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Heart & Vascular
Institute - Texas
Medical Center
Cardiovascular Surgery
The most modern heart facility in Texas, Memorial Hermann Heart & Vascular Institute-TMC offers leading-edge cardiovascular programs and technology, backed by a commitment to excellence in care, research and technology.
Our surgical expertise ranges from conventional cardiac bypass to complex procedures for peripheral vascular disease, aneurysm repair and limb salvage, including the use of robotic-assisted surgery.
The Institute is a leader in advanced cardiovascular procedures, the first in the world to perform robotic-assisted reconstructive aortic surgery and the first in Houston to correct atrial fibrillation via minimally invasive surgery.
Scope of Robotic-Assisted Expertise
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Valve Surgery
- Heart Valve Procedures
Disorders such as mitral or aortic valve regurgitation or stenosis require valve replacement or repair. When possible, valve-preservation is preferred; if replacement is necessary, surgeons at the Institute perform the most advanced techniques.
- Minimally Invasive Mitral Valve Repair
The surgeon inserts a scope through a tiny incision, views the operative area on a video monitor and repairs the valve. Advantages include reduced surgical trauma, less blood loss, less chance of infection and faster recovery.
- Advanced Aortic Valve Replacement
Renowned for pioneering aortic surgery techniques, surgeons here are aggressive in their approach to aortic valve treatment, an area where valve replacement (rather than repair) is often required. Surgeons at the Institute use bioprosthetic heart valves, a recent advancement that allows patients to avoid anticoagulant therapy.
Bypass Surgery
- Coronary Artery Bypass Graft (CABG)
Each year, 700 CABG procedures are performed at Memorial Hermann Heart & Vascular Institute-TMC, treating such disorders as unstable angina, acute coronary syndrome, non-ST segment elevation and myocardial infarction. Surgeons at the Institute utilize the least invasive techniques possible to achieve less blood loss, reduced pain, shorter length of stay and faster recovery.
- Off-Pump Coronary Artery Bypass
The off-pump procedure provides a safer alternative to the heart-lung machine. Surgeons attach the bypass grafts to the blocked arteries of the beating heart, a technique that leads to faster recovery. Bypass grafting with all-arterial conduits instead of veins, is also being performed off-pump, which may provide better long-term survival.
- MIDCAB (Minimally Invasive)
The MIDCAB treats blockages in the left anterior descending coronary artery (LAD), as well as its branches. (Right-side blockage may be treated with a hybrid MIDCAB.) The surgeon makes a small incision between the ribs on the patient’s left side. Heart-lung equipment may or may not be used.
- Robotic-Assisted Coronary Artery Bypass (RACAB)
The most recent technological advance, RACAB provides access to the coronary arteries without opening the sternum. The surgeon does not have direct contact with the patient but guides robotic instrumentation via a video monitor.
- Heart Valve Procedures
Disorders such as mitral or aortic valve regurgitation or stenosis require valve replacement or repair. When possible, valve-preservation is preferred; if replacement is necessary, surgeons at the Institute perform the most advanced techniques.
- Minimally Invasive Mitral Valve Repair
The surgeon inserts a scope through a tiny incision, views the operative area on a video monitor and repairs the valve. Advantages include reduced surgical trauma, less blood loss, less chance of infection and faster recovery.
- Advanced Aortic Valve Replacement
Renowned for pioneering aortic surgery techniques, surgeons here are aggressive in their approach to aortic valve treatment, an area where valve replacement (rather than repair) is often required. Surgeons at the Institute use bioprosthetic heart valves, a recent advancement that allows patients to avoid anticoagulant therapy.
Referrals
Cardiothoracic surgeons maintain communication with referring physicians throughout treatment. To refer a patient, contact 713.7CARDIO (22.7346).
Aorta Surgery
Ruptured aortic aneurysms kill an estimated 15,000 Americans each year. Another 100,000 are diagnosed before rupture, typically as the result of an incidental imaging procedure. The incidence of abdominal aortic aneurysm (AAA) and thoracoabdominal aneurysm (TAA) has increased substantially in recent decades; surgery is the only effective treatment.
Designed as the heart hospital of the future, the Institute was the first: globally to perform robotic reconstructive aortic surgery, globally to show that heart disease can be reversed, in Texas to give patients clot-dissolving drugs to stop heart attacks, in Texas to offer cardiac risk screening designed specifically for women and in Houston to perform minimally invasive surgery to correct atrial fibrillation.
Scope of Expertise
- Open thoracoabdominal aneurysm repair
- Endovascular aortic aneurysm repair
- Abdominal aortic aneurysms (EVAR procedure)
- Thoracic aortic aneurysms (TEVAR procedure)
Program Highlights
- Thoracoabdominal Aneurysm Repair (TAA)
TAA repair is one of the most extreme surgeries the body can tolerate. Because the surgery involves both the thoracic and abdominal portions of the aorta, the patient is almost literally cut in half. A catheter, inserted at the start of the procedure to drain spinal fluid, relieves pressure created during surgery and reduces the risk of post-surgical paralysis. Surgical methods used by the Memorial Hermann Heart & Vascular Institute-TMC team since 1992 have dramatically reduced the incidence of paralysis from 15 percent to less than 3 percent.
- Endovascular Abdominal Aneurysm Repair (EVAR)
The minimally invasive endovascular abdominal aneurysm repair (EVAR) procedure involves making small incisions in the groin and threading catheter tubes through the femoral arteries and into the aorta. A fabric covered metal stent is introduced through the artery and fixed in place, relieving pressure on the artery to prevent rupture. Patients remain conscious under local anesthesia during the procedure. Patients who undergo EVAR have lower morbidity rates and shorter recovery times and can usually resume normal activity a week after surgery.
- Thoracic Endovascular Aortic Repair (TEVAR)
A minimally invasive alternative to open surgical repair of diseases of the thoracic aorta, TEVAR is most commonly used to correct thoracic aneurysmal disease. Using the TEVAR procedure, the vascular surgeon inserts an endograft into the aneurysm as a replacement for the diseased segment of the aorta. Patients benefit from reduced mortality and morbidity, shorter hospitalizations and more rapid recovery.
- Early Evaluation for High-Risk Patients
Memorial Hermann Heart & Vascular Institute-TMC offers periodic early detection evaluations for abdominal aortic aneurysm, peripheral arterial disease and carotid artery disease. Screenings are strongly encouraged for people who meet the high-risk profile for stroke and aneurysm – men over the age of 60 and women over the age of 65 with at least one of the following risk factors: smoking, high blood pressure, cardiovascular disease or a family history of AAA.
Vascular and Endovascular Surgery
- Open aortic aneurysm repair
- Endovascular aortic aneurysm repair (EVAR)
The minimally invasive EVAR procedure involves making small incisions in the groin and threading catheter tubes through the femoral arteries and into the aorta. A fabric covered metal stent is introduced through the artery and fixed in place, relieving pressure on the artery to prevent rupture. Patients remain conscious under local anesthesia during the procedure. Patients who undergo EVAR have lower morbidity rates and shorter recovery times and can usually resume normal activity a week after surgery.
- Thoracic aortic aneurysms (TEVAR procedure)
A minimally invasive alternative to open surgical repair of diseases of the thoracic aorta, Thoracic Endovascular Aortic Repair (TEVAR) is most commonly used to correct thoracic aneurysmal disease. Using the TEVAR procedure, the vascular surgeon inserts an endograft into the aneurysm as a replacement for the diseased segment of the aorta. Patients benefit from reduced mortality and morbidity, shorter hospitalizations and more rapid recovery.
- Management of peripheral arterial disease
- Angioplasty, stenting, atherectomy
- Open bypass procedures
- Management of carotid artery disease
We perform carotid endarterectomy and stenting to repair stenosis of the carotid artery. Endarterectomy to strip atheromatous plaque from the carotid vessels has been shown to reduce the two-year risk of stroke by 80 percent for patients who have severe stenosis of 70-99 percent. For patients who may not be candidates for endarterectomy, angioplasty and stent insertion provide a minimally invasive alternative.
- Carotid endarterectomy
- Carotid angioplasty and stenting
- Treatment of varicose veins
Closure Procedure for Varicose Veins - Using ultrasound, the surgeon positions a closure catheter into the diseased vein through a small incision. The catheter delivers radiofrequency energy to the vein wall. As the catheter is withdrawn, the vein wall is heated causing collagen in the wall to shrink and the vein to close. Outcomes are positive: 90 percent of treated veins have remained reflux free at two years. Patient benefits include less postoperative pain and bruising, return to normal activity within one day and return to work more than a week earlier than patients who undergo vein stripping.
- Minimally invasive ablation procedures
- Sclerotherapy
- Dialysis access procedure
- Renovascular and mesenteric artery disease
- Thoracic outlet syndrome (TOS)
TOS is caused by compression of nerves or blood vessels, or both, as a result of trauma, disease or congenital deformity in the thoracic outlet between the clavicle and first rib. Treatment begins with exercises to stretch and open the tissues associated with the thoracic outlet. If symptoms persist, surgery is an option. The surgeon make an incision above the clavicle and removes scalene muscles, along with the first rib, easing pressure on the brachial plexus nerves. About 80 percent of patients experience complete resolution of symptoms; 20 percent report significant improvement.
- Limb salvage in chronic critical limb ischemia
Critical limb ischemia is manifested by pain in the limbs at rest, non-healing pressure ulcers and the presence of gangrene. Caused by multiple blockages at various levels in the limb vasculature, continuous ischemia at rest can indicate vascular insufficiency severe enough to present a threat to the affected limb. Blockage location is isolated using Doppler ultrasound, CT, CT angiography, MR angiography and, when necessary, invasive angiography. Intervention varies according to diagnosis and may include conservative therapy, revascularization or amputation. When arterial openings are extremely narrow, balloon angioplasty is the preferred procedure for revascularization. Less frequently, deposits are removed by atherectomy using either a laser or a tiny, rotating knife inside a catheter to shave the obstruction from the arterial wall. The procedure is followed by stent placement, if required.
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