For the first time in Israel: advanced minimally invasive surgery to close the ear in the heart

Significant news for patients with atrial fibrillation: A procedure of sealing the left ascending ear of the heart, performed successfully at the Herzliya Medical Center, for the first time in Israel with a turboscopic (minimally-invasive approach, using long and special tools, camera and light source).

The turboscopic approach achieves the same good surgical results of the open approach – but without the need to make a large incision in the thoracic bone (the surgical instruments are inserted through tiny holes in the side of the chest). This significantly reduces the surgical trauma and allows the procedure to be performed even on patients who were previously unable to perform it.

To perform the new procedure, Herzliya acquired a unique technology called AtriClip PRO-V, which was brought to Israel from abroad in a very short time.

Atrial fibrillation

Atrial fibrillation (also known as “atrial fibrillation”) is the most common heart rhythm disorder, occurring in 3% -1% of the adult population in Israel (about 100,000 people). Its incidence increases with age: less than 0.5% at age 50; 7% aged 65 and over; And 11% over the age of 80.

Properly, the ventricles and ascents of the heart contract at a constant, steady, and adjusted rate, as needed (the rate increases with physical exertion, for example). In the condition of atrial fibrillation, the ascents “lose rhythm” and contract very quickly and irregularly.

Atrial fibrillation can be symptomatic (adequate, accelerated or irregular heartbeat; chest pain or pressure; shortness of breath; weakness and fatigue; feeling dizzy; fainting) and may also show no symptoms at all (the patient feels normal but has a routine ECG Reveals the problem).

Why treat atrial fibrillation?

Atrial fibrillation is not a dangerous medical condition per se and is not life-threatening (although it can certainly cause unpleasant sensations). However, without treatment and over time, it significantly increases the risk of future illness and even mortality.

The first significant complication is the increased risk of stroke, which can lead to disability and even death: The risk of stroke patients to suffer a stroke is 5 to 7 times higher compared to patients without atrial fibrillation.

Stroke, illustration (Photo: Ing Image)

Another typical complication of a rapid and disorganized rate of contraction is the development of heart failure – the heart muscle is weakened and unable to properly supply blood to the body organs.

Blood thinners

Treatment for atrial fibrillation varies from patient to patient and is tailored to the severity of its symptoms, its type of fibrillation, its intensity and its unique risk profile.

One of the most common and common families of drugs in atrial fibrillation is blood thinners (anticoagulants), such as coumadin, aspirin and paradexa. Blood thinning reduces its clotting – thus reducing the risk of developing clots in the heart atria, which can reach the blood vessels in the brain and clog them.

Anticoagulant therapy has been shown in the research literature and in the clinic to reduce morbidity and mortality (through significant reduction of cerebral events) and is most common and accepted in patients with atrial fibrillation, with appropriate contraindications (not everyone is required for such treatment).

However, this is a complex treatment, which requires frequent monitoring (regular blood test called INR for clotting) and maintaining a delicate balance: too low an INR value means that the blood is too viscous, which can produce a blood clot – a condition we are not interested in; Too high an INR value means that the blood is too “diluted” and the risk of bleeding increases – this is also a condition we are not interested in.

The left ascending ear of the heart

The left atrial appendage (LAA for short) is a small heart structure, a kind of sac (like a small pouch) in the shape of an ear, located in the wall of the heart muscle, near the left atrium.

The role of the headset is not yet completely clear, however it is known to play a role in regulating the pressure of the left ascendant during contraction.

In the condition of atrial fibrillation, when the ascents contract irregularly, the heart has a tendency to produce blood clots. These clots tend to form in the left ascendant – and 90% of them form in the ear.

If treating blood thinners for a patient with atrial fibrillation is tolerable and balanced (i.e .: works well) – then it is considered good risk management (reducing the risk of clot formation) and reduces his chance of having a stroke.

In contrast, a patient who is unable to take thinners (e.g. with kidney failure), who is unable to reach balance (e.g. someone who has difficulty performing frequent INR tests) or whose blood thinners cause unwanted side effects (such as recurrent gastrointestinal bleeding and need for blood transfusions) – Considered a good candidate to close or remove the headset.

Closing the headset in a minimally invasive procedure

The first method developed to reduce the risk of blood clots from the ear is heart surgery with an open incision, in which the surgeon reaches the heart and cuts the ear. The disadvantages of this approach are during the prolonged recovery from a cut in the sternum, which involves pain.

A less invasive approach developed later uses catheterization (under general anesthesia) in which the catheter closes the earpiece using a kind of umbrella worn on it. This is a more minimal approach, but there are patients who are not suitable for the operation and can not perform it with them.

Dr. Yaron Barak, A senior heart and chest surgeon at Medical, brought to Israel along with Dr. Yuri Feischowitz, A senior breast surgeon at Medical, a new method that combines the benefits of surgery with the more minimal invasiveness of catheterization: closing the ear in a turquoise (minimally-invasive) approach, in which the surgeon reaches the heart through tiny holes that open on the side of the patient’s chest, between ribs.

The new approach allows, for the first time, patients who are unsuitable for open surgery and cannot undergo catheterization (or who are after failed catheterization) – to undergo a procedure of closing the head in the left ascension with a turoscopic approach, which has hitherto been impossible for them.

These are patients who can not or are not suitable for taking blood thinners and therefore the medical recommendation for them is to close the ear in the heart – but to date they have not been able to perform this procedure and therefore were at increased (and tangible) risk of stroke.

The procedure, which includes the new technology, is performed using unique equipment (long and sophisticated tools, camera and light source) from AtriCure – the world leader in minimally invasive technology for heart and chest surgery. It is performed under general anesthesia in an operating room at the Herzliya Medical Center and involves a short hospital stay and a speedy recovery.

Dr. Barak explained that “the device that was installed is a hug that is installed on the headphone and actually cuts off the blood flow to it – and therefore also the possibility of blood clots forming. The operation was performed under skilled echo monitoring, which ensured that the headset was completely closed – and there was no blood flow to it. “Performing the procedure opens a new window for an entire population of patients, who so far have remained unanswered.”

Dr. Feischowitz added that “the combination of capabilities from the world of breast surgery and the world of heart surgery, allowed us to take a minimally invasive approach and reach the patient’s heart from the left side of the chest, using a camera and three tiny holes in the chest. The anesthesia, which included a unique soul, allowed us easy access to the patient’s heart and the installation of the hug. The possibility of using a minimally invasive approach in these patients is innovative, and also brings progress to a patient population that required a procedure and has not been able to perform it to this day. “


Source: Maariv.co.il – בריאות by www.maariv.co.il.

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