In BriefA Vancouver surgeon has pioneered the 3M, or "multidisciplinary, multimodality, but minimalist" approach to replacing the heart's aortic valve. The surgery requires only 45 minutes and has a recovery time of mere days.
A New Type of Heart Surgery
Dr. David Wood’s patients tend to have a rather unusual schedule the week that they see him: wake up; drive to the hospital; have heart surgery; head home a few hours later; go back to work the next day.
This rapid recovery is possible thanks to a minimally invasive heart surgery technique, which Wood, a Vancouver cardiologist, has been pioneering for the treatment of aortic heart valve disease. The procedure, called 3M transcatheter aortic valve replacement, has successfully been performed on 411 patients in Canada and the US. It’s so minimally invasive that Wood assures it will “blow people’s minds.”
“You had no breathing tube, no catheter in your bladder, you could return to work the next day, you could be driving the next day. These are things that I think the average person can’t believe are feasible in 2017,” Wood said in an interview with The Canadian Globe and Mail.
All of Wood’s patients are awake for this procedure, which lasts only 45 minutes, and all were able to get back on their feet within a few hours. Eighty percent of patients went home the next day.
The procedure, which Wood presented at the Transcatheter Cardiovascular Therapeutics conference in Denver, is dubbed 3M for its “multidisciplinary, multimodality, but minimalist” approach.
The 3M procedure joins a growing trend of technologically-assisted, minimally-invasive techniques changing the way doctors perform surgery. Robots are now carrying out rapid brain surgery and minimally invasive eye surgery, and hospitals are using virtual reality to train surgeons. In the future, brain implants may be a common tool in treating mental health and driving our species’ evolution.
Minimally Invasive Medicine
Open heart surgery has traditionally required general anesthetic, which places the patient in a medically induced coma and requires them to be connected to a ventilator to keep them breathing. Doctors then cut open the sternum (the bone connecting the ribcage) and spend between three to four hours working on the heart.
In surgery for aortic heart valve disease, a damaged aortic valve—which pumps oxygenated blood from the heart out to the body—is usually replaced with a mechanical valve or donated tissue. Patients who receive the traditional form of this surgery usually require several weeks of recovery.
Circumventing this long ordeal, in Wood’s technique, the surgeon places a tube the width of a pinkie finger into the patient’s leg. They then move a balloon through the tube and into the heart valve to expand it, followed by instruments to install the new valve.
“By doing less, actually the patients did better,” Wood added about the surgery.
One of the study’s participants, Max Morton of British Columbia, had the procedure at age 79 in the emergency room of Vancouver General Hospital, a decade after he had open heart surgery.
“Within 24 hours I thought, well, this is nice. It was such an amazing experience being awake for the whole thing,” Morton said to the Globe and Mail. He reported that five days later he was able to go fishing.