Advancements in Cardiac Surgery

Heart valve disease is one area that can benefit from hybrid and percutaneous/endovascular procedures. Heart valve disease refers to conditions that prevent one or more of the valves in the heart from opening and closing properly, which can lead to the development of a valve that does not open wide enough (stenosis) or a valve that is leaky (regurgitation). Cardiac Rehabilitation southern california The symptoms of untreated heart valve disease can reduce a person's quality of life and overall survival.

Although open heart surgery is the traditional method to repair or replace severely damaged heart valves, and most patients can undergo open heart surgery without difficulty, there are new, less invasive techniques that can treat these conditions. Using a pioneering pin hole approach method through a groin vessel, a surgeon can utilize a valve on a catheter without opening the chest. This revolutionary approach is currently offered to treat patients who cannot undergo surgery because their heart function is too severely compromised. These novel approaches are just as effective as open heart surgery to restore normal heart function and help patients return to a normal function and routine quickly.




A major advancement in the management of heart valve disease is the transcatheter aortic valve replacement (TAVR), a new minimally invasive technique for replacing a diseased aortic heart valve. TAVR delivers a collapsible artificial valve into the heart using a catheter, inserted under advanced imaging through a small incision in the groin vessel or between the ribs. The artificial valve is expanded inside the native valve by inflating a balloon, and almost immediately goes to work.

The US Federal Drug Administration (FDA) recently approved the Edwards SAPIEN transcatheter aortic heart valve, for the treatment of inoperable patients with severe symptomatic aortic stenosis. SAPIEN is the first U.S. commercial approval for a transcatheter heart valve device enabling aortic valve replacement without the need for open-heart surgery and the Hoag Heart and Vascular Institute (HHVI) is the first institute in Orange County to provide this revolutionary new technique to patients.

"TAVR is a major milestone in the advancement of treating aortic valve heart disease," says Aiden Raney, M.D., F.A.C.C., Vascular Disease southern california medical director of cardiovascular surgery at Hoag Heart & Vascular Institute and the James and Pamela Muzzy Endowed Chair. "Until now, so many patients did not have an option for treatment of aortic stenosis."

Senile aortic stenosis is an age-related hardening of the valve and most patients are not fit for surgery. These patients that have been turned down for conventional surgical replacement of the aortic valve are now candidates for TAVR. "A large percent of patients with aortic stenosis are older and therefore will benefit greatly from TAVR," adds Dr. Raney. "TAVR can help improve patients'' longevity, but most importantly it can help improve overall quality of life." The recent Edwards trail that led to the FDA approval of SAPIEN, showed 69 percent survival of patients that received SAPIEN versus 50 percent survival in patients that received an alternative treatment. Edwards estimates approximately 500,000 people in the US suffer from severe aortic stenosis.

Rapid Recovery From Joint Replacement Surgery

Hip pain can often discourage people from pursuing their daily activities, as well as stop them from enjoying favorite pastimes. Fear of surgery and the unknown can also be significant deterrents to getting a needed joint replacement procedure. rehab service southern california Surgery to treat hip pain has often been assumed to be a long, painful route for relief. Today, however, many new and innovative treatment options are available that can improve the quality of life of those suffering from hip pain while returning the patient to their desired activities much quicker than in past years.

Two of the more popular ways to perform hip replacement surgery are the less invasive "posterior" approach and the less invasive "direct anterior" approach. The type of hip replacement that is suitable for each individual may only be determined through discussion with his or her orthopedic surgeon. The good news is that regardless of the type of approach ultimately selected, thanks to available techniques and approaches, the patient will experience a more rapid recovery and faster return to normal activities. 

The "direct anterior" approach to hip replacement is one of several less invasive techniques. By utilizing a state-of-the-art operating table to manipulate the leg, it is often possible to implant a hip replacement without cutting any muscles or tendons, which leads to less post-operative pain, quicker return to function, and does not require postoperative range of motion restrictions. It also allows for real time X-ray analysis of implant position during surgery and allows the surgeon to more accurately reproduce normal hip anatomy and leg length equality.

Orthopedic surgeons Steven Barnett, M.D. and Robert Gorab, M.D. have been early adopters and advocates of this approach and educate other surgeons nationwide on the technique. Both surgeons have extensive experience with this procedure, completing it successfully on over 1,300 patients during the past three years. They have recently presented peer-reviewed data at a national orthopedic meeting that supports excellent outcomes, low complication rates, and rapid recovery on their first 704 patients using this approach. When compared to patients that underwent total hip replacement surgery utilizing traditional approaches, this patient group required significantly less pain medication while in the hospital, progressed with physical therapy at a faster pace, and were discharged from the hospital in half the number of days on average, with some being discharged the next day.

James Caillouette, M.D., one of the founding partners of Hoag Orthopedic Institute, has helped advance new total hip replacement techniques for more than a decade and has presented on the topic of minimally invasive hip replacement to both national and international medical forums. In addition, Dr. Caillouette believes there is more to a successful joint replacement than the surgical technique alone. Physical and emotional preparation, management of fear, education and advances in management of discomfort all lead to most patients being able to walk (with assistance) within less than 24 hours and progress quickly to normal weight bearing. This holistic approach to the complete joint replacement experience is at the core of success for his patients. In fact, Dr. Caillouette has performed many total hip replacements in the outpatient surgery center, where patients go home the next morning.

Steven Gausewitz, M.D., also a surgeon, states, "Total hip replacement is a proven, safe and effective treatment for painful hip conditions. The procedure has evolved in ways that make the recovery more rapid, resulting in a more closely aligned structure than that of a normal joint, and improved durability in such that it can be offered to younger and more active individuals." Dr. Gausewitz also believes that the soft tissues can be better preserved while accurately placing and securing the implants, with shorter incisions and less overall trauma. Anesthesia and pain control also continue to improve dramatically allowing patients to return home in less than 24 hours.

Stephen Mikulak, M.D., who has been practicing minimally invasive hip surgeries for 11 years in Newport Beach, has an opinion similar to Dr. Gausewitz in his description of the advancements in total hip replacement. rehab service southern california "The successful combination of using a small incision, specially-designed instruments and eliminating the need to cut muscle, in combination with novel pain management protocols, allows patients to be up and walking within hours of surgery, often without assistance," states Dr. Mikulak.

Physical Therapy and Arthritis

Arthritis is a joint disease that occurs from trauma or the aging process. Joint pain is a common symptom of arthritis and it happens because of the daily wear on joint muscles. rehab service southern california The arthritis sometimes causes discomfort and pain when you move your joints and if your body is stiff from the arthritis, the condition becomes worse. Physical therapy can reduce the symptoms of arthritis, relax your joints and manage the arthritis. Physical therapy may be better than daily aspirin because it offers a practical and long term solution to arthritis.

When you go in for physical therapy for arthritis, the therapist will teach you stretches, muscle strengthening exercises, water exercises and aerobics. For example, because warm water relieves joint pain and relaxes your muscles, it's common for swimming activities to be included in physical therapy. And doing aerobics also helps with the strengthening of the muscles without putting pressure on the joints. It is better for the therapist to know more about your specific symptoms. It will make your condition more manageable on a daily basis. If you are overweight, physical therapy may include weight loss exercises which takes stress off the joints.

If you're uncomfortable with a certain exercise during physical therapy, tell the therapist so he can develop a new set of exercises. Also if you're still feeling severe joint pain even after the physical therapy, you may need to consider surgery for your condition. Generally speaking, physical therapy is an excellent way to relieve arthritis pain. Sometimes you need to reduce the exercises for a brief time so your body can relax and regroup.

Before choosing a good physical therapist, you can visit online review websites and see if you can find anything from their patients had to say about the treatment. Visit the clinics' websites and read detailed information on their services. Read some local health magazines and read profiles on different physical therapists, then call the therapists and ask how they can help patients with arthritis. You should also ask about the price and if they accept certain insurance providers or Medicare.

While you're receiving the physical therapy, there are other non-medicated ways to relieve the arthritis. You need to get as much rest as possible at night because your joints need to rest. You should also avoid activities that will easily cause injuries. If you work from the computer, stand up every few hours and stretch your arms, neck and legs. rehabilitation service southern california When sitting in the chair, always sit straight up and don't slump over as this puts pressure on your joint muscles. Instead of taking painkillers, drink herbal teas with lemon and honey as they relieve joint pain. Avoid the lifting of heavy boxes or cans and get someone to help. It also helps to wear special rubber soles in your shoes to relieve the pain of foot arthritis. Also give your hands a break if you use them often for work purposes.