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Cardiothoracic Surgery

Program Update: Cardiothoracic Surgery / Cardiac Surgery

Cardiac Surgery

12/21/2007

The UCLA Division of Cardiothoracic Surgery is among the nation’s leaders in providing care for a wide range of heart and lung disorders. With a depth and breadth of experience that are difficult to match, and offering a full spectrum of treatment options, UCLA surgeons achieve top outcomes in cases ranging from the relatively routine to the unusually complex. The division’s pioneering work often defines the frontier of medical science, and UCLA’s patients reap the most direct benefit of the leading-edge tools, technology and vast experience available within the Division of Cardiothoracic Surgery.

As a leading center of patient care and treatment innovation, UCLA can often give patients access to therapies available at only a handful of top centers. UCLA is constantly conducting clinical studies — both in areas of surgical technique and medical management for postoperative care — that bring the latest innovations to its patients.

Mitral and Aortic Valve Surgery

UCLA surgeons have accumulated knowledge, judgment and technical refinements that contribute significantly to their success in cardiac valve surgery, particularly in the use of minimally invasive techniques. Minimally invasive cardiac valve repair and replacement procedures produce less trauma to the patient, resulting in shorter hospital stays, reduced wound complications and better cosmetic results than traditional open surgery. The amount of time it takes these patients to recover sufficiently to pursue their normal activities — the time of disability — is cut in half from four to six weeks down to two to three weeks.

Surgeons can both repair and replace mitral valves using minimally invasive techniques. At UCLA, surgeons aggressively favor repairing mitral valves when possible. Repair surgery avoids the risk of infection from a prosthetic valve and eliminates the need for blood-thinning medications. When compared to replacement surgery, repair surgery may yield better heart function and lead to better postoperative quality of life.

Mitral valve repair can be done through even smaller incisions with robotically assisted surgery. The surgeon works at a nearby console with sensors attached to his or her fingers that direct the motion and actions of the surgical instruments. Unlike open surgery and even conventional minimally invasive procedures, robotic surgery does not rely on direct visualization of the surgical site. Instead, cameras are used to generate three-dimensional views of the inside of the patient's heart at magnification levels of 10 to 15 times their actual size. Because there is no need to create a direct visual field, incisions can be twothirds to one-half the size of those used in conventional minimally invasive procedures and surgeons need not spread the ribs as far.

Arrhythmias

UCLA is a leading center for the treatment of all types of arrhythmia. Atrial fibrillation, a common arrhythmia originating in the upper chambers of the heart, affects over 2.5 million Americans, increasing their risk for stroke and premature death and impacting their quality of life. The UCLA Center for the Advanced Treatment of Atrial Fibrillation offers the latest treatments and takes advantage of the newest technological innovations. Patients are evaluated by cardiologists and cardiac surgeons with advanced expertise in the latest medical therapies, interventional radiology and minimally invasive surgery. In many cases, atrial fibrillation can be cured with atrial tissue ablation.

Hypertrophic Cardiomyopathy

UCLA’s multidisciplinary team of cardiologists and cardiac surgeons evaluates hypertrophic cardiomyopathy patients and individualizes their care. In this serious cardiac disease, which often runs in families, blood moving from the left ventricle to the aorta is blocked by excessive thickening of the heart muscle. This obstruction can lead to atrial fibrillation, cardiac enlargement and hypertrophy, mitral valve regurgitation and congestive heart failure. Appropriate use of medical management, muscle ablation and myomectomy are vital to alleviating symptoms and improving survival.

Chronic Pulmonary Embolism

UCLA offers expert evaluation and treatment of chronic pulmonary embolism, a condition that can lead to pulmonary hypertension and right ventricular dysfunction. In appropriate cases, the multidisciplinary team of pulmonary medicine specialists and cardiac surgeons can recommend pulmonary thromboendarterectomy, a surgical procedure that cures pulmonary embolism by removing the thrombus obstructing the pulmonary artery.

Heart Transplantation

UCLA runs one of the largest and most successful heart-transplant programs in the U.S. Performing more than 100 transplants per year for several years running, with results that continue to surpass the national average, UCLA surgeons have exceptional experience in the procedure. Its expertise and technical proficiency allow the UCLA heart-transplant team to accept both recipients and donated organs that may be refused at other centers. UCLA is a leader in accepting patients who might not be eligible for heart transplantation at other centers due to comorbidities or advanced age, and in surgically correcting the donor heart to make it a more viable organ for transplantation. Because of its more broadly accepting standard for donor organs, and the fact that it is willing to work with organs harvested anywhere in the country, UCLA is able to match patients with new hearts more quickly than many other centers. UCLA maintains a very active clinical-research program that brings its patients the very latest therapies while advancing the body of scientific knowledge to benefit all patients.

Ventricular Assist Devices

UCLA is a leader in the use of ventricular assist devices both as a bridge to heart transplantation and as a destination therapy for patients who are not candidates for transplantation. UCLA surgeons are experienced in the use of a number of currently approved devices, and are also able to offer patients access to the very latest technology through enrollment in one of a number of ongoing clinical trials of investigational ventricular assist devices. UCLA’s success rate in using ventricular assist devices as an effective bridge to heart transplantation is among the best in the country. The newest devices, which are smaller in size and can be implanted with less morbidity, are available at UCLA.

Other Therapies for End-stage Heart Disease

In addition to offering repair procedures for faulty heart valves, UCLA surgeons perform a number of other advanced procedures for treating endstage heart disease. The division treats high-risk bypass graft patients who have previously undergone open-heart surgery and bypass grafting, who have evidence of blockage in their blood vessels, or have been refused bypass grafting at other centers. UCLA’s highly experienced team carefully evaluates candidates and can offer selected patients a better quality of life, as well as possibly improved survival. The availability of ventricular assist devices for use in cases where bypass surgery is unsuccessful is critical to UCLA’s ability to proceed with many high-risk bypass cases.

Transmyocardial laser revascularization (TMLR) is often effective in patients with intractable angina requiring revascularization. The procedure may be suitable for patients who are either not candidates for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) or in conjunction with CABG.

The left ventricle can be remodeled by removing scar and surgically restoring the shape, size and function. This procedure is often effective in patients with severe damage to the heart after a myocardial infarction.

Further out on the horizon of potential experimental treatments are cellular therapies that aim to repair damaged hearts using either skeletal muscle cells, stem cells or advanced techniques of gene therapy.

Aortic Diseases

As a recognized Center of Excellence specializing in complex, high-risk procedures, UCLA Aortic Center has assembled a skilled and experienced team that is available any time they are needed to evaluate difficult cases, determine the best course of action, and carry out treatment rapidly and expertly. In cases of aortic disease, including aortic aneurysm and aortic dissection, this ability is critically important due to the risk of an aortic rupture.

But the ability to diagnose aortic aneurysms prior to a rupture offers patients even better outcomes. Modern imaging technologies at UCLA facilitate accurate diagnosis and permit surgical repair before the patient’s condition becomes a crisis. In elective repair procedures, stent grafts can be deployed via catheter from the femoral or iliac arteries and minimally invasive techniques can be used to directly access the aorta and aortic valve through small incisions in the chest.

Pediatric Cardiothoracic Surgery

Since its inception, the UCLA Pediatric Cardiothoracic Surgery Program has provided leading-edge care for children with congenital heart disease. Always offering the latest medical and surgical treatments available, UCLA physicians and research scientists are among those developing new therapies and expanding the boundaries of care. The extensive experience accrued by surgeons and staff help produce results that only a very few elite programs can match.

Pediatric cardiac surgeons perform neonatal heart surgery to correct a wide range of heart defects, often within the first week of life. Innovative techniques developed by UCLA surgeons have often elevated the national standards of care. For example, aortic-valve-repair techniques pioneered at UCLA, in many cases reconstructing the patient’s native valve using the pericardium, have proven to be superior in many ways to valve replacement.

UCLA, a regional referral center in the southwestern United States for pediatric cardiothoracic surgery, has the largest pediatric heart-transplant program in the country. UCLA surgeons perform more than 25 pediatric heart transplants per year among a total of several hundred pediatric heart operations. Because it is such a busy transplant center, UCLA is also very active in mechanical support for pediatric patients who may be candidates for heart transplantation. This includes ECMO (extracorporeal mechanical oxygenation) and ventricular assist devices.

The division also includes a very active Adult Congenital Heart Surgery Program. Serving a growing population of adult patients who have already undergone operations in childhood for congenital heart conditions, the program offers surgical procedures to improve the function of prior repairs. Program surgeons also treat congenital conditions in adults who have not had previous surgical treatment.

Lung Transplantation

UCLA’s lung-transplant program has grown five-fold in the last six years. As with heart transplantation, UCLA is a leader in accepting patients who might not be eligible for lung transplantation at other centers due to comorbidities or advanced age. At UCLA, older patients and those with comorbidities have been successfully treated with lung transplantation. UCLA is also aggressive in accepting donated organs that are less than ideal, which can result in substantially reduced waiting time for a donated organ. UCLA’s successes with these organs show that they can be used safely and effectively.

UCLA offers a variety of other therapies, both medical and surgical, for patients with end-stage lung diseases. For example, UCLA is one of only three centers on the West Coast approved by Medicare to perform lung-volume-reduction surgery for patients with end-stage emphysema. UCLA also offers therapies for patients with pulmonary hypertension and patients with interstitial lung disease.

Multidisciplinary Support

The UCLA Division of Cardiothoracic Surgery works in collaboration with other UCLA services to provide the most comprehensive care possible for its patients. Surgeons work closely with adult and pediatric cardiologists to develop a management strategy uniquely suited to each patient.

The division also has the support of a state-of-the-art cardiac catheterization laboratory. Performing both diagnostic catheterizations and a full range of catheter-based interventional therapies for adults and children, the catheterization laboratory offers such treatments as dilatation and stenting of narrowed blood vessels, and device closures of atrial septal defects and patent ductus arteriosus. When appropriate, hybrid procedures are performed by surgeons and interventionalists working collaboratively to obtain high-quality results with reduced risk and morbidity.

  

UCLA Cardiothoracic Surgery Milestones

1952 Pulmonary-artery banding for the surgical treatment of congenital heart disease was first reported at UCLA Medical Center.

1956 The first open-heart surgery in the western United States was performed at UCLA Medical Center.

1962 A single-patch technique for the surgical treatment of atrioventricular-canal defects in children was first reported at UCLA Medical Center.

1975-85 A decade of pioneering laboratory and clinical research on myocardial protection produced new standards in preserving heart muscle during cardiac operations and techniques to re-perfuse the myocardium.

1988 UCLA performed the first heart-lung transplant in Los Angeles.

1992 UCLA pioneered the country's first alternative heart transplant and was the first center to perform bypass surgery on a donor heart prior to transplantation.

1999 UCLA transplant surgeons developed a cutting-edge "modified reperfusion" technique that replenishes nutrients in newly transplanted lungs and removes white blood cells that could injure them.

 

2001 Cardiothoracic surgeons at UCLA Medical Center
were the first on the West Coast — and the fourth
nationwide — to implant an AbioCor™ Implantable Total Artificial Heart.

2002 For the first time on the West Coast, UCLA cardiothoracic surgeons used a pioneering technique to harvest an artery from a patient’s wrist for heart-bypass surgery —a procedure called endoscopic radial artery harvesting.

2007 UCLA surgeons working with the Center for
Advanced Surgical Interventional Technology (CASIT) created a simulation center for perfecting surgical robotic and hybrid minimally invasive surgical procedures for aortic aneurysm, cardiac valve repair and replacement.

2007 Working collaboratively with the cardiologists in the Arrhythmia Center, UCLA surgeons introduced advanced procedures for the treatment of atrial arrhythmias.

2007 UCLA surgeons were the first in the western United States to use new perfusion technology to maintain a heart beating outside the body from donor harvest to transplant.

Richard J. Shemin, MD
Chief, Division of Cardiothoracic Surgery
Executive Vice Chair, Department of Surgery
Co-Director, Cardiovascular Center
Director, Endovascular Aortic Aneurysm Service

Cardiac Surgery

Abbas Ardehali, MD
Director, Heart, Lung and Heart-Lung Transplant Program
Director, Cardiac Surgery, West Los Angeles VA

Fardad Esmailian, MD
Director, Cardiac Surgery Nurse Practitioner & Physician Assistant Program

Curtis Hunter, MD
Director, Cardiac Surgery, UCLA Medical Center, Santa Monica

Hillel Laks, MD
Chancellor’s Professor, Cardiac Surgery

Daniel Marelli, MD
Director, Heart and Heart-Lung Procurement

Thoracic Surgery

John R. Benfield, MD
Professor Emeritus

Robert B. Cameron, MD
Chief, Thoracic Surgery West Los Angeles VA

E. Carmack Holmes, MD
Executive Director, Center for Advanced Surgical and Interventional Technology (CASIT)
Acting Section Director, General Thoracic Surgery

Jay M. Lee, MD
Surgical Director, Thoracic Oncology Program

Raja Mahidhara, MD
Surgical Director, End-stage Lung Disease

Mary S. Maish, MD
Surgical Director, Center for Esophageal Disorders

UCLA Division of Cardiac Surgery
10833 Le Conte Avenue 62-182 CHS
Los Angeles CA 90095
310-206-8232 voice 310-825-7473 fax
www.uclahealth.org/cardiothoracicsurgery





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