L. Ben Mime
Deutsches Herzzentrum Berlin, Germany
Title: Evolution in congenital heart defects surgery since Gibbon first closed an ASD using cardiopulmonary bypass:
Biography
Biography: L. Ben Mime
Abstract
Paradigm shift to a "Personalized Repair" of congenital heart defects and its challenges.
The four eras of cardiac surgery since Gibbon first closed an ASD using cardiopulmonary bypass:
1. Anatomical era: recognizable patterns of normal and pathological anatomy; restoration of functional anatomy. ASD, VSD closures; Total abnormal venous drainage; valve repair; Dacron conduits.
2. Pathophysiologic Era: increased understanding of cardiac physiology; emphasis on physiologic goals, staged procedures, Fontan principle. Valve prosthetic replacements; Shunts for cyanotic lesions; Bypass grafts, conduits, Homografts.
3. Biochemical and technological era: increased understanding and incorporation into surgical tactics of the biochemistry of myocardial metabolism, ventricular biomechanics, and applied technologies, e.g. improved CPB circuitry; material development and improved prosthetic heart valves based on engineering design principles; improved imaging, single stage neonatal/infant repairs, minimizing staging and palliation. 3rd generation valve replacement; aortic root replacements; 80% cardiac repairs < 12 months of age; hypoplastic left heart staged repairs.
4. "Regenerative surgery" era: viable replacement constructs molecular and genetic therapies incorporated into surgical repairs: bioengineering, tissue engineering, cell and gene therapies, regenerative medicine, molecular therapies, "Personalized" repairs, e.g. Tetralogy of Fallot reconstruction with growth capable RVOT and pulmonary artery viable tissue conduits.
This revolution will require a combination of expertise including cell and molecular biology, tissue engineering, surgery, tissue mechanics, cell signaling, chronic animal modeling.