Derek Brinster, MD: The Adaptation of Innovation

JANUARY 27, 2018
Matt Hoffman
Derek Brinster, MD, the director of aortic surgery at Northwell Health, sat with MD Magazine to discuss what he's keeping an eye on in thoracic surgery, and how his department plans to adapt to the new innovations in surgery to improve their patients' outcomes.

Derek Brinster, MD, director of aortic surgery at Northwell Health:
I think some of the most exciting avenues to improving patient outcomes in cardiothoracic surgery is the adaptation of innovation. Innovation has always been at the forefront of cardiac surgery from the first initial use of the cardiopulmonary bypass circuit, and now we're turning to a new era. Some say that this is the adolescence of cardiac surgery and the fact that we went through the cardiopulmonary bypass machine and coronary bypass grafting, which were standard tools and techniques of cardiac surgery. But, over the last 10 years or so, we're seeing advances in our entire scope of our field, from preoperative imaging that allows us to better see exactly what we're going to encounter in the surgical field, to the adaptation of percutaneous avenues (meaning that we're not making an incision in the skin anymore), to treating some of the most severe heart problems, to our adaptation of using them as a hybrid approach, where we use some of those percutaneous technologies and open surgeries and even where we go to minimally invasive surgery as well.

Some of the things that we're keeping an eye on are what's called our fusion imaging where we can actually in real time see a display of the patient's body as we intervene on it. So it's an adaptation of the radiological imaging that we're used to seeing before surgery. We're seeing it in our surgical operating room theater at the time of surgery and allowing that to guide us into making the correct movements during our surgery. Some of the other avenues are our thoracic stent grafting techniques, where we're not just simply treating aneurysm disease with a simple stent craft, but we're now having multiple branch devices able to be utilized both in the abdomen and also in the neck vessels as well, where we can treat aortic aneurysm disease. As well as percutaneous valves that were already being put in for the aortic position, the aortic valve position.

We're starting to adopt technologies for the mitral valve position both in a mitral valve clips as well as full mitral valve replacements using a wire and a catheter. And those, combined with our standard minimally invasive approaches where we used to just replace a single valve through a tiny incision, we're now doing much bigger surgeries through tiny incisions including full aortic reconstructions at the base of the heart, at the head vessels, etc. This allows the patient to recover and a much more expeditious manner faster recovery faster return to work faster recovery to activities of daily living so I think it's a combination of our imaging the technological advances in both the vows the stent grafts that are at our fingertips and also that apt Asian of smaller incisions and our whole goal as physicians is to provide a better outcome to our patients and these are the driving forces that allow us, cardiac surgeons, to say what is the best for our patients and we have a handle on all of this to provide those best outcomes to them.

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