Surgical Innovations

Emerging Field Combines Cardiac Surgery and Interventional Cardiology

Mathew R. Williams, MD
Surgical Director, Cardiovascular Transcatheter Therapies

Intricate repairs to the heart can now be performed through flexible catheters threaded into blood vessels in the groin or arm. Using this method, physicians can repair or replace heart valves, open blockages in the blood vessels, gently ablate the surface of the heart to stop atrial fibrillation, and perform a host of other diagnostic and therapeutic procedures. In comparison to open surgery, catheter techniques can mean less pain and faster recovery for patients. For some patients who may be too sick to undergo surgery, the availability of catheter techniques can sometimes mean the only chance to receive treatment.

Yet open surgery is still the only option in certain cases, and the skill of experienced surgeons remains indispensable. There are simply some procedures that are better performed through traditional methods.

"Surgeons tend to have a set of skills and think a certain way about how to approach a patient's problem, while interventional cardiologists have a different set of skills and take a different approach," says Mathew R.Williams, MD, Surgical Director, Cardiovascular Transcatheter Therapies. He chose to pursue both paths so that he could "combine the best of both worlds. "As the first U.S. physician to have joint training and appointments in interventional cardiology and cardiac surgery, Dr. Williams performs an increasing number of what he calls "hybrid" procedures — procedures that use the best of both surgical and less invasive methods to achieve optimal solutions.

"We can make complicated procedures safer and perhaps more effective by utilizing hybrid approaches," he says.

One such example is the transapical catheter procedure for replacing the aortic valve, which may be an option for select patients who are too sick to undergo traditional surgery. In one experimental procedure, interventional cardiologists thread a catheter through the femoral artery up to the heart, and with imaging of the interior of the vessels and heart, replace a diseased aortic valve with a new tissue valve. In some patients, however, the vessels in the leg are too small for the catheter to be inserted. So in the transapical approach, Dr. Williams makes a small incision in the chest, inserts a short catheter into the tip of the heart, and through this catheter replaces the aortic valve. "This requires surgical skills to access the heart, and it requires catheter skills to replace the valve," he explains. This method avoids having to stop the heart or use the heart-lung machine, steps that are usually necessary during open surgery, but that carry risks.

For patients who are at high risk for surgery, or are not eligible for open surgery, this hybrid approach offers an important alternative. "If not for this approach, some of our patients would have undergone very high risk surgery. A few patients would not have been able to undergo surgery or receive any treatment for their aortic disease," he says.

The catheter aortic valve procedure is available to select patients as part of the PARTNER study. Led by the Center for Interventional Vascular Therapy at Columbia University Medical Center and the Division of Cardiothoracic Surgery, this trial is investigating the safety and efficacy of percutaneous replacement of the aortic valve.

Learn more about interventional cardiology at www.crf.org, and heart surgery at www.columbiasurgery.org.