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my area of expertise is in the medical
what that really means and translated
into you’ve seen people with a heart
attack coronary disease into the oil
damage of the inside of the vessel wall
which blocks the vessel causes poor
blood flow to the heart and therefore
damage and the heart dies itself in
certain areas in addition a aortic
stenosis is another type of disease it’s
a calcium buildup on the vessel the
valves are just like doors they open and
they close so there’s two malfunctions
they could have they can not open enough
or they open too much and we’ll just
look at something called a or text
enosis why is coronary disease so
important mainly it affects over ten
percent of the population in the entire
United States it’s the leading cause of
death every 42 seconds someone has a
heart attack every minute someone dies
from heart disease the annual cost of
all of this is over 200 billion dollars
a year so I want to just go on a journey
talking about the past the present and
the future Stephen Padgett was a
well-regarded surgeon in the late 1800s
he founded Paget’s disease of the bone
he was thought to be the founder of
pathology along with Bercow but he made
the statement early on surgery of the
heart has probably reached the limit set
by nature to all surgery no new method
and no new discovery can overcome the
natural difficulties that attend a wound
of the heart
so what he was saying is that anytime
there’s damage to the heart or we need
to operate I feel it’s impossible well
let’s make an analogy it is like a
mechanic working on an engine except now
the engine is actually running there we
go so really the underlying theme of
this discussion is more about how do we
deal with the impossibilities we have
thousands of thoughts on a daily basis
it’s all really about the growth the
seed of growth for all of our desires
the desires to achieve the extraordinary
from this as long as we believe that we
can do it it certainly will happen the
it took over 60 years but in the 1950s
Lily hi at the University of Minnesota
figured out that well if we open up the
heart we’re going to lose a lot of blood
and where is that blog on a Duke go he
thought well I could connect it to
tubing and have it go to another
recipient the recipient in this case was
the patient father the son had a
ventricular septal defect which is a
hole right in the ventricle the hole in
the heart and the blood released came to
the patient’s father and then back to
the patient it was their first
successful operation of the heart and
the 1950s this actually led to the
development of by John Gibbons of the
heart-lung machine so this was a major
technological revolution because but now
is that over millions of operations are
now performed throughout the world so
what about the present what are we doing
now well this is the way we do the
operation currently we actually open up
the middle of the chest I see people
closing their eyes
let me tell you it’s only going to get
worse than you might want to cover your
ears and so what we see here is that
when the chest is open we’ve exposed the
pericardium which is the SAC around the
heart and here’s the heart and it’s
allowed us to do operations such as on
the blood vessels to make sure blood
flow on the valves to make sure if
they’re infected if they leak if they’re
stenotic that replaced them the aorta
which is the blood vessel of the body
that allows the blood to circulate
throughout the body to repair that if
it’s torn or enlarged eruption there’s
new technology coming along now called
tavor trans a ortak valve replacement so
what you see here is that the catheter
is passed up through the femoral artery
through the aorta and up to where the
aortic valve resides of this catheter is
the valve itself and is crimped on the
catheter it is then expanded and then
deployed such that we don’t even have to
open the chest to do this operation I
think this is going to be a technique
within the next several years that is
probably going to take over open-heart
surgery this is called robotic surgery
what we see here multiple arms are about
five or six arms that are inserted into
the chest cavity to expose the heart and
the surgeon isn’t even at the table the
surgeon is over here at a console what I
find what I’ve tried to use this is as
probably if you learn how to play video
games so if any of you are doing that
but there are certain barriers to
minimally invasive cardiac surgery one
of those is finding the optimal
procedure technique unfortunately we’re
talking about doing this on live people
to start and it takes many years
sometimes to do that there’s a steep
learning curve sometimes you have to
operate on fifty to a hundred people to
really get it right capital requirements
that robot that we showed you is over a
million and a half to two million
dollars and there’s an annual cost of
about a quarter of a million dollars a
year and the reimbursement constraints
whenever something new coming out just
like there’s another procedure that I do
called Broca’s navigational bronchoscopy
the different third-party payers that
are in medicine now they like were
minimal and will not pay for it what
this really results and just what i
wanted to show is that in nineteen sixty
the gross domestic product it was only
five percent of the overall cost and now
we fast forward to 2010 dollars and the
expected growth is that by 2050 it will
be over sixty percent of the gross
domestic product so in the past it was
very affordable although and in the
present we don’t know if it’s going to
be sustainable so for those of you who i
saw cover your eyes you might want to do
that again do i need to push it you want
to cut it down a little cut it down so
so what we see here is opening the
sternum the breastbone there to expose
the heart this was one i just did a
couple days ago we’ve done several
here’s the pericardium the SAC around
the heart and these are the lungs that
you see expanding back and forth as the
patient is on the ventilator
what i’m doing here is opening the SAC
around the heart to actually expose the
heart you see the right ventricle on top
the left ventricle is sitting below here
is the pulmonary artery where you see
the suction catheter and here’s exposure
of the aorta and the right atrium this
is the tubing that’s going to be
connected to the heart-lung machine so
this is the right atrium that is
connected to so we take the blood from
the heart so that we can quiet the heart
and work in a bloodless field this is
going into the aorta we’re returning
oxygenated blood free of any debris back
to the rest of the body for the brain we
are all connected now you see the heart
beating and now we’ve clamped the aorta
we stop the heart and at this point and
this is the picture of the heart-lung
machine as you saw which came about in
the late 1950s I’m opening up the aorta
at this time to expose the valve here is
a bicuspid valve normally there should
be three leaflets there’s only two this
is a congenital abnormality and this is
why this person has such problems they
were only in their 50s very short of
breath a lot of chest pain this is the
bicuspid valve this is the new valve
that is made from pure cardium of a cow
and this is what is being implanted we
see it in planted here within the aorta
and now I’m closing up the aorta if I
try to tow any of this minimally
now all the tubing is out the heart is
back to beating we close the sternum
and this patient was done on monday and
should be going home tomorrow so so what
does the future look like of course i
could start talking about a number of
different items but there’s something
that is interested to me now that
actually i’m starting to get involved
with and that’s called pris / just by a
show of hands how many people have heard
of crisper oh very knowledgeable
audience what does it stand for now so
crisper is clustered regularly
interspaced short palindromic repeat so
palindromic meaning of course backwards
or forwards the same and what that is is
that bacteria for billions of years have
what happens is this is the bacteria
whenever a virus or other microorganism
invades the cell the DNA of the bacteria
is able to actually recognize this and
incorporate it between the spacer once
it does that through transcription the
crisper RNA the messenger and RNA is
produced and once that’s produced any
time there’s any other invasion of a
microorganism or virus it recognizes
that gene and incorporates itself in the
exact location what is able to do so you
then destroy that gene so that it’s no
longer functional so i can either
silence it so that it is non-functional
or it can edit to actually have a
totally new function that as at the
direction of the lab this is currently
being done today so what are the
benefits of crisper i bring this up
mainly from the standpoint
I think we could see eradication
eradication of heart disease and cancer
they’re already working on it for cures
of infectious diseases such as aids in
addition for genetic diseases from
Alzheimer’s marfans a number of things
the one that I’m actually involved with
is which Fuchs disease so again the boy
who had the ventricular septal defect
maybe could be treated with crisper
coronary artery disease actually could
be eradicated the main issues with
disease such as that is one of the risk
factors hypertension hyperlipidemia
diabetes that’s a reversible process
through genetic engineering also that of
lung cancer I lobectomy for lung cancer
in the future we’ll see if that’s still
the case now there’s top could you
actually be taller more muscular could
it be that you change your eye color or
as we look at this we would say we’re
looking at this picture from right to
left but now it might be that you’re
looking at it from left to right because
now people are talking about working on
aging so my overall thought as far as
this process is is that the way we think
develops into our belief system and our
desires and from that we form our habits
and our habits shape our future thank
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you [Applause]