The treatment of heart disease has been rapidly evolving over the past five to 10 years. There has been a plethora of innovation among current technologies with new devices and techniques that allow for more rapid recovery, less invasive procedures and treatment of patients who previously never had an option due to their age or frailty.

Let’s consider two major types of heart surgery: those that require a heart-lung bypass machine, and those that do not.

Procedures that require a heart-lung machine — considered conventional open-heart surgery, where the heart is usually stopped and the machine maintains blood flow to the body — have continued to become safer over time. The machines now have extra filters, checks and monitors to ensure a safe operation.

There have been great efforts to reduce blood loss and, as a result, fewer patients need blood transfusions after open-heart surgery. Even the solutions that are used to stop the heart have evolved in the past few years to make it safer and much more likely that the heart will return to its full function after surgery. More and more operations are done using a minimally invasive approach without cutting the breastbone and can be done with the use of small incisions and a small camera.

There have been great advances in the use of percutaneous (through the skin) approaches that do not use the heart-lung machine. These technologies first started with replacing the aortic valve and have now become the gold standard over open-heart heart surgery for this particular disease. In fact, most valve procedures are performed through a needle stick in the groin — something that was unfathomable more than 10 years ago. As technology has evolved, there are many new devices and techniques that can fix other valves that could not be treated before, like the mitral and tricuspid valves. UVa Health is one of only a handful of places in the country that can offer these cutting-edge valve procedures through clinical trials.

The most advanced heart disease results in severe heart failure, where the heart cannot provide adequate blood and oxygen to vital organs. The number of patients with this serious condition continues to rise. Patients in this critical stage require heart transplantation. However, since donated organs remain in short supply, researchers have worked to expand the supply of hearts available for transplant and develop alternate treatments for heart failure.

For example, if a potential donor heart is too weak to be transplanted into a heart failure patient, it is not used. Now, a donor heart can be removed and put on a special machine to see if the heart improves enough to be usable for transplant in a heart failure patient. This can dramatically increase the number of organs available.

In addition, there have been advances in the insertion of permanent pumps implanted in the heart called LVADs (left ventricular assist devices). The newest LVADs, which were investigated at major centers across the U.S. — including at UVa — are safer than ever, with low stroke and bleeding rates. This is an exciting time in heart surgery, with many more options to help patients regain a good quality of life and live longer.

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Dr. Gorav Ailawadi is chief of cardiac surgery at the University of Virginia Health System.

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