Leading the charge in minimally invasive cardiac surgery

Middle East Health speaks to Joseph Lamelas, MD, an internationally recognised expert in minimally invasive heart surgery at Baylor St. Luke’s Medical Center in Houston, Texas. He joined Baylor St Luke’s in January this year. He was previously Chief of Cardiac Surgery for eight years at Mount Sinai Medical Center in Miami, Florida.

Middle East Health: Can you tell us what lead you into the field of cardiac surgery and specifically into minimally invasive heart surgery?

Joseph Lamelas: I have always enjoyed cardiac surgery since it is such a dynamic specialty and one of the few in which you can perform a significant procedure and see almost immediate results, both from a cardiac standpoint as well as a patient recovery standpoint.

My interest in minimally invasive surgery came from a desire to perform a less invasive operation that would provide even more benefit for my patients. As I began to operate on higher risk patients and noticed such a significant difference as far as benefit is concerned, I truly realised that this was the future and I needed to be involved. The rest is history.

Middle East Health: How long have you been performing minimally invasive heart surgery?

Joseph Lamelas: I have been in practice for the past 27 years and have been super-specialising in minimally invasive surgery for the past 14 years.

Middle Eash Health: I understand that you have played a significant role in advancing the field of minimally invasive cardiac surgery and have developed a number of new instruments in this field. Can you please give us some detail about what advances you have facilitated and what instruments you have helped develop?

Joseph Lamelas: I have further advanced the techniques in minimally invasive valvular cardiac surgery to make them safer and more reproducible. In addition, I have expanded the realm of the surgery to include double and triple valve surgery as well as surgery Interview of the ascending aorta through small 5cm incisions on the right lateral aspect of the chest, working between the ribs without fracturing or breaking the ribs. New instruments were needed to work through limited access and improve both visualisation as well as technical ease. These instruments were crucial to the success of this surgery.

Middle Eash Health: What simultaneous advances in medicine in general, such as imaging, have assisted you in developing your own unique advances? How have they helped?

Joseph Lamelas: Imaging is important in identifying the external anatomy as it correlates with the internal anatomy. This improves more precision in identifying the entry point in the chest as well as any anatomical cardiac variants. In the future, we hope to have imaging that can be used on the operating table to facilitate this.

Middle East Health : For which cardiac surgery procedures can you use minimally invasive techniques?

Joseph Lamelas: This can be applied to single valve disease (aortic or mitral valve surgery), which includes any type of valve repair, double valve surgery, triple valve surgery as well as resection of cardiac tumours and repairing simple congenital cardiac defects. I have also applied this to replacement of the ascending aorta and the entire aortic root.

Middle East Health: What are the benefits of minimally invasive surgery compared to traditional surgery? Has there been a notable decrease in mortality, for example?

Joseph Lamelas: The benefits include: less trauma to the tissues, less cardiac manipulation, less bleeding in surgery, less transfusions, quicker intensive care and hospital stay as well as a speedy recovery back to normal lifestyle. Overall complication rates have decreased and with experience, mortality rates have improved compared to the traditional surgery.

Middle East Heal : Are there currently certain cardiac surgery procedures where minimally invasive surgery is not an option? Do you think this is likely to change in the near future with technical advances?

Joseph Lamelas: If the patient requires 3 or 4 coronary bypasses along with valve surgery, these patients will need a traditional sternotomy operation. Additional advances may facilitate this in the future.

Middle East Health : Looking at these advances, are you involved in any research in this field? Can you give us an indication of what this research is about and how you think it will improve this specialty?

Joseph Lamelas: Research and technical advances are always part if any academic centre’s culture. With the development of new instrumentation and exposure devices as well as training courses, we will see wider use of minimally invasive surgery.

Middle East Heatlh : What does the future hold for us in this field of minimally invasive cardiac surgery?

Joseph Lamelas: I believe that minimally invasive surgery will ultimately be the standard of care and will be the benchmark upon what we will need to compare any technology and technique.


Date of upload: 16th Sep 2017

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