[Music] [Applause]
[Applause]
[Applause] [Music]
[Music]
[Music] my area of expertise is in the medical
my area of expertise is in the medical
my area of expertise is in the medical and surgical treatment of heart disease
what that really means and translated
what that really means and translated into you’ve seen people with a heart
into you’ve seen people with a heart
into you’ve seen people with a heart attack coronary disease into the oil
attack coronary disease into the oil
attack coronary disease into the oil damage of the inside of the vessel wall
damage of the inside of the vessel wall
damage of the inside of the vessel wall which blocks the vessel causes poor
which blocks the vessel causes poor
which blocks the vessel causes poor blood flow to the heart and therefore
blood flow to the heart and therefore
blood flow to the heart and therefore damage and the heart dies itself in
damage and the heart dies itself in
damage and the heart dies itself in certain areas in addition a aortic
certain areas in addition a aortic
certain areas in addition a aortic stenosis is another type of disease it’s
stenosis is another type of disease it’s
stenosis is another type of disease it’s a calcium buildup on the vessel the
a calcium buildup on the vessel the
a calcium buildup on the vessel the valves are just like doors they open and
valves are just like doors they open and
valves are just like doors they open and they close so there’s two malfunctions
they close so there’s two malfunctions
they close so there’s two malfunctions they could have they can not open enough
they could have they can not open enough
they could have they can not open enough or they open too much and we’ll just
or they open too much and we’ll just
or they open too much and we’ll just look at something called a or text
look at something called a or text
look at something called a or text enosis why is coronary disease so
enosis why is coronary disease so
enosis why is coronary disease so important mainly it affects over ten
important mainly it affects over ten
important mainly it affects over ten percent of the population in the entire
percent of the population in the entire
percent of the population in the entire United States it’s the leading cause of
United States it’s the leading cause of
United States it’s the leading cause of death every 42 seconds someone has a
death every 42 seconds someone has a
death every 42 seconds someone has a heart attack every minute someone dies
heart attack every minute someone dies
heart attack every minute someone dies from heart disease the annual cost of
from heart disease the annual cost of
from heart disease the annual cost of all of this is over 200 billion dollars
all of this is over 200 billion dollars
all of this is over 200 billion dollars a year so I want to just go on a journey
a year so I want to just go on a journey
a year so I want to just go on a journey talking about the past the present and
talking about the past the present and
talking about the past the present and the future Stephen Padgett was a
the future Stephen Padgett was a
the future Stephen Padgett was a well-regarded surgeon in the late 1800s
well-regarded surgeon in the late 1800s
well-regarded surgeon in the late 1800s he founded Paget’s disease of the bone
he founded Paget’s disease of the bone
he founded Paget’s disease of the bone he was thought to be the founder of
he was thought to be the founder of
he was thought to be the founder of pathology along with Bercow but he made
pathology along with Bercow but he made
pathology along with Bercow but he made the statement early on surgery of the
the statement early on surgery of the
the statement early on surgery of the heart has probably reached the limit set
heart has probably reached the limit set
heart has probably reached the limit set by nature to all surgery no new method
by nature to all surgery no new method
by nature to all surgery no new method and no new discovery can overcome the
and no new discovery can overcome the
and no new discovery can overcome the natural difficulties that attend a wound
natural difficulties that attend a wound
natural difficulties that attend a wound of the heart
of the heart
of the heart so what he was saying is that anytime
so what he was saying is that anytime
so what he was saying is that anytime there’s damage to the heart or we need
there’s damage to the heart or we need
there’s damage to the heart or we need to operate I feel it’s impossible well
to operate I feel it’s impossible well
to operate I feel it’s impossible well let’s make an analogy it is like a
let’s make an analogy it is like a
let’s make an analogy it is like a mechanic working on an engine except now
mechanic working on an engine except now
mechanic working on an engine except now the engine is actually running there we
the engine is actually running there we
the engine is actually running there we go so really the underlying theme of
go so really the underlying theme of
go so really the underlying theme of this discussion is more about how do we
this discussion is more about how do we
this discussion is more about how do we deal with the impossibilities we have
deal with the impossibilities we have
deal with the impossibilities we have thousands of thoughts on a daily basis
thousands of thoughts on a daily basis
thousands of thoughts on a daily basis it’s all really about the growth the
it’s all really about the growth the
it’s all really about the growth the seed of growth for all of our desires
seed of growth for all of our desires
seed of growth for all of our desires the desires to achieve the extraordinary
the desires to achieve the extraordinary
the desires to achieve the extraordinary from this as long as we believe that we
from this as long as we believe that we
from this as long as we believe that we can do it it certainly will happen the
can do it it certainly will happen the
can do it it certainly will happen the impossible therefore can become possible
it took over 60 years but in the 1950s
it took over 60 years but in the 1950s Lily hi at the University of Minnesota
Lily hi at the University of Minnesota
Lily hi at the University of Minnesota figured out that well if we open up the
figured out that well if we open up the
figured out that well if we open up the heart we’re going to lose a lot of blood
heart we’re going to lose a lot of blood
heart we’re going to lose a lot of blood and where is that blog on a Duke go he
and where is that blog on a Duke go he
and where is that blog on a Duke go he thought well I could connect it to
thought well I could connect it to
thought well I could connect it to tubing and have it go to another
tubing and have it go to another
tubing and have it go to another recipient the recipient in this case was
recipient the recipient in this case was
recipient the recipient in this case was the patient father the son had a
the patient father the son had a
the patient father the son had a ventricular septal defect which is a
ventricular septal defect which is a
ventricular septal defect which is a hole right in the ventricle the hole in
hole right in the ventricle the hole in
hole right in the ventricle the hole in the heart and the blood released came to
the heart and the blood released came to
the heart and the blood released came to the patient’s father and then back to
the patient’s father and then back to
the patient’s father and then back to the patient it was their first
the patient it was their first
the patient it was their first successful operation of the heart and
successful operation of the heart and
successful operation of the heart and the 1950s this actually led to the
the 1950s this actually led to the
the 1950s this actually led to the development of by John Gibbons of the
development of by John Gibbons of the
development of by John Gibbons of the heart-lung machine so this was a major
heart-lung machine so this was a major
heart-lung machine so this was a major technological revolution because but now
technological revolution because but now
technological revolution because but now is that over millions of operations are
is that over millions of operations are
is that over millions of operations are now performed throughout the world so
now performed throughout the world so
now performed throughout the world so what about the present what are we doing
what about the present what are we doing
what about the present what are we doing now well this is the way we do the
now well this is the way we do the
now well this is the way we do the operation currently we actually open up
operation currently we actually open up
operation currently we actually open up the middle of the chest I see people
the middle of the chest I see people
the middle of the chest I see people closing their eyes
closing their eyes
closing their eyes let me tell you it’s only going to get
let me tell you it’s only going to get
let me tell you it’s only going to get worse than you might want to cover your
worse than you might want to cover your
worse than you might want to cover your ears and so what we see here is that
ears and so what we see here is that
ears and so what we see here is that when the chest is open we’ve exposed the
when the chest is open we’ve exposed the
when the chest is open we’ve exposed the pericardium which is the SAC around the
pericardium which is the SAC around the
pericardium which is the SAC around the heart and here’s the heart and it’s
heart and here’s the heart and it’s
heart and here’s the heart and it’s allowed us to do operations such as on
allowed us to do operations such as on
allowed us to do operations such as on the blood vessels to make sure blood
the blood vessels to make sure blood
the blood vessels to make sure blood flow on the valves to make sure if
flow on the valves to make sure if
flow on the valves to make sure if they’re infected if they leak if they’re
they’re infected if they leak if they’re
they’re infected if they leak if they’re stenotic that replaced them the aorta
stenotic that replaced them the aorta
stenotic that replaced them the aorta which is the blood vessel of the body
which is the blood vessel of the body
which is the blood vessel of the body that allows the blood to circulate
that allows the blood to circulate
that allows the blood to circulate throughout the body to repair that if
throughout the body to repair that if
throughout the body to repair that if it’s torn or enlarged eruption there’s
it’s torn or enlarged eruption there’s
it’s torn or enlarged eruption there’s new technology coming along now called
new technology coming along now called
new technology coming along now called tavor trans a ortak valve replacement so
tavor trans a ortak valve replacement so
tavor trans a ortak valve replacement so what you see here is that the catheter
what you see here is that the catheter
what you see here is that the catheter is passed up through the femoral artery
is passed up through the femoral artery
is passed up through the femoral artery through the aorta and up to where the
through the aorta and up to where the
through the aorta and up to where the aortic valve resides of this catheter is
aortic valve resides of this catheter is
aortic valve resides of this catheter is the valve itself and is crimped on the
the valve itself and is crimped on the
the valve itself and is crimped on the catheter it is then expanded and then
catheter it is then expanded and then
catheter it is then expanded and then deployed such that we don’t even have to
deployed such that we don’t even have to
deployed such that we don’t even have to open the chest to do this operation I
open the chest to do this operation I
open the chest to do this operation I think this is going to be a technique
think this is going to be a technique
think this is going to be a technique within the next several years that is
within the next several years that is
within the next several years that is probably going to take over open-heart
probably going to take over open-heart
probably going to take over open-heart surgery this is called robotic surgery
surgery this is called robotic surgery
surgery this is called robotic surgery what we see here multiple arms are about
what we see here multiple arms are about
what we see here multiple arms are about five or six arms that are inserted into
five or six arms that are inserted into
five or six arms that are inserted into the chest cavity to expose the heart and
the chest cavity to expose the heart and
the chest cavity to expose the heart and the surgeon isn’t even at the table the
the surgeon isn’t even at the table the
the surgeon isn’t even at the table the surgeon is over here at a console what I
surgeon is over here at a console what I
surgeon is over here at a console what I find what I’ve tried to use this is as
find what I’ve tried to use this is as
find what I’ve tried to use this is as probably if you learn how to play video
probably if you learn how to play video
probably if you learn how to play video games so if any of you are doing that
games so if any of you are doing that
games so if any of you are doing that now is the time
but there are certain barriers to
but there are certain barriers to minimally invasive cardiac surgery one
minimally invasive cardiac surgery one
minimally invasive cardiac surgery one of those is finding the optimal
of those is finding the optimal
of those is finding the optimal procedure technique unfortunately we’re
procedure technique unfortunately we’re
procedure technique unfortunately we’re talking about doing this on live people
talking about doing this on live people
talking about doing this on live people to start and it takes many years
to start and it takes many years
to start and it takes many years sometimes to do that there’s a steep
sometimes to do that there’s a steep
sometimes to do that there’s a steep learning curve sometimes you have to
learning curve sometimes you have to
learning curve sometimes you have to operate on fifty to a hundred people to
operate on fifty to a hundred people to
operate on fifty to a hundred people to really get it right capital requirements
really get it right capital requirements
really get it right capital requirements that robot that we showed you is over a
that robot that we showed you is over a
that robot that we showed you is over a million and a half to two million
million and a half to two million
million and a half to two million dollars and there’s an annual cost of
dollars and there’s an annual cost of
dollars and there’s an annual cost of about a quarter of a million dollars a
about a quarter of a million dollars a
about a quarter of a million dollars a year and the reimbursement constraints
year and the reimbursement constraints
year and the reimbursement constraints whenever something new coming out just
whenever something new coming out just
whenever something new coming out just like there’s another procedure that I do
like there’s another procedure that I do
like there’s another procedure that I do called Broca’s navigational bronchoscopy
called Broca’s navigational bronchoscopy
called Broca’s navigational bronchoscopy the different third-party payers that
the different third-party payers that
the different third-party payers that are in medicine now they like were
are in medicine now they like were
are in medicine now they like were minimal and will not pay for it what
minimal and will not pay for it what
minimal and will not pay for it what this really results and just what i
this really results and just what i
this really results and just what i wanted to show is that in nineteen sixty
wanted to show is that in nineteen sixty
wanted to show is that in nineteen sixty the gross domestic product it was only
the gross domestic product it was only
the gross domestic product it was only five percent of the overall cost and now
five percent of the overall cost and now
five percent of the overall cost and now we fast forward to 2010 dollars and the
we fast forward to 2010 dollars and the
we fast forward to 2010 dollars and the expected growth is that by 2050 it will
expected growth is that by 2050 it will
expected growth is that by 2050 it will be over sixty percent of the gross
be over sixty percent of the gross
be over sixty percent of the gross domestic product so in the past it was
domestic product so in the past it was
domestic product so in the past it was very affordable although and in the
very affordable although and in the
very affordable although and in the present we don’t know if it’s going to
present we don’t know if it’s going to
present we don’t know if it’s going to be sustainable so for those of you who i
be sustainable so for those of you who i
be sustainable so for those of you who i saw cover your eyes you might want to do
saw cover your eyes you might want to do
saw cover your eyes you might want to do that again do i need to push it you want
that again do i need to push it you want
that again do i need to push it you want to cut it down a little cut it down so
to cut it down a little cut it down so
to cut it down a little cut it down so so what we see here is opening the
so what we see here is opening the
so what we see here is opening the sternum the breastbone there to expose
sternum the breastbone there to expose
sternum the breastbone there to expose the heart this was one i just did a
the heart this was one i just did a
the heart this was one i just did a couple days ago we’ve done several
couple days ago we’ve done several
couple days ago we’ve done several here’s the pericardium the SAC around
here’s the pericardium the SAC around
here’s the pericardium the SAC around the heart and these are the lungs that
the heart and these are the lungs that
the heart and these are the lungs that you see expanding back and forth as the
you see expanding back and forth as the
you see expanding back and forth as the patient is on the ventilator
patient is on the ventilator
patient is on the ventilator what i’m doing here is opening the SAC
what i’m doing here is opening the SAC
what i’m doing here is opening the SAC around the heart to actually expose the
around the heart to actually expose the
around the heart to actually expose the heart you see the right ventricle on top
heart you see the right ventricle on top
heart you see the right ventricle on top the left ventricle is sitting below here
the left ventricle is sitting below here
the left ventricle is sitting below here is the pulmonary artery where you see
is the pulmonary artery where you see
is the pulmonary artery where you see the suction catheter and here’s exposure
the suction catheter and here’s exposure
the suction catheter and here’s exposure of the aorta and the right atrium this
of the aorta and the right atrium this
of the aorta and the right atrium this is the tubing that’s going to be
is the tubing that’s going to be
is the tubing that’s going to be connected to the heart-lung machine so
connected to the heart-lung machine so
connected to the heart-lung machine so this is the right atrium that is
this is the right atrium that is
this is the right atrium that is connected to so we take the blood from
connected to so we take the blood from
connected to so we take the blood from the heart so that we can quiet the heart
the heart so that we can quiet the heart
the heart so that we can quiet the heart and work in a bloodless field this is
and work in a bloodless field this is
and work in a bloodless field this is going into the aorta we’re returning
going into the aorta we’re returning
going into the aorta we’re returning oxygenated blood free of any debris back
oxygenated blood free of any debris back
oxygenated blood free of any debris back to the rest of the body for the brain we
to the rest of the body for the brain we
to the rest of the body for the brain we are all connected now you see the heart
are all connected now you see the heart
are all connected now you see the heart beating and now we’ve clamped the aorta
beating and now we’ve clamped the aorta
beating and now we’ve clamped the aorta we stop the heart and at this point and
we stop the heart and at this point and
we stop the heart and at this point and this is the picture of the heart-lung
this is the picture of the heart-lung
this is the picture of the heart-lung machine as you saw which came about in
machine as you saw which came about in
machine as you saw which came about in the late 1950s I’m opening up the aorta
the late 1950s I’m opening up the aorta
the late 1950s I’m opening up the aorta at this time to expose the valve here is
at this time to expose the valve here is
at this time to expose the valve here is a bicuspid valve normally there should
a bicuspid valve normally there should
a bicuspid valve normally there should be three leaflets there’s only two this
be three leaflets there’s only two this
be three leaflets there’s only two this is a congenital abnormality and this is
is a congenital abnormality and this is
is a congenital abnormality and this is why this person has such problems they
why this person has such problems they
why this person has such problems they were only in their 50s very short of
were only in their 50s very short of
were only in their 50s very short of breath a lot of chest pain this is the
breath a lot of chest pain this is the
breath a lot of chest pain this is the bicuspid valve this is the new valve
bicuspid valve this is the new valve
bicuspid valve this is the new valve that is made from pure cardium of a cow
that is made from pure cardium of a cow
that is made from pure cardium of a cow and this is what is being implanted we
and this is what is being implanted we
and this is what is being implanted we see it in planted here within the aorta
see it in planted here within the aorta
see it in planted here within the aorta and now I’m closing up the aorta if I
and now I’m closing up the aorta if I
and now I’m closing up the aorta if I try to tow any of this minimally
try to tow any of this minimally
try to tow any of this minimally invasive you wouldn’t see it any of it
now all the tubing is out the heart is
now all the tubing is out the heart is back to beating we close the sternum
back to beating we close the sternum
back to beating we close the sternum with wires to bring the chest together
and this patient was done on monday and
and this patient was done on monday and should be going home tomorrow so so what
should be going home tomorrow so so what
should be going home tomorrow so so what does the future look like of course i
does the future look like of course i
does the future look like of course i could start talking about a number of
could start talking about a number of
could start talking about a number of different items but there’s something
different items but there’s something
different items but there’s something that is interested to me now that
that is interested to me now that
that is interested to me now that actually i’m starting to get involved
actually i’m starting to get involved
actually i’m starting to get involved with and that’s called pris / just by a
with and that’s called pris / just by a
with and that’s called pris / just by a show of hands how many people have heard
show of hands how many people have heard
show of hands how many people have heard of crisper oh very knowledgeable
of crisper oh very knowledgeable
of crisper oh very knowledgeable audience what does it stand for now so
audience what does it stand for now so
audience what does it stand for now so crisper is clustered regularly
crisper is clustered regularly
crisper is clustered regularly interspaced short palindromic repeat so
interspaced short palindromic repeat so
interspaced short palindromic repeat so palindromic meaning of course backwards
palindromic meaning of course backwards
palindromic meaning of course backwards or forwards the same and what that is is
or forwards the same and what that is is
or forwards the same and what that is is that bacteria for billions of years have
that bacteria for billions of years have
that bacteria for billions of years have been able to understand the genetic code
what happens is this is the bacteria
what happens is this is the bacteria whenever a virus or other microorganism
whenever a virus or other microorganism
whenever a virus or other microorganism invades the cell the DNA of the bacteria
invades the cell the DNA of the bacteria
invades the cell the DNA of the bacteria is able to actually recognize this and
is able to actually recognize this and
is able to actually recognize this and incorporate it between the spacer once
incorporate it between the spacer once
incorporate it between the spacer once it does that through transcription the
it does that through transcription the
it does that through transcription the crisper RNA the messenger and RNA is
crisper RNA the messenger and RNA is
crisper RNA the messenger and RNA is produced and once that’s produced any
produced and once that’s produced any
produced and once that’s produced any time there’s any other invasion of a
time there’s any other invasion of a
time there’s any other invasion of a microorganism or virus it recognizes
microorganism or virus it recognizes
microorganism or virus it recognizes that gene and incorporates itself in the
that gene and incorporates itself in the
that gene and incorporates itself in the exact location what is able to do so you
exact location what is able to do so you
exact location what is able to do so you then destroy that gene so that it’s no
then destroy that gene so that it’s no
then destroy that gene so that it’s no longer functional so i can either
longer functional so i can either
longer functional so i can either silence it so that it is non-functional
silence it so that it is non-functional
silence it so that it is non-functional or it can edit to actually have a
or it can edit to actually have a
or it can edit to actually have a totally new function that as at the
totally new function that as at the
totally new function that as at the direction of the lab this is currently
direction of the lab this is currently
direction of the lab this is currently being done today so what are the
being done today so what are the
being done today so what are the benefits of crisper i bring this up
benefits of crisper i bring this up
benefits of crisper i bring this up mainly from the standpoint
mainly from the standpoint
mainly from the standpoint I think we could see eradication
I think we could see eradication
I think we could see eradication eradication of heart disease and cancer
eradication of heart disease and cancer
eradication of heart disease and cancer they’re already working on it for cures
they’re already working on it for cures
they’re already working on it for cures of infectious diseases such as aids in
of infectious diseases such as aids in
of infectious diseases such as aids in addition for genetic diseases from
addition for genetic diseases from
addition for genetic diseases from Alzheimer’s marfans a number of things
Alzheimer’s marfans a number of things
Alzheimer’s marfans a number of things the one that I’m actually involved with
the one that I’m actually involved with
the one that I’m actually involved with is which Fuchs disease so again the boy
is which Fuchs disease so again the boy
is which Fuchs disease so again the boy who had the ventricular septal defect
who had the ventricular septal defect
who had the ventricular septal defect maybe could be treated with crisper
maybe could be treated with crisper
maybe could be treated with crisper coronary artery disease actually could
coronary artery disease actually could
coronary artery disease actually could be eradicated the main issues with
be eradicated the main issues with
be eradicated the main issues with disease such as that is one of the risk
disease such as that is one of the risk
disease such as that is one of the risk factors hypertension hyperlipidemia
factors hypertension hyperlipidemia
factors hypertension hyperlipidemia diabetes that’s a reversible process
diabetes that’s a reversible process
diabetes that’s a reversible process through genetic engineering also that of
through genetic engineering also that of
through genetic engineering also that of lung cancer I lobectomy for lung cancer
lung cancer I lobectomy for lung cancer
lung cancer I lobectomy for lung cancer in the future we’ll see if that’s still
in the future we’ll see if that’s still
in the future we’ll see if that’s still the case now there’s top could you
the case now there’s top could you
the case now there’s top could you actually be taller more muscular could
actually be taller more muscular could
actually be taller more muscular could it be that you change your eye color or
it be that you change your eye color or
it be that you change your eye color or as we look at this we would say we’re
as we look at this we would say we’re
as we look at this we would say we’re looking at this picture from right to
looking at this picture from right to
looking at this picture from right to left but now it might be that you’re
left but now it might be that you’re
left but now it might be that you’re looking at it from left to right because
looking at it from left to right because
looking at it from left to right because now people are talking about working on
now people are talking about working on
now people are talking about working on aging so my overall thought as far as
aging so my overall thought as far as
aging so my overall thought as far as this process is is that the way we think
this process is is that the way we think
this process is is that the way we think develops into our belief system and our
develops into our belief system and our
develops into our belief system and our desires and from that we form our habits
desires and from that we form our habits
desires and from that we form our habits and our habits shape our future thank
and our habits shape our future thank
and our habits shape our future thank [Applause]
[Applause]
[Applause] you
you
you [Applause]
”
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