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Vital Signs with Dr. Sanjay Gupta
Technological Advancements in Heart Surgery Examined. Aired 2:30-3p ET
Aired June 25, 2016 - 14:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
[14:30:49] DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: It's the hardest working muscle in the body, beating on average 100,000 times per day. We're talking about the heart. This is "Vital Signs." I'm Dr. Sanjay Gupta.
The right side of the heart pumps blood to your lungs while the left side pumps it back to your body. It's the critical center of life in our bodies, but it's also vulnerable to disease. In the United States, the American Heart Association says heart disease impacts someone every 42 seconds. In the Middle East, it's the leading cause of death. That's why the focus on treating patients with heart disease is top priority. For surgeons in Abu Dhabi, a robot is lending a helping hand.
Dr. Rakesh Suri dedicates much of his life to treating the human heart.
DR. RAKESH SURI, CHIEF OF CARDIOVASCULAR SURGERY, CLEVELAND CLINIC, ABU DHABI: I knew I wanted to be a heart surgeon because in heart surgery we seek excellence every day, and we're always pushing ourselves to advance the field of heart disease and heart care and heart surgery.
GUPTA: Dr. Suri is the chief of cardiovascular surgery at the Cleveland clinic in Abu Dhabi a region where heart health is an increasing concern. Cardiovascular disease accounts for 30 percent of deaths in the UAE and 45 percent of deaths in the overall Gulf region.
SURI: We're seeing exactly the same types of diseases we would see in the western world. We're seeing coronary artery disease, heart valve disease, and heart muscle disease in roughly the same proportions. So when people assume that heart conditions are different here, that's probably not as true as we once imagined that to be. What is different here is that there's a tremendous under-diagnosis of heart disease.
GUPTA: Undiagnosed heart disease can lead to major complications requiring some patients to undergo invasive treatments, like open heart surgery.
SURI: To access the heart, we need to divide the sternal bone in order for our eyes to see the structures on the heart and place our hands to fix it with a needle and thread and various devices that we sew on the heart. GUPTA: But surgeons like Dr. Suri are increasingly relying on robotic
technology to change the way certain heart operations are performed. The team at the Cleveland Clinic agreed to give us a demonstration of the innovative equipment and techniques they use to perform closed chest heart surgeries.
SURI: The unique thing about minimally invasive and finally robotic surge are is we're now able to accomplish these exact same things to deliver the most sophisticated therapies without ever looking at the heart itself because we utilized 10 times high definition magnification, or without ever touching the heart because we utilize small instruments that have risk-light functions that slide between the ribs, having never to cut a rib, break a bone or -- or server a muscle.
GUPTA: With robotically assisted heart surgery, again sometimes caused closed chest surgery, three small incisions are made in spaces between the ribs. Surgical instruments and a camera are placed through those incisions, allowing the surgeon to control the instruments using a computer consol.
SURI: Many people assume the robot is an autonomous, self-thinking being. That's simply not true. The robot is merely an extension of the surgeon's eyes, hands, and arms, but with one significant difference. It's much easier to be able to climb inside of the heart, in virtual reality 10 times high definition magnification. We're able to now repair those intricate structures of the human heart in ways that we were unable to before. And it's this saving of vital structures that allows patients to walk, essentially, to their rooms the night of surgery and walk out of hospital three days later returning back to their normal lives. It's really a miraculous evolution in medicine.
[14:05:00] GUPTA: But these technological advancements aren't one size fits all. Patients have to undergo diagnostic tests to determine if they're eligible for the operation. Surgeons have to be properly robotic equipment. And the $2 million price tag for the robotic technology could mean increased costs for procedures and limited accessibility for hospitals. For Dr. Suri and his team at the Cleveland Clinic, these robotic surgical tools aren't just advancements for the future of medicine. There a way to make their patients healthier faster.
SURI: When I see patients they simply can't believe we're able to repair their own broken heart valve right here in Abu Dhabi, and that this means they'll be able to enjoy many more years of life with they're friends, their families, and their community, avoiding heart failure and living longer.
GUPTA: In the United States, someone's name is added to the National Organ Transplant waiting list every 10 minutes. That amounts to more than 120,000 men, women, and children in need of a life-saving transplant. And when a match does finally become available, it can sometimes be all the way across the country. For heart transplants, the usual way of transporting the organ is on
ice, in a cooler, similar to the one you take on a picnic. Since the first heart transplant in the late 1960s, technology has come a long way, and now it might be catching up to organ preservation by keeping hearts alive outside the human body in a machine designed to function just like we do.
This is the Cornish coastline in England. And 27-year-old Lee Hall lives here with his wife and young son. Surrounded by this beautiful landscape, he doesn't get out to enjoy it much, at least not yet. Lee has spent much of his life in hospitals.
LEE HALL: My lifestyle was OK until I was around two-years-old and was diagnosed with leukemia, which went on for quite a long time, and luckily I pulled through. By the time I was 14 I had an echo done on my heart, and came out that I had a problem with my heart then.
[14:10:16] GUPTA: The walls of Lee's heart were too thin and his art was failing. It had to work even harder to pump blood through his body. Doctors at the Harefield Hospital in London implanted a mechanical pump. But these devices are not typically long-term solutions. Lee would need a new heart.
DR. ANDRE SIMON, DIRECTOR OF TRANSPLANTATION HAREFIELD HOSPITAL: He was on the urgent waiting list for a heart transplant.
GUPTA: Dr. Andre Simon is the director of transplantation at the Harefield Hospital. In the United Kingdom, the biggest issue is a shortage of suitable donor hearts and an aging population.
SIMON: The current situation in the United Kingdom is that we have only very, very few hearts. And you're only transplanted when you're on the urgent waiting list. No one really gets a heart who is on the normal waiting list unless you're very small or have a specific blood group.
GUPTA: There's been a lot of focus on helping transplants succeed after they are complete. For instance, getting the immune system to accept the donor unit instead of attacking about. But what about before all that? What about the way the heart is preserved before it even reaches the recipient.
WALEED HASSANEIN, CEO, TRANSMEDICS: The heart in many cultures and in parts of the world is really perceived at the most important organ that keeps every part of the body alive.
GUPTA: Waleed Hassanein began his career as a heart surgeon. As a junior resident, he went on an organ-retrieval, getting a donor heart for transplant from another hospital. Walled was in charge of a cooler, and that's when he realized just how rudimentary the transportation of this vital organ can be.
HASSANEIN: It really upset me that at the time to become a cardiac surgeon, still to today, you need to spend 10 to 11 to 12 years in training. And I looked at this and I said from a selfish standpoint that I'm going to spend 12 years of my life learning how to you to protect this organ, but when it comes to heart transplantation, which is the pinnacle of cardiac surgery, the heart is just going to be thrown in his Igloo box.
GUPTA: Waleed left medicine to start a company called TransMedics. The aim, change the way organs are preserved and delivered for transplant. The traditional way is called storage, flushing the heart with a solution that drops its core temperature and putting it in a cooler on ice. This method can have limitations due to organ decay, time, and distance of retrieval.
HASSANEIN: We're losing a lot of organs because of that time and distance limitation. This is why there are a lot of organs that go unutilized. In fact, we're only utilizing two off three out of every 10 organs every year.
GUPTA: To improve that, TransMedics developed a device called the Organ Care System. The machine is designed to replicate our human functions as closely as possible by keeping the organs alive outside the body. This is video of a heart transplant from the University of Washington in Seattle, one of seven hospitals in the United States participating in a clinical trial of the organ care system. Now, we want to warn you, the beating heart in the device may be graphic for some viewers. Unlike the cold storage in a cooler, this heart is still warm. It's beating, and it's being fed oxygenated blood and nutrients. All the while, the organs vitals are monitored.
HASSANEIN: In the early days it was really a paradigm shift. But as the technology evolved, as we gained experience, as we generate evidence, the obviously resistance becomes lower and lower.
GUPTA: The organ care system is still experimental in the United States, but it's always approved for use in other countries like Australia and the United Kingdom. In the U.K., Harefield Hospital now uses it for all their heart transplants, including the one for Lee Hall. Last summer, Lee received a heart transplant. Dr. Simon was his surgeon.
SIMON: I think we will see a significant change in technique and technology. The last step thank you we've taken is we have now taken hearts from donors who have died from heart arrest. We now have been able to take those hearts and restart them outside of the body in that system. So that's another revolutionary step.
GUPTA: With cold storage, the heart is ideally transplanted in under four hours. It has a low tolerance to the cold because it has to function immediately upon transplantation. In the Organ Care System, the time window has tripled, which has led to an increase in viable donor hearts.
SIMON: The time, again, between stopping the heart in the donor and starting the heart in the recipients, we have up to 12 hours now.
[14:45:04] GUPTA: For Lee Hall, it's a second chance. Less than a year after his transplant, he is still not 100 percent and has frequent checkups at Harefield. But he went from being on borrowed time to making long-term plans with his son. HALL: It did feel weird at first, you know, someone's passed away and
given something to me to stay alive, but without their passing I wouldn't be here now. So I thank them for changing my life.
GUPTA: In the world of pediatric cardiology there's a saying - babies' hearts are like snowflakes. No two are exactly the same. That means imaging is especially important before surgery. Traditional imaging like CT's and MRIs, they've offered more of a two dimensional look. But now 3D printer are bringing those images to life, enabling surgeons to hold these hearts in their hands before setting foot in an operating room.
It's time for dance class at Spotlight Academy in Miami, Florida.
UNIDENTIFIED FEMALE: Very good, Molly. One more.
GUPTA: These young girls are tumbling across the room.
UNIDENTIFIED FEMALE: Push all the way over. There we go.
GUPTA: And right in the middle of it all is five-year-old Mia Gonzalez
UNIDENTIFIED FEMALE: There we go.
KATHERINE GONZALEZ, MIA'S MOTHER: Mia is like a ray of sunshine. She's a happy girl. Everybody that meets her loves her. She's very active. She loves playing sports. She's girly and a tomboy at the same time.
GUPTA: But for Mia, that wasn't always the case. In fact, right from the start Mia's mother Katherine knew something wasn't quite right with her little girl.
[14:50:00] GONZALEZ: From the second Mia was born she basically had like a strider noise, just sounded like a gurgling noise when she was born. And I noticed it right away. I asked the doctors. They thought maybe some type of amniotic fluids that she had in her lungs. So they said it would go away eventually. But as weeks went by it continued.
GUPTA: For the first four years of her life, Mia was hospitalized 10 different times for at least a week each time. Her little girl kept getting sick, but no one had answers for Mia's family. Doctors thought her breathing issues were from asthma.
GONZALEZ: It was just, really just torturing. From the time she was three months old she was just always sick with one thing or the next. And everywhere we went, either they couldn't find something, or they thought she had something which she really didn't have. She just kept being misdiagnosed.
GUPTA: Doctors prescribed asthma medication, but it wasn't working. Asthma treatments target inflammation of the airwaves from the inside, but Mia's trachea wasn't inflamed. Her aorta was wrapped around it, and as she grew, the pressure tightened on her windpipe. Essentially she was being choked by her own body. It's a rare congenital anomaly of her aortic arch.
GONZALEZ: It was bittersweet. It was scary because when you realize it's something to do with the heart, it's always, of course, very scary. But at the same time, we're like, we finally know what's wrong.
GUPTA: Doctors at Nicklaus Children's Hospital in Miami had solved Mia's mystery, but it meant heart surgery would be required as soon as possible. Dr. Redman Burke is the chief of pediatric cardiac surgery at Nicklaus.
DR. REDMAN BURKE, DIRECTOR OF CARDIOVASCULAR SURGERY, NICKLAUS CHILDREN'S HOSPITAL: What frequently happens to us is patients will be sent to us who are deemed inoperable. And that's a terrible word for a parent to hear. That means they're going to lose their child because no one thinks that anything can be done for them. And we don't want people to feel that hopelessness.
GUPTA: Dr. Burke has always been fascinated with technology. He'd been keeping an eye on 3D printers. Instead of printing ink, they print using plastic that can harden into three dimensional shapes. As the technology improved, he decided to get one for the hospital. Dr. Juan Carlo Muniz runs the cardiac imaging center here where you will find the hospital's 3D printer.
DR. JUAN CARLOS MUNIZ, DIRECTOR OF CARDIAC MRI IMAGING, NICKLAUS CHILDREN'S HOSPITAL: The imaging that we use to figure out the structure of these hearts are all two dimensional techniques. So having the technology that actually lets you hold one of these hearts in your hands or an exact replica of it and really get that three- dimensional tactile feel to it is really a great method of communication.
GUPTA: Hospitals around the United States are starting to use 3D printers for everything, from prosthetics to splints. Mia's heart was only the second model printed here. Being educated about the procedure before operating was important for the surgeons, and also for Mia's family.
GONZALEZ: Remember, four-and-a-half years of thinking she had asthma to one day to the next, she needs heart surgery. So we were freaking out a little bit, and we asked to speak to Dr. Burke. He showed us a picture of the heart and talked about the 3D modeling.
BURKE: So this is Mia's heart, and particularly this is Mia's aorta. So all of us have an aorta that comes out of our heart, carries blood to every part of our body. Now, most of us have one main arch. Mia has two.
GUPTA: There are challenges with the system, like the material used to make the model. It's a hard, brittle plastic that can easily break and obviously feels differ than a real human heart. It's also critical that the images used to build the model of clear for accuracy. The lives of young patients depend on it.
MUNIZ: We work together as a team to make sure that these images are as accurate as possible, because if there are errors in the model that don't necessarily reflect exactly what the anatomy of the heart is, then that could lead us down the wrong path.
GUPTA: In Mia's case, Dr. Burke knew exactly what he wanted to do before he operated on her. The operation was a success and the pressure on Mia's trachea was alleviated. For the first time her life she could breathe normally.
GONZALEZ: It literally brought tears to my eyes to see how it actually alleviated here, to actually see what was there before is not there now and her trachea is now like a normal person.
GUPTA: Dr. Burke estimates his team made 40 heart models so far. Without the model of Mia's heart before surgery, he says there may have been a different outcome.
BURKE: I know that in Mia's case I was able to make a much smaller incision because I had total confidence I could go into her left chest, find the part of her aorta that needed to be divided and not dissect her whole heart. I already had her whole heart in my hand.
[14:55:05] So inside her chest I could leave all the other tissues untouched and go to the exact spot that needed to the divided, and I could divide it with confidence and safety and know that I wasn't going to hurt her, because if you divide the wrong part of her aorta, which could easily happen, you change her life. You create a problem. You don't solve the problem. So for Mia, it might he been the difference between a very good outcome and a terribly bad outcome.
GUPTA: Dr. Burke says his less invasive approach also cut down on Mia's recovery time and pain. Just three weeks after her open heart surgery she performed in a dance recital, and today a common cold no longer means a visit to the hospital.
GONZALEZ: It's been drastically different since the surgery. We don't have to worry. Even when she had her surgery in May and she still remembers everything, and if you ask her who Dr. Burke is, she'll say he fixed my heart.
UNIDENTIFIED FEMALE: Ready?
UNIDENTIFIED FEMALE: Yes.
GUPTA: Technology continues to evolve and improve, but heart health starts with each of us and the choices we make. Proper nutrition and exercise will help combat issues like obesity, diabetes, high cholesterol, all risk factors for cardiovascular disease. So take care of your heart, and it will take care of you.
For "Vital Signs," I'm Dr. Sanjay Gupta.