse blood transfusion for many reasons. For example, Jehovah’s Witness patients reject blood transfusions on religious grounds. In surgery, bleeding must be controlled meticulously, and minimally invasive surgical techniques are used.  Instead of donated blood, blood substitutes may be used. During bloodless surgery, the blood from the patient is collected and is given back to the patient, this technique is called blood salvage or cell saver technique. In some cases, patients may also donate their blood for use during their surgery.