Minimally Invasive Treatments for Atrial Fibrillation
Nearly 10% of people over the age of 80 are affected by an abnormal heart rhythm called atrial fibrillation (AF). AF can lead to the formation of clots that can cause strokes. AF currently affects over 2 million Americans and is responsible for nearly 75,000 new cases of stroke each year. In extreme cases AF may cause death. The surgical treatment for AF promises far greater chances for cure than medical or catheter-based treatments. However, current surgical treatments are complex and difficult. We are currently developing and testing minimally invasive surgeries to treat AF. In our new approach, various probes are used to interrupt the electrical paths in the heart that cause the AF. This will allow for smaller incisions, reduced pain, and shorter hospital stays after surgery.
Immunotherapy and cox-2 Inhibitors for Lung and Esophageal Cancer
Immunotherapy involves the body’s own immune system in the fight against cancer. We are currently conducting clinical trials investigating the use of cancer vaccines in patients with lung cancer. In addition, the enzyme cyclooxygenase 2 (COX-2) is believed to be involved in the development of many cancers, including cancer of the lung and esophagus. Specifically blocking the activity of COX-2 may reduce the growth of cancers. Results from a recent research study conducted at Weill Cornell investigating the use of COX-2 inhibitors in combination with chemotherapy prior to surgical resection of the lung are published in the Journal of Clinical Oncology. To further test the efficacy of these treatments, a randomized multicenter double blind study is in progress. A study of the use of COX-2 inhibitors in combination with chemotherapy to treat esophageal cancer is also underway.
Learn more about ongoing clinical trials in lung and cancer research in the Division of Thoracic Surgery.
Treatments to Improve Graft Patency
Each year around 600,000 coronary artery bypass grafts (CABG) are carried out in the US. The success of this procedure ultimately depends on whether the graft remains patent (i. e. open), especially when veins are used in the graft. This is because the wall of the vein becomes more muscular and thickens as it adapts to carrying blood at the higher pressure that occurs in arteries. However, this process can go too far, resulting in excessive thickening and closure of the graft. Our previous research identified potential targets for drugs to help prevent excessive thickening of the grafted veins that can cause the graft to fail. We are currently testing these drug treatments to determine whether they can actually improve the outcome of CABG.
Gene Chip Studies Identify New Targets for Cardiac Gene Therapy
A principal focus of research carried out in the Department of Cardiothoracic Surgery is cardiac gene therapy. We recently showed that adenoviral mediated transfer of the vascular endothelial growth factor (VEGF) gene can initiate growth of new blood vessels in the heart and thus help repair the damage caused by coronary artery disease. Nonetheless, we have much to learn about coronary artery disease. Each year over 600,000 coronary artery bypass grafts (CABG) are carried out in the US alone. Of these, up to 15% fail within 1 year after surgery, and up to 40% fail by 10 years. Although the characteristics of failing grafts are well known, the underlying mechanisms are only poorly understood. To gain insight into these mechanisms we are using cutting edge technology in the form of DNA arrays, called "gene chips", that enable us to examine the expression of thousands of genes simultaneously. By comparing the pattern of gene expression in normal and failing grafts we will be able to identify new targets for gene therapy (and possibly new drugs), to improve surgical outcomes, and to relieve patients of the need for repeat surgery.
Novel Surgical Techniques in Lung and Heart Surgery
The outcomes of lung and heart operations can be improved with technical innovations. The cardiothoracic laboratory is currently involved in several studies using new surgical materials and techniques to decrease the time of surgery and post-operative complications. These innovations, which include minimally invasive approaches, should make thoracic and cardiac procedures safer and potentially less expensive by decreasing the length of hospitalization.
Further clinical research focuses on the development of a right heart assist device for the treatment of right ventricular failure. In addition, the Department continues its long established line of research that has pioneered developments in bloodless surgery.
Aldosterone in Heart and Vascular Disease
Both human and animal studies have implicated angiotensin II and aldosterone in heart failure and atherosclerosis. Recent clinical studies in humans (RALES trial) have demonstrated the salutary benefits of aldosterone blocking drugs in patients with congestive heart failure. Our own studies showed that excess aldosterone exacerbates atherosclerosis in mice with genetically high cholesterol levels. Therefore, we believe that at least part of the benefit of aldosterone blockade may be to prevent atherosclerosis in coronary vessels. Similarly, aldosterone blockade may prevent – or at least slow – the unique type of atherosclerosis that occurs in coronary artery bypass grafts. We are currently testing these hypotheses in our animal surgical lab.
Contact
Charles Mack, MD
Associate Professor, Cardiothoracic Surgery
Telephone: (212) 746-5168
Arash Salemi, MD
Assistant Professor, Cardiothoracic Surgery
Telephone: (212) 746-5873
Jan Vander Goot
Departmental Administrator
Telephone: (212) 746-5158
E-mail: janvandergoot@med.cornell.edu
