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OUT OF OUR HANDS:
Interventional cardiologists deliver artery-opening devices through the leg // Electrophysiologists zap wayward hearts into line // But traditional surgeons contend they still have plenty to do.

Is Heart Surgery History?

By Cathryn Delude // Spring 2007
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Tools for open heart surgery: armamentarium, skin knife, Weitlaner retractor, sternum saw, Finochietto retractor, sutures, pericardium, rake retractor, needle holder

Bruce Peterson for Proto

Open-heart surgery requires an armamentarium. With a skin knife (center of three shown), the surgeon makes an incision, then uses a Weitlaner retractor (lower left) to spread underlying tissues. After the sternum saw (lower right) has cut through the breastbone, the Finochietto retractor (top) pushes aside tissue and bone to bare the heart. Sutures, largest to smallest (bottom), close the sternum, pericardium and incisions on the heart. The rake retractor and needle holder (top right) hold skin and tissue in position during suturing.

You’ll just have to live with it.” That’s what doctors told Donna Colicchio about her recurring attacks of atrial fibrillation. But after 20 years, Colicchio felt the scope of her existence shrinking. Once, when taking her niece to a movie, she dropped to her knees outside the theater and couldn’t get up. Another time, she brought a table set for Christmas dinner crashing down when she collapsed in her Groton, Mass., home. She had an attack on a transatlantic flight and on a beach in Barbados.

Colicchio was what physicians refer to as a “lone fibber,” an otherwise healthy person with episodic atrial fibrillation, the most common kind of heart arrhythmia, a condition characterized by irregular heartbeats. More than 2 million Americans have AF, and many, like Colicchio, have no other heart condition, though they all have an elevated risk of stroke.

In fact, by the early 1990s, Colicchio could have been cured in one fell swoop. All she needed was to have someone saw through her breastbone, pry apart her ribs, put her on a heart-lung pump, stop her heart from beating, cut a maze of incisions through her heart’s atrial chambers and sew her back up.

But Colicchio, like most lone fibbers, wasn’t considered sick enough to justify the risks of open-heart surgery. Most people with AF either aren’t treated at all or are cared for with drugs alone, even though medication relieves symptoms only half the time and may cause serious side effects. Drugs didn’t help Colicchio, but finally in 2003, with the attacks continuing, her doctor told her there was another alternative. She underwent a new catheter-based, or percutaneous (through the skin, implying a puncture rather than an incision), procedure that, like angioplasty, approaches the heart via a peripheral blood vessel. Though she required a follow-up treatment, necessary in about half the cases, she has been symptom-free ever since.

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Highlights of Heart Repair

Daniel Hale Williams

Self-cardiac catheterization, balloons, stents and more, through the decades.

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hed-dossier

1.“Percutaneous Heart Valve Replacement: Enthusiasm Tempered,” by R. David Fish, Circulation, October 2004. An insightful overview of the challenges facing surgeons and cardiologists in addressing the unmet need for less invasive means of treating valvular disease.

2. “Surgical Management of Atrial Fibrillation,” by James L. Cox, Medscape Cardiology, Vol. 9, No. 1, 2005. A concise overview of atrial fibrillation and the development of the surgical Cox-Maze, “mini-maze” and pulmonary vein isolation procedures for treating AF.

3. “Controversies in Cardiovascular Medicine: Should atrial fibrillation ablation be considered first-line therapy for some patients?” pro position by Atul Verma and Andrea Natale; con position by Benzy J. Padanilam and Eric N. Prystowsky, Circulation, Vol. 112, No. 8, 2005. An in-depth debate about the merits of catheter ablation to treat atrial fibrillation, compared with drug therapy alone.

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