It used to be that the only way for surgeons like Arnar Geirsson, MD, to visualize and repair the heart was to do a sternotomy, splitting the sternum in half with a vertical incision six to eight inches long through the chest. Today, Geirsson can achieve the same results through minimally invasive approaches.
For aortic valve surgery, he makes a 2.5-inch incision in the upper part of the sternum and uses two small saws to gain access to the heart. Lines that connect patients to the heart-lung machine pass through a small incision in the neck or the groin. To improve exposure of the aortic valve, the procedure requires some maneuvering and takes slightly longer, but the results are well worth it. “Patients are very happy with it cosmetically, and there are fewer complications and faster recovery times,” Geirsson said. While recovery from a standard sternotomy takes six weeks, recovery time for minimally invasive surgery is three to four weeks, although patients usually feel better after about one week.
Aortic valve surgery is poised to become even less invasive, thanks to a new percutaneous technique which allows surgeons to access the heart through the groin, completely avoiding an incision in the sternum. Although Geirsson has yet to perform this type of surgery, he will soon be able to develop the necessary skills; Yale will be part of a study on the procedure, which is reserved for patients who are considered too high a risk to tolerate an open operation.
Geirsson also does beating heart coronary surgery which is less invasive because it avoids use of the heart-lung machine. “We can do a bypass and pretty much all of the coronary surgical procedures this way,” he said.
Geirsson always wanted to be a surgeon and became interested in cardiac pathophysiology during medical school in Iceland. After training under the late Margrét Oddsdóttir, MD, who was professor and chief of surgery at Landspitali University Hospital in Reykjavik, he continued his training at Yale. He is generally in the OR about three days each week, spending the rest of his time seeing patients and conducting basic science research in ischemic cardiac remodeling, heart failure, cardiac regeneration and mitral valve disease.
More about Dr. Geirsson
Name: Arnar Geirsson, MD
Title: Assistant professor of surgery (cardiothoracic); Director, Minimally Invasive Cardiac Surgery
Area of expertise: Adult cardiac surgery, minimally invasive surgery, aortic surgery, valve surgery
Place of birth: Providence, RI
College: Hamrahlid College, Reykjavik, Iceland
Med School: University of Iceland
Training: Residency in general surgery and fellowship in immunobiology and transplantation at Yale-New Haven Hospital; Fellowship in cardiothoracic surgery at Hospital of the University of Pennsylvania.
Family: Married to Sigridur Benediktsdottir, associate chair, department of economics at Yale; three sons: Benedikt, 10; Kristjan, 8; and Arnar, 5.
What is most challenging to you in academic medicine? Shuffling time and prioritizing family, academics, and clinical practice.
What is most rewarding? After cardiac operations patients and families are generally very grateful.
What do you like most about your practice? The diversity of the various operations I do and my work at the VA, in addition to my basic science laboratory.
Personal interests or pastimes:Marathon running and long-distance triathlons.
Last book read: Riddley Walker by Russell Hoban
This Article was submitted by Mark Santore, on Thursday, January 16, 2014.
Source: Yale Medical Group