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Significant changes thanks to hybrid surgery

Healthcare News | 2012-08-27

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Tatsuhiro Komiya, MD, Kurashiki Central Hospital, Japan

Today, Japan’s population is living longer than ever, but that also means a higher national incidence of elderly patients needing heart valve replacements. Siemens is collaborating with surgeons at Kurashiki Central Hospital to introduce lower-risk catheter-based procedures that eliminate the need for open-heart surgery in many of these cases.

Kurashiki Central Hospital is among three Japanese medical institutions whose multidisciplinary surgery teams conducted clinical trials of catheter-delivered Edwards prosthetic valves over the past year. All of these institutions are equipped with Siemens hybrid rooms – a conventional operating room (OR) equipped with an angiography system to allow for both open and minimally invasive treatment in one room. The first round of clinical trials is especially important in Japan, where many elderly people among the aging population are outliving the normal lifespan of their heart valves. Catheter delivery minimizes or eliminates the need for open-heart surgery along with the trauma of opening large parts of the thorax. The patient also spends far less time in surgery, and there is no longer a need for external blood circulation with a cardiopulmonary bypass machine.

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“Each specialist has had to gain some familiarity with other team members’ tasks.”

A multi-disciplinary team in a multi-disciplinary room

“The methods for implanting heart valves cannot be learned on one’s own because close teamwork is essential among the different specialists, including interventional cardiologists, echocardiographers, imaging specialists, and heart surgeons like myself,” says Tatsuhiro Komiya, MD, Chief of the hospital’s Cardiovascular Surgery Department.

The Kurashiki heart team is focusing on two different options for catheter-delivered replacements of the heart valves, transapical and transfemoral. The aortic valve from Edwards is replaced through a transapical insertion on a valve-mounted catheter, which is introduced through a surgical puncture into the apex of the left ventricle. Kurashiki Central and two other hospitals – in Osaka and Sakakibara – are now tracking the recuperation phase of some 50 patients who volunteered for the heart valve trials. Among this cohort, some also received Medtronic’s CoreValve, an aortic valve that is being implanted via the femoral arteries instead of the apex of the heart.

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Dr. Komiya explains the placement of the prosthetic heart valve.

Positioning matters

Navigation of a valve into the correct location demands orchestration of many components, including several high-tech imaging modalities, intensive planning and preparation, real-time monitoring, and multidisciplinary collaboration in ensemble. “A vast amount of planning precedes the operation,” Komiya states. Echocardiograms, pre-operative computed tomography and intra-operative syngo® DynaCT images provide the heart team with a three-dimensional schema of the target region.

The aortic valve trials at Kurashiki Central have spurred development of valves of smaller diameter that are more suitable for Japanese patients who on average are smaller than European or American patients.

“The technique is rapidly developing, and Japanese patients and physicians are expressing enthusiasm,” Komiya concludes. “This is a new frontier for medical science and surgical practice worldwide and here in Japan.”

Key Benefits

  • Catheter delivery minimizes or eliminates the need for open-heart surgery along with the trauma of opening large parts of the thorax
  • The patient spends far less time in surgery, and there is no longer a need for external blood circulation with a cardiopulmonary bypass machine
  • The smaller incision and minimally-invasive intervention enables faster recovery of the patient
  • The hybrid operating theater has both coronary catheterization and open cardiac surgery capability, should need arise

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The outcomes achieved by the Siemens customers described herein were achieved in the customer's unique setting. Since there is no "typical" hospital and many variables exist (e.g. hospital size, case mix, level of IT adoption) there can be no guarantee that others will achieve the same results.

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