FacebookTiaraThe trend toward smaller incisions and less invasive heart surgery is progressing yet again with the opening of a new trial at the Columbia Heart Valve Center. Following on the heels of TAVR, an important advance in the treatment of aortic valve disease, the Tiara trial is applying the same minimally invasive approach to mitral valve disease.

This early clinical trial is testing the viability of the Neovasc Tiara mitral valve system for patients with severe mitral regurgitation. If proven safe and effective, Tiara could become the first minimally invasive device in the U.S. for full replacement of the mitral valve.

In patients with mitral valve regurgitation, the flaps of the mitral valve fail to close properly, allowing blood to leak back into the heart instead of flowing through the body as it should. Mitral regurgitation affects approximately four million people in the U.S., but only about 20% are eligible for open surgery, leaving many patients without treatment options. Tiara could represent an important option for those with severe disease who require replacement of the mitral valve.

While repair of the mitral valve is sufficient for some patients, in others the valve is too diseased and replacement is needed instead. The Neovasc TMVR system device is designed to replace the mitral valve through a small incision in the chest while leaving all the surrounding tissues intact. Delivered through a catheter, the new valve pushes the diseased leaflets back and conforms to the shape of the mitral opening, fully replacing the function of the diseased valve.

The Heart Valve Center is one of only a few sites in the U.S. to evaluate the Tiara device, in addition to sites in Canada and Europe. The study’s Executive Committee includes Co-Chair Martin B. Leon, MD, Director of the Center for Interventional Vascular Therapy, and Michael A. Borger, MD, Director of the Aortic Surgery Program. To learn more, please call 212.342.0444.

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Gallbladder Surgery: What you need to know

by Columbia Surgery on February 23, 2015

FacebookGALLstones

 

Gallstones affect up to 1 in 10 people, making it the most common disease of the gallbladder and one of the most common problems leading to surgery overall. Surgery is performed not just to relieve immediate symptoms, but to also prevent ongoing attacks of gallstones and other complications.

Zachary Gleit, MD, Assistant Professor of Surgery at NewYork-Presbyterian/Columbia and Director of Surgery at the Allen Hospital, answers frequently asked questions about gallbladder surgery below.

 

What are gallstones?

Gallstones form when the chemical makeup of the bile becomes imbalanced, and bits of extra cholesterol or bilirubin, a substance in the bile, harden into small particles. Bile is a yellowish-green fluid produced by the liver and stored by the gall bladder, and which helps to digest fats.

Who gets gallstones?

Women, Hispanics, and Native Americans are at highest risk; other risk factors include obesity, diabetes, and higher estrogen levels (which may occur during pregnancy, while taking birth control pills, or hormone replacement therapy).

Are gallstones dangerous?

In addition to causing pain and gastrointestinal discomfort, gallstones are associated with a small but increased risk of gallbladder cancer. However there are a host of additional risks that are more pressing, including:

  • higher rates of complications from infection
  • formation of stones that block the ducts leading from the liver
  • pancreatitis (inflammation of the pancreas)

If gallstones have caused pancreatitis, patients have a high risk of recurrent pancreatitis (30% within 6 weeks) if the gallbladder is not removed promptly after the pancreatitis attack.

Because of these risks, patients are almost always advised to undergo gallbladder removal once they start having symptoms related to their gallstones.

I have gallstones. Must I have my gallbladder removed?

While medication and lifestyle changes might be an important part of the treatment plan (see below), if the gallbladder is not removed, the risk of recurrent attacks is high enough that surgery is actually considered to be a preventive measure.  Gallstones do not pass through the body like kidney stones do. Rather, every time fat is consumed, the gallbladder contracts and causes pain and other symptoms.

The most common and safest approach is to surgically remove the gallbladder through a procedure called laparoscopic cholecystectomy.

How safe is gallbladder surgery?

Removal of the gallbladder is among the most common operations performed every day, both across the country and by the Division of General Surgery. Our surgeons use a minimally invasive, laparoscopic approach through four very small incisions; most patients are able to return home the same day and return to work after one week. Removal of the gallbladder is considered extremely safe, as complication rates are less than 2%.

Can I take medicine to dissolve my gallstones instead of surgery?

Medicines to dissolve cholesterol gallstones include ursodiol (Actigall) and chenodiol (Chenix). These are not considered a first-line approach to treatment because it takes months or years of taking the medication to dissolve the stones if it works — but it works in only about half of patients, and stones return if the patient stops taking the medication.  These medications may be considered if a patient is unable to undergo surgery due to other medical conditions.

Can I prevent gallstones by losing weight or avoiding fatty foods?

Obesity can increase cholesterol levels and prevent the gallbladder from emptying completely.  Preventing gallstones is just one of the many benefits achieved by eating a low-fat diet and maintaining a healthy weight. However, the nature of the disease is such that once symptoms start, most people will continue to have more. Losing weight and avoiding fatty foods may possibly help reduce the severity or frequency of attacks, but will not reverse the overall trend towards forming more stones. Ironically, patients who undergo extremely rapid weight loss (such as after bariatric surgery) are at a higher risk of developing gallstones and may be prescribed ursodiol as a preventive measure.

 

For more information, please visit http://columbiasurgery.org/general/ or call us at 212.304.7810.  We have convenient locations in Washington Heights and Inwood in Upper Manhattan, Midtown, and Bronxville (Westchester County).

 

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Beyond More Organ Donations: How to Meet the Transplantation Needs of the 21st Century

February 14, 2015

Tweet Did you know that February 14th has significance beyond jewelry, chocolate, roses, and romance? This day is also celebrated as National Organ Donor Day by those whose lives have been touched by organ transplantation. While most of us would like to believe we would receive a life-saving transplant if it were needed, the unfortunate […]

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February Story of Hope: Love & The Pancreas Center Support Group

February 11, 2015

Tweet     A diagnosis of pancreatic cancer can make one feel alone. The very gravity of the disease bears a tremendous emotional burden, while the actual disease can wear one down physically. It’s common for patients to be aware of how or what can be done for the treatment of the disease, whether it’s […]

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Go Nuts! Advice on preventing heart disease in women, from Columbia’s heart surgeons

February 6, 2015

Tweet   You may see a lot of women wearing red Friday, February 6th, to mark “Wear Red” Day. We support this – go ahead and wear read, even if it’s not your color! Because heart disease is the number 1 killer of women. That’s right – one in three women die of heart disease […]

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Thyroid Nodules Explained

January 30, 2015

Tweet Dr. Jennifer Kuo, Director of the Biopsy Clinic at Columbia University Medical Center explains thyroid nodules and the minimally invasive procedure to determine if they are cancerous. For more information, please visit: columbiathyroidcenter.org

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NewYork-Presbyterian Recognized for Reducing its Environmental Footprint

January 26, 2015

Tweet On Behalf of Public Affairs:  NewYork-Presbyterian is one of a select few hospitals in the country to be honored by The American Society for Healthcare Engineering (ASHE) for reducing its energy consumption NewYork-Presbyterian is one of a select few hospitals in the country to be honored by The American Society for Healthcare Engineering (ASHE) […]

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Towards a Vision of Humanity: Cancer Treatment for All

January 19, 2015

Tweet “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”  These words were spoken by Dr. Martin Luther King, Jr. in a speech to the Medical Community of Human Rights in Chicago a half century ago. Even then, while Dr. King risked his life to secure basic civil […]

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2014: A Year in Review

December 26, 2014

Tweet Using 3D printing technology to repair a baby’s heart, discovering new ways to preserve livers for transplantation, helping chemotherapy drugs find their way to treat pancreatic cancer, and performing surgery with robots through pinhole incisions are just some of the breakthroughs that stood out during 2014 at Columbia University Department of Surgery. Some of […]

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PHOTOS: Pancreatic Cancer Awareness Day, 2014

November 24, 2014

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