A: Yes there is. Dr. Marc Ruel of the UOHI has introduced a new, minimally invasive multivessel bypass procedure in which he does grafts on a beating heart through a tiny "keyhole" incision. In this innovative procedure, called Multi-Vessel Small Thoroctomy (MVST), the surgeon makes a small incision (not much larger than a paper clip) between the ribs and uses specially designed precision tools to move the heart into position. MVST is especially suitable for patients who need to return to physically demanding jobs soon after surgery, and for those with complex medical issues that put them at higher risk for surgical complications such as stroke, internal bleeding – even death.
"We’ve done this on close to 100 patients in Ottawa of all ages, from their late 30s to mid-80s,” says Ruel. “The results are very good and the recovery can be quite rapid," with patients usually leaving hospital within four days and returning to work within a month.
Ruel has trained surgeons at the Sunnybrook Health Sciences Centre in Toronto and Laval University Hospital in Quebec in this new technique.
Q: We've heard that stem cells are the key to fixing a damaged heart. How far along is this research and when will it be widely available?
A: The research is advancing at a quick pace, thanks in part to Dr. Gordon Keller, director of the McEwen Centre for Regenerative Medicine at the UHN in Toronto. Keller has discovered the elusive "recipe" for three of the major cell types of the human heart from embryonic stem cells.
He begins by adding a cocktail of growth factors and other molecules to stem cells to develop early-stage heart cells, also known as heart progenitor cells. He then coaxes these cells to make millions of cardiac muscle cells (beating cells, which pump blood), endothelial cells (which line blood vessels) and vascular smooth muscle cells (which form blood vessels). "You can see the heart muscle cells contracting in the petri dish, which is spectacular," says Keller.
The plan is to eventually produce a large supply of these heart cells to attempt to replace damaged heart tissue.
Keller's team is also doing experiments attempting to make comparable heart cells from reprogrammed human skin. This would transform human skin cells into early-stage heart cells, thus avoiding organ rejection in tissue transplants. He plans to work with tissue engineers in Toronto to combine lab-cultured heart cells with supportive scaffolding to create pieces of artificial heart tissue that would then be grafted onto the heart. Keller believes these cardiac patches would be more effective than transplanting the cells alone.
It will likely be several years before results of these animal studies are known and even longer for this approach to reach your local hospital.
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