Announcement: Division of Cardiac, Thoracic and Vascular Surgery

by Columbia Surgery on February 11, 2013

Within the NYP/Columbia Department of Surgery, more than two dozen departments and programs offer specialized care in breast surgery, colorectal surgery, pancreas surgery, and more.

The department is pleased to announce that three of its divisions – Cardiac Surgery, Thoracic Surgery, and Vascular Surgery – have united into an integrated Division of Cardiac, Thoracic, and Vascular Surgery. According to Deborah Schwarz, RPA, CIBE, Executive Director of the Office of External Affairs, the unification will facilitate integration of procedures, sharing of techniques, and cross-collaboration between the disciplines.

Emile Bacha, MD is the Chief of the newly combined division. Joshua Sonett, MD, remains the Thoracic Section Chief, and James F. McKinsey, MD, remains the Vascular Section Chief.

{ 7 comments… read them below or add one }

Stephanie February 12, 2013 at 7:47 am

can this treat pulmonary valve surgery without open-heart surgery someone who doesn’t have measurements within 18mm-21mm?

Columbia Surgery February 12, 2013 at 10:03 am

Thank you, Stephanie, for your inquiry.

Unfortunately, I am a bit confused with your question. Which procedure are you referring to? If you let me know, I can better direct your question.

stephanie February 12, 2013 at 3:53 pm

I have full repair of Tetralogy of Fallot s/p in 1991 by Dr. Quaegebeur however I will need to get my pulmonary valve replaced in the future.. The question is, Is Columbia coming up with transcatheter approach that allows patients who don’t measure up to this new transcatheter apporach. Is there another approach in mind besides getting open- heart surgery . Is Columbia remodeling the size of the original catateher?

Columbia Surgery February 13, 2013 at 2:13 pm

Thank you, Stephanie, for clarifying your question.

I am forwarding your question to Dr. Bacha who will be the best person to address your question. When I hear back from him, I will respond.

You may also contact his office directly at: 212-305-2688. More information about Dr. Bacha can be found by clicking on his profile below:
http://asp.cpmc.columbia.edu/facdb/profile_list.asp?uni=eb2704&DepAffil=Surgery

Columbia Surgery February 13, 2013 at 3:53 pm

Stephanie,

I have received the following response from Dr. Bacha.

If a conduit was not used, then the only option at this time and in the near future is to surgically implant a new pulmonary valve (open-heart surgery). This surgery uses the exact same incision and has a < 1% complication rate.

I hope you find this information helpful. Note the above is intended to be for informational purposes only, as we cannot give medical advice without a thorough patient exam and history. Please consult your physician before any medical course of action. Please let us know if there is anything else we can do.

Stephanie February 26, 2013 at 8:05 am

I found out I was replaced with a conduit oppose to a transannual patch so which could possibly make me a candidate for the transcatheter approach however I know the patient has to measure between 18 mm – 22 mm so the question is , will the transcatheter be remodeled anytime soon for patients who’s measurements are smaller than what the tool calls for ? Thanks

Columbia Surgery March 4, 2013 at 11:56 am

Stephanie,

I have received the following information from Dr. Vincent:

If a conduit/homograft was at least 16 mm in diameter when it was put into place between the right ventricle and pulmonary arteries then that person may be a candidate for a transcatheter pulmonary valve (put in via a large catheter from one of your femoral veins and without open heart surgery with bypass). There are many things that need to be considered however. First, the conduit/homograft that was received in 1991 (if it has never been replaced) has been in for about 22 years. Typically we hope they last 10-15 years at most. If it is very calcified and somewhat small (many shrink down by this time or it were outgrown it as the person is now adult size) then it is likely that the best option at this stage would be surgical replacement of the old conduit/homograft with a new bioprosthetic valve that is adult sized (23-29 mm in diameter). If it was fairly large when it was put in and is not really calcified or shrunk down and it’s not tight but leaks a lot, then the person may be a candidate for a transcatheter valve.

If we decide that a person “possibly” a candidate then we would take them to the cath lab and we have to take some pictures and measurements of the homograft/condiut as well as the pulmonary arteries, and coronary arteries. In some patients with TOF, they had a conduit/homograft placed because their coronary arteries were in an abnormal position. In these and other patients, the conduit/homograft may course right over an important coronary branch and a transcatheter valve cannot be placed as these valves are sewn onto metal stents that could compress a coronary that runs under the conduit/homograft when placing the valve. This all sounds a little complicated but it isn’t really. Columbia has been on the leading edge of transcatheter pulmonary valve placement since the initial FDA protocol started in 2007 and Dr. Vincent, the head of the Pediatric/Congenital Interventional Catheterization Laboratory, has gone around the country teaching other physicians when to use these transcatheter valves and how to perform the procedures. The valve that has been approved by the FDA is called the Medtronic Melody Valve. There is also another transcatheter valve that is still under FDA protocol. This is the Edwards Sapien transcatheter heart valve that is now being used in older high-risk adult patients for aortic valve disease. This valve has also been placed in the RV-PA position and there is an ongoing trial for this. It is bigger than the Melody valve so works in larger conduits/homografts.

I hope this is helpful information for you. If you have any more questions regarding this procedure you may contact Dr. Vincent’s office at 212 342-0610. More information about Dr. Vincent can also be found on her profile: http://nyp.org/physician/javincent/

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