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Dr. David Mishaly

A less invasive approach to pediatric heart surgery

by Gus Iversen , Editor in Chief
Congenital heart defects (CHD), also known as congenital heart anomaly, is a defect found in the structure in the heart that can be detected at birth. While most conventional treatments may include invasive surgical procedures, Sheba Medical Center in Israel has successfully implemented a minimally invasive surgical technique in young patients developed by Dr. David Mishaly, the director of the center’s Pediatric and Congenital Cardiothoracic Surgery.

The minimally invasive procedure is performed via a small (4cm) incision under the patient's right breast. This allows for minimal scarring as the child matures – the small scar remains hidden under the future breast. When compared to conventional open-heart surgery, the recovery process is much simpler, the central chest area is left intact, the aesthetic result is considerably more appealing and the overall medical outcomes are not compromised.

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HealthCare Business News spoke to Mishaly about the treatment and what drove him to seek a new method of treating the CHD.

HCB News: You have developed your own technique for treating congenital heart disease in children. Can you tell us what need you set out to meet with your novel approach?
Dr. David Mishaly: The technique I used is already well known and commonly performed in adult cardiac surgery. My innovation involved implementing the technique for children. In order to do so, we needed to improvise cannulas, cameras and surgical machines to facilitate the procedure.

We had to develop special tubes that enabled connection to a heart-lung machine through a small incision. Machines had to be specifically adapted for children. And of course, we had to establish the optimal way of repairing the defect.

HCB News: How did you come to develop the technique and what is it called?
DM: It greatly disturbed me that a high proportion of defects can be completely repaired, without affecting the child’s physical condition, but little attention was being paid to the aesthetics of the scar left along the middle of the child’s chest and the immeasurable emotional, psychological and social after effects.

I set out to find a solution to this very issue. Initially, I called the technique Minimal/Less Invasive Congenital Heart Surgery. I subsequently referred to it as Aesthetic Consideration in Congenital Heart Surgery.

HCB News: Does the procedure require any specialized tools? How many people are involved in the procedure?
DM: It doesn’t require special devices or equipment, rather the adaptation of existing equipment for this specific purpose. Nevertheless, there is, of course, room for advances and improving the method by developing suitable machinery.

HCB News: How do the outcomes from this procedure compare to the outcomes from conventional pediatric congestive heart disease treatment?
DM: The medical outcomes are identical to those of the conventional procedure, however admission and recovery times are reduced using my technique.

HCB News: Currently Sheba Medical Center is the only hospital performing this procedure. Do you expect other facilities to begin adopting it?
DM: Like any new procedure, it must first be studied and requires extensive practical experience. I hope it will also be adopted in other medical centers, but I am currently unaware of the technique being used elsewhere.

HCB News: Can the principles of this procedure be applied to treating other medical conditions less invasively?
DM: My impression is that pediatric heart surgery is one of the last specialties to implement these principles. As a result, I don’t expect that the benefits of this technique will be applied to other medical situations, as they have already implemented these principles.

HCB News: Approximately how many of the procedures have been performed?
DM: So far, over 250 operations have been performed to date.

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