February 2, 2007

Hybrid OR gets to heart of the matter

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Loretta Minor’s high-risk cardiac condition was able to be treated thanks to her determination and Vanderbilt’s Hybrid OR. (photo by Susan Urmy)

Hybrid OR gets to heart of the matter

Rashid Ahmad, M.D., made use of the Hybrid OR to treat Loretta Minor’s cardiac condition. 
(photo by Susan Urmy)

Rashid Ahmad, M.D., made use of the Hybrid OR to treat Loretta Minor’s cardiac condition.
(photo by Susan Urmy)

Within hours of undergoing a cardiovascular procedure, Loretta Minor immediately reached up to touch her chest.

She expected to feel a long, jagged scar — but there wasn't one.

Immediately she thought the doctors were unable to perform the stenting procedure she needed to unblock her main coronary artery. But then, before placing her arms back down at her sides, she remembered she was not going to have open heart surgery. Instead she reached for her right shoulder, and there she felt the thick padding.

“I just thought I had too much going on and they were not able to do the surgery,” said Minor. “But when I felt my shoulder I knew. I knew he was able to do everything he said he would.”

'He' is Rashid Ahmad, M.D., assistant professor of Cardiac Surgery at Vanderbilt University Medical Center. Minor, 68, was referred to Ahmad after a diagnosis of left main disease, a blockage in the left main coronary artery. Standard therapy for left main disease is coronary artery bypass, but not in Minor's case.

A host of medical conditions including congestive heart failure, lung disease, kidney dysfunction, poor nutritional status with unexplained weight loss in the previous six months, abdominal aneurysm and hypertension placed her in the high-risk category for any cardiac procedure, and a poor candidate for surgery.

Trying to place a stent would put Minor at risk of lethal arrhythmia and decompensation because all the blood flow would be stopped to the left side of her heart.

Stenting of the left main coronary artery with cardiopulmonary support was the best option. This involved placing Minor on a heart-lung bypass machine, which required a small incision near her right clavicle while inserting the stent via a catheter through her groin up to her heart, negating the need for open-heart surgery.

This scenario was only possible because VUMC is the only hospital in the region with a Hybrid OR. The state-of-the-art operating suite houses all the equipment and monitoring devices necessary to perform open-heart surgeries, like coronary bypass, as well as percutaneous coronary interventions and procedures, including angioplasty and stenting.

“When a patient presents with several co-morbid conditions, surgery is a big risk,” said Ahmad. “The goal is to provide an intervention that the patient benefits from and can go home from in a timely fashion. What is the point of doing surgery if a patient stays in the hospital or a nursing facility the rest of their lives because they cannot recuperate? You can do the surgery, but high-risk patients would have prolonged hospitalization.

“The recovery time is significant in making the decision about an intervention. Because the trauma to the body is far less, the recovery time is better.”

Ahmad admits that the long-term success of standard therapy is greater.

But the risks to the patient must be carefully considered. Mark Robbins, M.D., is the interventionist who collaborated with Ahmad on this case.

“The difference is that a young person can tolerate the recovery process much better. We're talking about a trade off. The risk of intervention to a patient with many co-morbid conditions must be small enough that they are able to benefit.

“For an appropriately selected group of patients who might not have other options because of co-morbid conditions, this provides them a way to address their coronary artery disease.”

It was the right solution for Minor, who spent three days at Vanderbilt. She arrived at the hospital by ambulance, unsure of her fate.

“I was home for Thanksgiving,” she said. “I had no idea I would even be coming back home when I left. No one had been able to pinpoint my problem and how to help me.

“But when Dr. Ahmad sat down next to me and took my hand and explained how he could help me, I felt so comfortable. One by one, his crew spoke to me to make sure I understood what was going on. I was no longer anxious or fearful of my outcome. It was such a relief to let go of that fear,” Minor said.

“And to know that if something was to happen, doctors would be available right there to take care of the problem. That's fantastic.”