The Q&A: Joseph Lamelas

With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week's subject:

Dr. Joseph Lamelas is associate chief of cardiac surgery at Baylor College of Medicine. We spoke with him about his experience with performing minimally invasive cardiac surgeries and how advancements in the field are helping to treat mitral valve disease, a condition that involves irregularities with the mitral valve in the heart. 

Editor's note: This interview has been edited for length and clarity.

Trib+Health: Can you briefly explain what mitral valve disease is? 

Joseph Lamelas: The blood that comes through the lungs goes through a chamber called the atrium, then through the ventricle where it goes to the rest of the body. The valves to the heart are essentially like doors, they open and close. The mitral valve is one of the most atomic valves that gets affected with either stenosis — what we call a narrowing of the valve — or insufficiency, which is a leak. When it's insufficient, the doors open well but they don't close well, so the blood goes back into the lungs. That's what we call a leaking mitral valve. 

When patients have a leak in the mitral valve, the blood goes through it, but instead of continuing out to the rest of the body, it goes back to where it came from, which is the lungs. 

Trib+Health: How are minimally invasive heart procedures different than other attempts to treat the disease? 

Lamelas: The minimally invasive approach is the least traumatic of all operations. Few require blood products afterward, and both the recovery in the hospital and return to a normal lifestyle are a lot quicker than any other operations. 

The minimally invasive approach is done through a 2-inch incision on the side of the chest without breaking the ribs. You go between the ribs with specialized instruments. Some of those instruments I've developed to facilitate the operation. I'm able to repair the valve by going between the ribs with specialized instruments, and I feel it's a more direct vision. The mitral valve is behind the heart, and you can see it from the side much better. 

This is not a procedure you start from day one. I've been in practice for 26 years and for the past 12 years I've been doing minimally invasive surgery. I've done over 14,000 operations. You need a little a little bit of experience before you can repair problems with the mitral valve.  

Trib+Health: Can you expand on how you came to develop tools for minimally invasive operations? 

Lamelas: 12 years ago when I started doing this operation, there were very few companies that had sufficient instruments to do the procedure through a minimally invasive approach. I operated on a patient who happened to be an engineer, who then helped me develop the instruments.

Those instruments are now available nationwide for surgeons to use. They allow you to visualize the different chambers of the heart in order to do the operation. In surgery, the most important thing is exposure — you have to be able to see it to do it. These instruments are exposure devices and allow you to see what you do. They also help facilitate other parts of the operation. 

Trib+Health: What are some of the biggest challenges currently facing the minimally invasive procedure climate? 

Lamelas: The big issue is that there aren't enough surgeons that can do this because it requires additional training and learning different skill sets. Very few learn this approach during their training program; they usually learn it on the job training afterward, like I did. You have to have the drive and determination to stay on the path and go through the learning curve. 

Trib+Health: What are your plans to continue advancing this field in the future? 

Lamelas: I think all surgery, especially cardiac surgery, needs to become less invasive, because it will be better for the patient. I'm going to be developing new instruments and expanding the application of this approach to different types of problems with the heart. Every day I'm in the operating room, I continue to learn how to make the technique better.