Monday, March 10, 2014

Groundbreaking medical procedures at Mass General Hospital by Dr. 
Farouc Jaffer and Dr. Robert Yeh, enabling patients to avoid bypass surgery and get back to leading normal lives...

Two cardiologists at Massachusetts General Hospital are honing a complex new procedure for unclogging plaque-filled arteries that could spare untold thousands of patients from having to undergo open-heart surgery.
The procedure is similar to regular angioplasty — a common technique that uses wires and balloons to open partially clogged blood vessels — but it’s far more intricate and designed to open arteries that are entirely blocked. Complete blockages typically require bypass, a surgery that comes with higher risks of complications and a monthslong, onerous recovery.
The new procedure has helped more than 50 patients at MGH, allowing some to skip bypass surgery altogether and giving a new option to others who weren’t eligible for bypass. It has given patients the chance to reclaim a lifestyle many didn’t think was possible.
“Patients have told us they can dance for the first time in years,” said Dr. 
Farouc Jaffer, who performs the procedures with fellow cardiologist Dr. Robert Yeh. “They’re able to make their beds without getting shortness of breath.”
“We’re providing new options for patients who were feeling hopeless,” Yeh said.

Clogged arteries are harmful because they restrict blood flow and cause chronic chest pain and shortness of breath, symptoms many people live with every day.
Joseph McComiskey’s decades long struggle with coronary artery disease was becoming desperate when he decided to try the new procedure at MGH this winter. It was eight hours long and not without complications, but he felt better the next day.
“I can go up and down stairs now without gasping,” said McComiskey of Woburn, who had bypass surgery 29 years ago and has been subject to myriad other heart procedures since then. “I can do something as mundane as tying my shoes without losing my breath.”
The procedure Jaffer and Yeh are performing in Boston was initially developed in Japan and has been mastered by an elite group of cardiologists in the United States. MGH has the most advanced chronic total occlusions intervention program in New England, Jaffer and Yeh said.
In regular angioplasty, a wire inserted into a blood vessel cannot travel through a total occlusion, or 100 percent blockage. Jaffer and Yeh have found different ways, traveling around the blockage, then going backward to attack the clog. Sometimes they get at the blockage by sending wires through tiny blood vessels called collaterals on the other side of the heart.
In the cardiology world, these approaches are “very futuristic, very different,” 
Jaffer said.
They typically enter the patient’s blood vessels through the leg, without having to open the chest as is done in bypass surgery. Yet the work is so complex that Jaffer and Yeh do each procedure together, talking before and during each case so they know just which way to move their hands and equipment.
Bypass surgery will still remain the best option for some patients, the doctors said, but this advanced form of angioplasty ultimately could help many thousands as it becomes more commonplace.
“Coronary disease is getting more complex over time,” Yeh said. “Patients are getting more complex over time. The extent of their disease is getting worse. The number of patients we can help with this procedure is only going to grow in the future.”
Without the procedure, McComiskey said, his quality of life would have deteriorated and ultimately led to an “early demise.”
“The whole coronary issue is extremely insidious,” McComiskey said. “It’s slow and it’s never stopping.”