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Tell Me About... Advances in Heart Surgery With Dr. Saleh

Saleh - lgDr. Saleh is a board-certified cardiothoracic surgeon with more than 20 years of experience, Dr. Saleh is a fellow of the American College of Surgeons, American College of Cardiology and American College of Chest Physicians. In addition, he is certified by the American Board of Surgery and the American Board of Thoracic Surgery.

Dr. Saleh is president of Advanced Heart and Lung Surgeons and is one of the outstanding physician leaders at Dayton Heart and Vascular Hospital at Good Samaritan.

What are some of the most exciting advances in heart surgery?

The most exciting and revolutionary advance in heart surgery is minimally invasive heart valve repair or replacement. The traditional approach to open-heart surgery is to split the breastbone entirely before spreading it open to access the heart. Using a minimally invasive approach, I can access the heart through a 2-to- 3-inch incision between the ribs on the right side of the chest. The entire surgery can be performed through this small opening.

What are the advantages of this minimally invasive approach?

The advantages of this approach are many. A superior cosmetic result due to the small incision is only the icing on the cake. In mitral valve surgeries, the incision is often below the breast line. In women particularly, it is practically invisible. Other important advantages include less pain after surgery, faster recovery, shorter hospital stay, less blood loss and less need for a blood transfusion, less chance of infection, and a quicker return to a healthy lifestyle and to work.

What kind of open-heart surgeries can be performed using this minimally invasive approach?

The most common is valve repair or replacement, most commonly the aortic valve, mitral valve and tricuspid valve. The aortic valve is usually not repaired but rather replaced by either a mechanical or tissue valve. The mitral valve may be too narrow, which impedes blood flow, or leaking, which can lead to congestive heart failure. The mitral valve is typically repaired but also can be replaced by either a mechanical or tissue valve. The tricuspid valve is most often repaired rather than replaced.

What other heart surgeries can be performed using this approach? What about coronary artery bypass surgery?

An atrial septal defect – an opening between the heart’s upper chambers resulting from a birth defect – can also be repaired easily using a minimally invasive approach. Tumors or growths in the heart can be removed as well. Minimally invasive coronary artery bypass surgery, however, is still in the early stages of development and is not yet standardized.

Is minimally invasive heart valve surgery widely available?

Minimally invasive heart valve surgery is not as widely available as the traditional approaches. It requires special skills and experience to be able to work through such a small incision. I am pleased to be able to personally provide this revolutionary approach to our patients in the Dayton area. Over the past few years, I have developed the technique and the team approach necessary to perform this surgery safely and effectively. As a result, patients living in the greater Dayton area do not have to travel long distances to benefit from this advanced technology.

Have there been any other important advances in heart surgery?

Another important cardiovascular advance is the ability to repair aortic aneurysms with stents rather than open surgery. The aorta is a large, major artery that originates in the heart and branches to all organs and parts of the body, carrying oxygenated blood pumped from the heart. Over time and with advancing age, parts of the aorta can enlarge. As a consequence, the artery wall thins and may rupture, causing massive bleeding and sometimes sudden death.

How are aortic aneurysms treated?

Traditionally, a long, complicated major surgery is required. The incision is large, and the patient may be placed on a heart-lung machine. Recovery from this surgery often requires several days in the intensive care unit and a very long hospital stay. Complications can be serious.

How do you use a stent used to repair an aortic aneurysm?

We can access branches of the aorta through small incisions, usually in the groin area, and insert large stents that are threaded over wires and catheters of different shapes and sizes. The stent can be opened like an umbrella to completely cover the aneurysm, thus restoring the blood flow through the stent rather than through the potion of the artery weakened by the aneurysm. This procedure usually requires only a one or two days in the hospital. Patient recovery is much faster and less painful. Most aortic aneurysms can be repaired using this less-invasive technique.

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