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University of Iowa expands minimally invasive options

Wednesday, May 13, 2015

 

In response to the increasing demand for less invasive surgical options, UI cardiac surgeons are expanding their minimal access treatment arsenal. In addition to performing robotic-assisted coronary artery bypass grafting (CABG) with the daVinci® Surgical System, the UI cardiac surgery program has added robotic-assisted transmyocardial laser revascularization(TMR) and minimally invasive left ventricular assist device (LVAD) implantation.

“University of Iowa Hospital is the only institution in Iowa to offer these three treatment options via minimal access,” says Peter J. Gruber MD, PhD.

Robotic-assisted CABG

The post-operative benefits of minimally invasive coronary artery bypass graft procedures (CABG) are well documented; no sternotomy, less post-operative pain, shorter recovery time, and fewer bleeding complications. Robotic-assisted CABG offer several unique therapeutic opportunities as well, including: robotic-assisted harvesting of internal mammary arteries (IMA), robotic-assist options for single vessel disease and unstentable lesions in the left anterior descending (LAD), and hybrid revascularization. “Hybrid coronary revascularization combines minimally invasive surgery with percutaneous intervention for multi-vessel disease,” reports Dr. Mohammad Bashir, UI cardiothoracic surgeon. “This approach provides a platform for complex repairs, while maximizing the benefits of the minimal access treatment.”

Minimally-invasive TMR

Transmyocardial Laser Revascularization (TMR), is well-established as a treatment option for patients with intractable or refractory angina, who are not candidates for further surgical or interventional revascularization. The angiogenic process stimulated by laser creation of channels in ischemic myocardium has proven to increase perfusion, enhance myocardial contractility, and improve quality of life in certain patients. However, utilization of the therapy as solo or stand-alone treatment has been limited by the need for a sternotomy.

“Robotic-assisted, minimally-invasive TMR eliminates the need for a sternotomy, a major deterrent to pursuing therapy for many patients,” says Dr. Bashir. “We are now able to offer this option to an expanded pool of patients.”

Inclusion criteria include:

  • Class III or IV angina without decompensated heart failure
  • An ejection fraction of at least 30 percent
  • Options exhausted for medical therapy and conventional revascularization

Exclusion criteria include:

  • Myocardial infarction within the past 2-3 weeks
  • Unstable patient who are unable to be weaned from IV antianginal medication
  • Uncontrolled tachy-arrhythmias
  • Decompensated heart failure