Medical Tests & Procedures Archive

Here's what you can do to get back on your feet quickly.

More than 415,000 people with coronary artery disease undergo coronary artery bypass grafting (CABG) every year. It's a big operation, but remarkably safe: although results vary among cities and states, the combined survival rate for all CABG procedures performed in Massachusetts hospitals is 98.7%.

How does controversy affect your treatment?

Pelvic organ prolapse is in the national spotlight because the surgical mesh sometimes used to keep pelvic organs in place can cause complications: infection, pain, urinary trouble, and recurrence of the original problem. So what do you do if you're struggling with a sagging bladder, uterus, or rectum?

The sagging truth

For about 50% of mostly older women, the connecting tissues and muscles that hold the pelvic organs in place weaken and stretch over time, causing the organs to descend (prolapse) into the vagina. Sometimes an organ falls so much it's visible at the vaginal opening. That happens to 10% to 15% of all women, according to Dr. George Flesh, director of urogynecology and pelvic reconstructive surgery for Harvard Vanguard Medical Associates.

An implantable cardioverter-defibrillator (ICD) helps establish a healthy heart rhythm and prevent sudden cardiac death. But psychosocial support needed to adjust to life with an ICD is often overlooked after the devices are implanted.

Q. I have had back problems for decades, and I have become quite dependent on oxycodone, regardless of whether my back is acting up or not. Now I am going to need heart surgery, but the surgeon I was sent to won't operate unless I can get off the pain pills. That seems cruel. What is he thinking?

A. Certainly if surgery were urgent, you could have a heart operation. But since your surgery is not urgent, it would be much better if you find a way to stop your oxycodone use first. You are going to need pain medications in the period after surgery, and when someone has addiction problems, the clinicians never know whether they are giving too much or not enough of these medications. In addition, surgeons want their handiwork to have lasting benefit, so showing that you can control your addiction problem helps assure your doctors that you will able to stick with your regimen after surgery—that is, take the medications you need to prevent recurrence. Even though this advice may seem hard-hearted, it is surely based upon some past experiences.

In coronary artery bypass grafting (CABG), the internal mammary (or thoracic) artery is the graft of choice for bypassing blockages in the main coronary artery, because it tends to remain open and functioning well for many years.

The way public data are presented may influence your choice.

If you're shopping for a car, it's easy to find information on gas mileage, repair rate, and other factors of interest to consumers. Moreover, it's possible to compare models in order to find which one is most likely to meet your needs. Can you do the same with heart surgeons?

How robots are transforming minimally invasive surgical procedures.

In an operating room at Brigham and Women's Hospital in Boston, Dr. Colleen Feltmate performs a hysterectomy on a woman with uterine cancer. As Dr. Feltmate operates, she doesn't stand next to the patient, but in front of a monitor and console. The hands holding the instruments are not her own—they belong to a robot.

Robot-assisted techniques are the next generation in minimally invasive surgery. Surgeons can now perform laparoscopic procedures with the assistance of remotely controlled instruments attached to a robot's arms. At Brigham and Women's (BWH)—and at other hospitals around the country—doctors are using robots to do everything from removing uterine fibroids (myomectomy) to cutting out kidney tumors (radical and partial nephrectomy).

Many factors go into your physician's recommendation.

When fatty plaques threaten to obstruct the coronary arteries, there are two options for restoring blood flow (otherwise known as revascularization): open the blockages with a balloon (angioplasty), followed by the placement of a stent; or bypass the blockages with coronary artery bypass grafting (CABG).

Balloon angioplasty can open a narrowed artery, and the stent (an expandable wire mesh cylinder) can hold it open. Angioplasty and stenting is a minimally invasive, nonsurgical procedure with less postoperative pain, a shorter hospital stay, and faster recovery than CABG. So it's no surprise that its popularity has soared. But despite these advantages, it's not the best choice for everyone. Now that thousands of stents have been implanted, cardiologists better understand the long-term effects of the procedure and can make an informed decision about which treatment might be best for each individual.

Bariatric surgery may significantly reduce a person's odds of developing type 2 diabetes. This stomach procedure that restricts food intake may reduce the long-term incidence of type 2 diabetes in obese individuals.

Many therapies can be effective, but care must be individualized.

Modern treatments for heart disease have saved many people. Some of them, however, now live with heart failure—a heart that does not function well. Blood from the body is constantly returning to the heart and then being pumped out to the body. A "failing" heart either resists the inflow of blood, struggles to pump it out, or both.