DR. LAMELAS EXPLAINS HIS METHOD ON MINIMALLY INVASIVE CARDIAC SURGERY AND HOW HE WAS INSTRUMENTAL IN DEVELOPING IT.
Q: WHAT ARE THE ADVANTAGES OF MINIMALLY INVASIVE CARDIAC SURGERY COMPARED TO THE TRADITIONAL APPROACH OF GOING THROUGH THE STERNUM?
A: By using this approach, we do not have to break any ribs nor the breastbone to access the heart. In addition, there is no manipulation or trauma to the heart that can promote inflammatory changes. Specialized instruments allow us to work through extremely small incisions with the heart in its normal location. As a result of this limited trauma, patients experience less bleeding as well as less need for blood products, which ultimately decreases the risk of respiratory system and kidney problems. Since we are not opening up the chest, breathing mechanics are better allowing patients to cough easier with less pain. All of this translates into a shorter ICU and hospital stay, and an earlier return to a normal lifestyle. The cosmetic impact of having just one very small incision between the ribs has allowed patients to feel like they are “not cardiac surgery patients” because they do not have a large incision down their chest, which can be psychologically impactful.
Q: WHAT IS THE “MIAMI METHOD” AND HOW WERE YOU INSTRUMENTAL IN DEVELOPING IT?
A: In 1990, I became very curious about how minimally invasive surgical techniques were being utilized in other fields and wanted to apply it to cardiac surgery. The “Miami Method” is a term I coined to describe the minimally invasive surgical techniques I apply to a variety of different cardiac procedures whether it’s single or double valve replacements, replacing the ascending aorta in patients with aneurysms, or single and double bypasses. I have since trained around 1,000 doctors from around the world on how to perform these techniques.
Q: HOW DOES YOUR APPROACH DIFFER FROM ROBOTIC HEART SURGERY?
A: Robotic heart surgery can only be used on a specific subset of patients. It requires five incisions, which can mean more discomfort for the patient. The “Miami Method,” on the other hand, can be applied to just about any subset of patients. Patients of any age, body habitus, and risk category are candidates. This “all comers” approach makes this procedure unique and beneficial to all patients.
Q: WHAT TYPE OF QUESTIONS SHOULD PEOPLE ASK BEFORE CHOOSING A CARDIAC SURGEON?
A: Finding a cardiac surgeon who is right for you or your loved one requires some education and research. You need to make sure you understand the specific cardiac issue that needs to be addressed and look into all of the alternative methods that can be applied. In addition, patients and their family members should not feel embarrassed to ask the surgeon about his or her experience and track record. Ask how many of these procedures the surgeon has performed, how often, and what his/her overall complication rate is for this type of surgery. In my practice, I perform three to four of these procedures a day. Repetition and experience are important and translates into improved outcomes. My high volume of surgeries and experience has led to excellent outcomes, resulting in one of the most consistent, and highest survival rates for cardiac surgery in the country.
By MARY JO BLACKWOOD WITH DR. JOSEPH LAMELAS, M.D., FACS
Chief of Cardiac Surgery, University of Miami Health Systems
Professor of Surgery, Miller School of Medicine