"There is no doubt in my mind that this is where spine surgery is headed, and I'm excited to be able to bring these advances to Middle Tennessee," Shibayama concluded.Hemodynamic loading is known to contribute to the development and progression of pulmonary arterial hypertension (PAH). but in addition to that, the post-operative pain is much less to the point where the surgery can be done as an outpatient." Other advantages, he continued, are a much abbreviated recovery time and faster return to work and normal activities. That reduction in complication rate alone is a massive advantage. Recognizing most spine surgeons have similar hesitation over minimally invasive procedures, Shibayama noted, "I have never had a deep infection with this surgery, nor have I ever had to return the patient to the operating room for repair of a dural tear. Instead, he said, "Doing the surgery arthroscopically allowed surgeons to have great visualization and perform an excellent surgery without causing collateral damage." "That was when arthroscopy was just becoming popular." He noted at the time, many surgeons thought the newer technique wouldn't take off, as it would prove to be inferior to open surgery. "Spine surgery today is where sports medicine was 50 years ago," said Shibayama. Shibayama had already reduced hospitalization to an overnight stay for observation before moving to an ambulatory setting this fall. Traditional open surgery typically requires a hospital stay of two to three days. Shibayama has been perfecting the spinal fusion procedure for the last eight years. The procedure is done by dilating the muscles therefore, there is no trauma to the muscles and ligaments to the spine during the surgery." "Rather than stripping and burning the muscles off the spine in a traditional open approach, doing it this way preserves the muscles and ligaments. "The minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is all about reducing the collateral damage done to the tissues during surgery," said Shibayama. Juris Shibayama, MD, an orthopaedic surgeon with Tennessee Orthopaedic Alliance in Smyrna, recently performed minimally invasive, same-day, outpatient lumbar surgery. In February 2017, the Tryton Side Branch Stent became the first dedicated bifurcation stent to receive regulatory approval in the United States. A conventional drug eluting stent is then placed in the main vessel. It is deployed in the side branch artery using a standard single wire balloon-expandable stent delivery system. The Tryton Side Branch Stent is a cobalt chromium stent based on Tri-ZONE ® technology engineered to provide complete lesion coverage. Myers said the side branch stent allows for total accommodation of the anatomy of the bifurcation without blocking the blood flow to the smaller vessels with an end result of more predictable patient outcomes and less likelihood of artery plaque shifting into larger side branches after a stent implantation. While provisional stenting of the main branch is the current standard of care, the side branch is not stented in many cases and can be compromised by shift of plaque from the main vessel into the side branch. "This innovative and comprehensive approach allows us to treat patients with complex and high-risk blockages that involve arteries with important larger branches off the main heart artery," said Myers.Īpproximately 20-30 percent of patients undergoing percutaneous coronary intervention (PCI) to open blocked arteries have a bifurcation lesion. The procedure was performed at TriStar Centennial Heart and Vascular Center led by Paul Myers, MD, in collaboration with Jeffrey Webber, MD, who are both interventional cardiologists with Centennial Heart. In late October, TriStar Centennial Medical Center announced completion of Middle Tennessee's first procedure utilizing the Tryton Side Branch Stent to treat a coronary bifurcation lesion involving a large side branch 2.5 mm or greater.
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