Brian Gruber: Dr Aubrey Galloway what is minimally invasive of mitral valve repair?
Dr. Aubrey Galloway: Minimally invasive valve surgery refers to a a new technique that has been developed over the last 10 years, where the surgeon can go to a small hole on the side of the chest between the ribs rather than cutting the breast bone up and down the top and spreading chest widely. That minimally invasive approach allows the patient to have less pain, less bleeding because there is not as much - a big open cut and allows them to the patients to recover more quickly. The minimally invasive surgery can be used for any valve, it can be used for aortic valves for replacement and for micro valves we have routinely used this minimally invasive approach foe valve repair surgery. So, what it really means is that we repair the micro valve like all surgeons would do in a conventional valve repair procedure, but we get there through a smaller incision so the patient can have a less traumatic recovery and a better cosmetic result, get back to work and full activities on a shorter period of time.
Brian Gruber: And what has been NYU's role in development of those techniques?
Dr. Aubrey Galloway: NYU really took the lead in developing minimally invasive approach to surgery back in 1994 in 1994 we worked with a group of surgeons from Stanford and a group of engineers in the industry to look at techniques for offering them balance to tiny incisions rather than by opening the chest in the traditional way. After two years of work on this we were able to go under clinical trials with minimally invasive surgery in 1996 and it was widely successful right out of the bed and NYU within quickly - adopted the minimally invasive approach for virtually all of our balance and this has now been our standard for the last 10 years. So since 1996, I think the whole field of cardiac surgery has evolved significantly from open chest surgery for everybody to minimally invasive approaches for the vast majority of patients, that require valve surgery.
Brian Gruber: I know surgeons came from all over the world to watch your procedures, why do they do that and how are the procedures here or another institutions in the United States different from how it's done else where?
Dr. Aubrey Galloway: Well, we set up programs to arrange this and recently we did saw was that certainly safety as the the primary theme for any patient, if a surgeon and the community is going to learn a new technique of doing heart surgery, we think it's smart for them to come to a center like NYU, we have a lot of experience with less invasive surgery. Watch us do this surgery and then we can then, give lectures on the technique, go over how the techniques should be done and work with them, so they can safely adopt this approach in their own community. In fact we have now trained close to 350 to 400 surgeons over the last three to four years that have come here and watched us do the technique and then work with us to try to develop this approach in their in their own communities.
Brian Gruber: You are co-creator of the Colvin Galloway futures band for valve repair. What is that?
Dr. Aubrey Galloway: When surgeons repair valves, part of the repair is reframing the valve almost like if you repair door you reframe the door and there is devices that are used to allow surgeons to effectively do this. After about 15 years of doing valve repair surgery, Dr. Colvin, one of my and myself begin to believe and see that there were some holes in the technology available that that could be improved upon and so, at that time we decided we would develop a repair device that facilitated the ability of surgeons to repair micro valves using new bio materials and and really a new design and that became the Colvin Galloway future band. It has been used very successfully around the world throughout surgeons in the United States and and Europe and we have been really happy that at least in some cases is is contributed to what we hope on improved outcomes.
Brian Gruber: And are these procedures that the elderly should avoid or are these are procedures that are particularly of interest for elderly?
Dr. Aubrey Galloway: Well, obviously people fortunately are living longer and and so many elderly patients are now faced with valve problems, the trouble with having to do major surgery on an elderly patient I that you might fix the heart of the patient might not be strong enough to recover from the surgery. So, in fact what does happen is that a minimally invasive approach is - had dramatically improved our outcomes in elderly patients, we can do the same for valve care repair or replacement. But we can do it on a way that the the older person doesn't get injured as badly with the surgery, it's less dramatic for the older person and they can recover more quickly. When we looked at aortic valve surgery in elderly patients over the last ten years, we have found that by doing minimally invasive surgery, we cut the risk in half for for patients in their 70's, 80's or 90's who needed valve surgery. So I think it's - a minimally invasive surgery is good a good approach for everybody, has got benefits for young people. For the older patient I think the benefits are greatly magnified because they need that little edge.
Brian Gruber: What if someone is not a candidate for valve repair?
Dr. Aubrey Galloway: For micro bound disease, actually most patients, a vast majority of patients can have their valves repaired. But if for some reason they are not a candidate, and if there is to much disease in their valve, there is something else wrong with the valve that precludes us reconstructing the valve, the newer valves now available are are light years ahead of what was available to patients in the past and particularly new vales which we term third generation tissue valves have been engineered in such a way as they are very natural, they are very similar to the patient's own valves and they probably going to last twenty years. So I think there is a lot available out there for patients who have valve disease. Yes, we would like to repair micro valves if if the patient has problems with the micro valve and we can't repair it. But if we can't repair the valve, there are great other options for replacing that are very natural, they are very long lasting and give people a very an excellent result with an excellent quality of life.
Brian Gruber: So you are physician and you are also a Chairman of the NYU Department of Cardiothoracic Surgery and Director of the Thoracic Surgery Residency program. When you develop a new procedure like this, who are the heroes, involved or required to have all other resources and infrastructure and intelligence that you need to develop a procedure like that. Are there outside companies, are there the pharmaceutical companies are there various types of other institutions that you have to get engaged?
Dr. Aubrey Galloway: One of the great things around being in an Academic Medical Centre is that everything that's necessary is available around you at a major Academic Medical Centre. Now that may be - mean basic scientists with new ideas on on cellular technology; it may mean engineers that have ideas on how to do things better, bright young doctors and and surgeons, they can look at how we want to do a technique and partnering with industry that will come in and work with Academic Medical Centers to try to put their engineering ideas forward, but introducing in a way that they will really work and really help patients so that's really what academic medicine is all about, I think partnering with industry, pulling the pieces together to take new knowledge and new know-how and put it forward for the benefit of patients.
Brian Gruber: And what's coming in the future that you are particularly exited about that you are seeing now?
Dr. Aubrey Galloway: There there is there are several really-really interesting things coming on - in a lot of the different areas with valorization in particular, we are launching on a program for repairing or replacing valves without surgery at all using catheters much like stenosis done for Coronary Artery disease. This project is working under division of Cardiology and and our Department of Cardiac Surgery are working together again along with industry to introduce some of these techniques, put them into trials to see which patients can benefit from them and I feel very confident that all a certain number of patients in the future will be able to get their valve repaired or replacement done that way. In terms of predicting how patients are going to respond there is these wonderful new diagnostic systems that are being developed so that we can do MRI scans or PET scans that give us ideas of how the heart is going to function, how it's going to recover, and I think we can begin to predict who is going to benefit from what surgery or what Medical therapy better in the future by the introduction of these new technologies.
Brian Gruber: What do you love most about your work?
Dr. Aubrey Galloway: I love everything about it. But, certainly the satisfaction that patient is doing well, still is what drives the day and I think every thing else then comes from that and that means, teaching other doctors how to reproduce hopefully better than I can do it in new techniques and new procedures. And coming out with new ideas and new things that - that eventually get translated and to the better care of patients, that's very, very exciting just to be a part of that process and I think the smart people around again academic medical center will allow them to happen, its really a wonderful thing to be a part of that.
Brian Gruber: What is your department focused on? What does your department do?
Dr. Aubrey Galloway: The one department of cardiothoracic surgery, really we have two major areas of focus, one heart disease in the surgical treatment of heart disease and that's all of heart surgery, Valve surgery, surgery for criminology disease, surgery for heart failure, reconstructive surgery of the heart, congenital and pediatric surgery for people with congenital heart defects. Another whole part of our department is is thoracic oncology and that really means cancers of the chest, lung cancer being one of the biggest killers in the United States. We have a wonderful team of thoracic oncology surgeons led by Dr. Pas that are doing amazing things in the treatment of the lung cancer that are going to improve the outcomes of this dreadful disease and patients, I think that's a extremely exciting filed as well. Lung cancer is moving into earlier diagnostics and to more effective treatments and lesson based treatments just like we are doing lesson based treatments of valve disease. So there is a lot going on that side of things too and it makes sense, the biggest health problems in the United States are heart disease, cancer and they both affect the chest, and and we tried to be really looking seriously how we can improve treatments to patients in both those major disease areas.
Brian Gruber: So looking 20 years down the road what are you hopeful of in terms of advances in heart disease?
Dr. Aubrey Galloway: I am I am hopeful that that every treatment we put forward in the future is going to be less traumatic for the patient in some way with less side effects and this is going to have a more effective result, that maybe lesson based in patient surgery that might be cather based surgery that might be introducing cells into the heart or new or even new medications that can be used to change the way the heart responds. So I think that its its, know how is biotechnology and engineering improves and we focused those advances into the care patients. I think each year each step we should be able to care the patients in a much more effective way been a way that is is much more easily tolerated by the patients. In terms of cancer I really hope and pay that it will have early detection of cancers so that we can detect the cancer early we can cure the cancer and if we can do that then that's that's going to change that that feel. So I think a lot of that comes to bio electric ways of looking of early detection or radio logic ways of looking at early detection so we can get in there before the disease hold on and and hope fully we have some some really good cures and right vision.
Brian Gruber: So speaking more broad about heart disease for a young man, a young woman graduating from New York University today who wants to have a healthy heart of for rest of their lives, give them some advice.
Dr. Aubrey Galloway: It is pretty much advice your grandma would give you I think but good exercise, good diet, don't be overweight, don't smoke. I think there are lot of things that we can do to prevent many heart problems and that is we have termed risk factor modification but its really a healthier life style obesity is a epidemic in the United States we have to keep people trim fit exercising and taking care of themselves and we can prevent certainly a lot of coronary disease some diseases we cant prevent we can prevent them that we want to detect them early and treat them early. So people can have normal life style and normal life expectancy despite having health disease.
Brian Gruber: What is it about the American life style that concerns you in terms of taking good care of ones heart?
Dr. Aubrey Galloway: I think the the big problem of American life style is that many people are sedentary they don't put exercise in to their daily routine and they developed a lot of bad habits driven some what by marketing campaigns for big meals and big diets and fatty foods and that's really unhealthy force we have to really pay attention to this this is a society if we let bad habits overtake a society though we more and more heart disease and that really shouldn't happen, because we now have the new found education that we should be able to teach people early on that that they can prevent many of these things that they just modify their life style.
Brian Gruber: Dr. Galloway, thank you very much.
Dr. Aubrey Galloway: Thank you.
