Dr. Aubrey Galloway discuses Cardiothoracic Surgery: Minimally Invasive Mitral Valve Repair and Valve Repair in the Elderly in an interview at NYU Medical Center. This program is part of FORA.tv's NYU Medical Center Wellness Series.
Dr. Galloway speaks on the benefits of mitral valve repair versus replacement; minimally invasive techniques for repair; and valve repair in the elderly population.
Cardiac surgeon Aubrey Galloway, MD is the Chairman of the NYU Department of Cardiothoracic Surgery and Director of the Thoracic Surgery Residency Program. He is widely recognized for the use of reconstructive techniques in the treatment of valvular heart disease, for surgical correction of thoracic aneurysms and for treatment of patients with advanced coronary artery disease and heart failure. He is a world leader in the development of minimally invasive techniques for valvular surgery and was co-creator of the Colvin-Galloway Futures band for valve repair. Additionally, he has published more than 100 papers in prestigious peer-reviewed publications including the Journal of Thoracic and Cardiovascular Surgery, Annals of Thoracic Surgery, Circulation and the Journal of the American College of Cardiology.
Dr. Aubrey Galloway
Cardiac surgeon Aubrey Galloway, MD is the Chairman of the NYU Department of Cardiothoracic Surgery and Director of the Thoracic Surgery Residency Program. He is widely recognized for the use of reconstructive techniques in the treatment of valvular heart disease, for surgical correction of thoracic aneurysms and for treatment of patients with advanced coronary artery disease and heart failure.
He is a world leader in the development of minimally invasive techniques for valvular surgery and was co-creator of the Colvin-Galloway Futures band for valve repair. Additionally, he has published more than 100 papers in prestigious peer-reviewed publications including the Journal of Thoracic and Cardiovascular Surgery, Annals of Thoracic Surgery, Circulation and the Journal of the American College of Cardiology.
Dr Aubrey Galloway what is minimally invasive of mitral valve repair?Minimally invasive valve surgery refers to a a new technique that has been developed over the last 10years, where the surgeon can go to a small hole on the side of the chest between the ribs rather thancutting the breast bone up and down the top and spreading chest widely. That minimally invasiveapproach allows the patient to have less pain, less bleeding because there is not as much - a big opencut and allows them to the patients to recover more quickly. The minimally invasive surgery can beused for any valve, it can be used for aortic valves for replacement and for micro valves we haveroutinely used this minimally invasive approach foe valve repair surgery. So, what it really means isthat we repair the micro valve like all surgeons would do in a conventional valve repair procedure, butwe get there through a smaller incision so the patient can have a less traumatic recovery and a bettercosmetic result, get back to work and full activities on a shorter period of time.And what has been NYU's role in development of those techniques?NYU really took the lead in developing minimally invasive approach to surgery back in 1994 in1994 we worked with a group of surgeons from Stanford and a group of engineers in the industry tolook at techniques for offering them balance to tiny incisions rather than by opening the chest in thetraditional way. After two years of work on this we were able to go under clinical trials with minimallyinvasive surgery in 1996 and it was widely successful right out of the bed and NYU within quickly -adopted the minimally invasive approach for virtually all of our balance and this has now been ourstandard for the last 10 years. So since 1996, I think the whole field of cardiac surgery has evolvedsignificantly from open chest surgery for everybody to minimally invasive approaches for the vastmajority of patients, that require valve surgery.I know surgeons came from all over the world to watch your procedures, why do they do that and howare the procedures here or another institutions in the United States different from how it's done else where?Well, we set up programs to arrange this and recently we did saw was that certainly safety as the theprimary theme for any patient, if a surgeon and the community is going to learn a new technique ofdoing heart surgery, we think it's smart for them to come to a center like NYU, we have a lot ofexperience with less invasive surgery. Watch us do this surgery and then we can then, give lectures onthe technique, go over how the techniques should be done and work with them, so they can safelyadopt this approach in their own community. In fact we have now trained close to 350 to 400 surgeonsover the last three to four years that have come here and watched us do the technique and then workwith us to try to develop this approach in their in their own communities.You are co-creator of the Colvin Galloway futures band for valve repair. What is that?When surgeons repair valves, part of the repair is reframing the valve almost like if you repair door youreframe the door and there is devices that are used to allow surgeons to effectively do this. After about15 years of doing valve repair surgery, Dr. Colvin, one of my and myself begin to believe and see thatthere were some holes in the technology available that that could be improved upon and so, at thattime we decided we would develop a repair device that facilitated the ability of surgeons to repairmicro valves using new bio materials and and really a new design and that became the ColvinGalloway future band. It has been used very successfully around the world throughout surgeons in theUnited States and and Europe and we have been really happy that at least in some cases is iscontributed to what we hope on improved outcomes.And are these procedures that the elderly should avoid or are these are procedures that areparticularly of interest for elderly?Well, obviously people fortunately are living longer and and so many elderly patients are nowfaced with valve problems, the trouble with having to do major surgery on an elderly patient I thatyou might fix the heart of the patient might not be strong enough to recover from the surgery. So, infact what does happen is that a minimally invasive approach is - had dramatically improved ouroutcomes in elderly patients, we can do the same for valve care repair or replacement. But we can do iton a way that the the older person doesn't get injured as badly with the surgery, it's less dramatic forthe older person and they can recover more quickly. When we looked at aortic valve surgery in elderlypatients over the last ten years, we have found that by doing minimally invasive surgery, we cut therisk in half for for patients in their 70's, 80's or 90's who needed valve surgery. So I think it's - aminimally invasive surgery is good a good approach for everybody, has got benefits for youngpeople. For the older patient I think the benefits are greatly magnified because they need that little edge.What if someone is not a candidate for valve repair?For micro bound disease, actually most patients, a vast majority of patients can have their valvesrepaired. But if for some reason they are not a candidate, and if there is to much disease in their valve,there is something else wrong with the valve that precludes us reconstructing the valve, the newervalves now available are are light years ahead of what was available to patients in the past andparticularly new vales which we term third generation tissue valves have been engineered in such away as they are very natural, they are very similar to the patient's own valves and they probably goingto last twenty years. So I think there is a lot available out there for patients who have valve disease.Yes, we would like to repair micro valves if if the patient has problems with the micro valve and wecan't repair it. But if we can't repair the valve, there are great other options for replacing that are verynatural, they are very long lasting and give people a very an excellent result with an excellent quality of life.So you are physician and you are also a Chairman of the NYU Department of Cardiothoracic Surgeryand Director of the Thoracic Surgery Residency program. When you develop a new procedure like this,who are the heroes, involved or required to have all other resources and infrastructure and intelligencethat you need to develop a procedure like that. Are there outside companies, are there thepharmaceutical companies are there various types of other institutions that you have to get engaged?One of the great things around being in an Academic Medical Centre is that everything that's necessaryis available around you at a major Academic Medical Centre. Now that may be - mean basic scientistswith new ideas on on cellular technology; it may mean engineers that have ideas on how to do thingsbetter, bright young doctors and and surgeons, they can look at how we want to do a technique andpartnering with industry that will come in and work with Academic Medical Centers to try to put theirengineering ideas forward, but introducing in a way that they will really work and really help patientsso that's really what academic medicine is all about, I think partnering with industry, pulling the piecestogether to take new knowledge and new know-how and put it forward for the benefit of patients.And what's coming in the future that you are particularly exited about that you are seeing now?There there is there are several really-really interesting things coming on - in a lot of the differentareas with valorization in particular, we are launching on a program for repairing or replacing valveswithout surgery at all using catheters much like stenosis done for Coronary Artery disease. This projectis working under division of Cardiology and and our Department of Cardiac Surgery are workingtogether again along with industry to introduce some of these techniques, put them into trials to seewhich patients can benefit from them and I feel very confident that all a certain number of patients inthe future will be able to get their valve repaired or replacement done that way. In terms of predictinghow patients are going to respond there is these wonderful new diagnostic systems that are beingdeveloped so that we can do MRI scans or PET scans that give us ideas of how the heart is going tofunction, how it's going to recover, and I think we can begin to predict who is going to benefit fromwhat surgery or what Medical therapy better in the future by the introduction of these new technologies.What do you love most about your work?I love everything about it. But, certainly the satisfaction that patient is doing well, still is what drivesthe day and I think every thing else then comes from that and that means, teaching other doctors how toreproduce hopefully better than I can do it in new techniques and new procedures. And coming outwith new ideas and new things that - that eventually get translated and to the better care of patients,that's very, very exciting just to be a part of that process and I think the smart people around againacademic medical center will allow them to happen, its really a wonderful thing to be a part of that.What is your department focused on? What does your department do?The one department of cardiothoracic surgery, really we have two major areas of focus, one heartdisease in the surgical treatment of heart disease and that's all of heart surgery, Valve surgery, surgeryfor criminology disease, surgery for heart failure, reconstructive surgery of the heart, congenital andpediatric surgery for people with congenital heart defects. Another whole part of our department is isthoracic oncology and that really means cancers of the chest, lung cancer being one of the biggestkillers in the United States. We have a wonderful team of thoracic oncology surgeons led by Dr. Pasthat are doing amazing things in the treatment of the lung cancer that are going to improve theoutcomes of this dreadful disease and patients, I think that's a extremely exciting filed as well. Lungcancer is moving into earlier diagnostics and to more effective treatments and lesson based treatmentsjust like we are doing lesson based treatments of valve disease. So there is a lot going on that side ofthings too and it makes sense, the biggest health problems in the United States are heart disease, cancerand they both affect the chest, and and we tried to be really looking seriously how we can improvetreatments to patients in both those major disease areas.So looking 20 years down the road what are you hopeful of in terms of advances in heart disease?I am I am hopeful that that every treatment we put forward in the future is going to be lesstraumatic for the patient in some way with less side effects and this is going to have a more effectiveresult, that maybe lesson based in patient surgery that might be cather based surgery that might beintroducing cells into the heart or new or even new medications that can be used to change the waythe heart responds. So I think that its its, know how is biotechnology and engineering improves andwe focused those advances into the care patients. I think each year each step we should be able to carethe patients in a much more effective way been a way that is is much more easily tolerated by thepatients. In terms of cancer I really hope and pay that it will have early detection of cancers so that wecan detect the cancer early we can cure the cancer and if we can do that then that's that's going tochange that that feel. So I think a lot of that comes to bio electric ways of looking of early detectionor radio logic ways of looking at early detection so we can get in there before the disease hold on andand hope fully we have some some really good cures and right vision.So speaking more broad about heart disease for a young man, a young woman graduating from NewYork University today who wants to have a healthy heart of for rest of their lives, give them some advice.It is pretty much advice your grandma would give you I think but good exercise, good diet, don't beoverweight, don't smoke. I think there are lot of things that we can do to prevent many heart problemsand that is we have termed risk factor modification but its really a healthier life style obesity is aepidemic in the United States we have to keep people trim fit exercising and taking care of themselvesand we can prevent certainly a lot of coronary disease some diseases we cant prevent we can preventthem that we want to detect them early and treat them early. So people can have normal life style andnormal life expectancy despite having health disease.What is it about the American life style that concerns you in terms of taking good care of ones heart?I think the the big problem of American life style is that many people are sedentary they don't putexercise in to their daily routine and they developed a lot of bad habits driven some what by marketingcampaigns for big meals and big diets and fatty foods and that's really unhealthy force we have toreally pay attention to this this is a society if we let bad habits overtake a society though we more andmore heart disease and that really shouldn't happen, because we now have the new found educationthat we should be able to teach people early on that that they can prevent many of these things thatthey just modify their life style.Dr. Galloway, thank you very much.Thank you.