“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.
Several weeks ago I wrote that our knowledge of medicine is constantly changing as new discoveries sweep out the old. Two recent breakthrough observations highlight that statement.
Twenty-five years ago, I underwent open heart surgery to repair a leaky mitral valve. As I detailed in my memoir, Damn the Naysayers, I was hospitalized for about five days after having the 3+ hour surgery under general anesthesia. I required a month to recover, and then needed repeat surgery six months later to wire together the two halves of my breastbone separated at surgery that had not healed properly — sternal nonfusion, the surgeons called it.
Now, the entire procedure of repairing/replacing a heart valve can be done in a matter of an hour or two under light anesthesia with a catheter inserted into a groin blood vessel. Same-day-discharge was accomplished in 124 of 2,100 low risk patients, average age 79 years, who underwent elective aortic valve replacement by catheter (transcatheter aortic valve replacement, TAVR). There were no major vascular complications, strokes, or deaths during the index admission and there was no significant difference in clinical outcomes among those discharged the same day versus next day discharge after the TAVR procedure.
TAVR and similar surgeries, first performed twenty years ago but now achieving widespread clinical application, have revolutionized valve repair/replacement, especially for the frail, elderly who might not have survived the rigors of open-heart surgery. Outcomes are comparable to surgical success achieved by opening the chest to replace a valve, not only in those patients who are not candidates for open-heart surgery, but also for those who are at extremely low risk of surgical complications.
It reminds me of the story about the automobile mechanic who complained to a heart surgeon that the surgeon earned ten times the mechanic’s fee, even though both replaced a valve. The surgeon retorted, “Yeah, but I do it while the engine is still running.”
The second astounding breakthrough, called a brain-computer interface (BCI), involves a brain implant that restores muscle movement in patients paralyzed by amyotrophic lateral sclerosis (ALS), so called Lou Gehrig’s Disease. Once again, catheter technology has replaced the surgical scalpel, this time as a substitute for brain surgery, to permit paralyzed patients to use their thoughts to perform daily tasks.
An array of 16 sensors or electrodes are mounted on a stent-like scaffold that is inserted by a catheter in a neck vein and positioned against the walls of a part of the brain called the superior sagittal sinus. The device records and decodes signals produced as a result of movement intention from an area of the brain called the precentral gyrus. The BCI transmits the brain signals to an electronic unit implanted beneath the skin that decodes movement signals. So when a participant attempts specific muscle movements, like moving an arm or leg, the decoder analyzes the nerve cell signals from those movement attempts and translates the movement signals into computer navigation to move the muscles.
Four patients paralyzed from ALS were trained to use the device and were able to complete tasks independently and in their own home with no serious adverse events at a 12-month follow-up. Although the study started with patients with ALS, those paralyzed from other causes, such as spinal cord injury or strokes, might benefit from the BCI in the future.
Amidst the chaos and strife of our present world, it’s nice to know that medical science is still advancing to make life better for our patients.
Featured image: Shutterstock
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