March 14, 2008

New approach eases cardiac surgery

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VHVI cardiac surgeons are using Medtronic's stabilizing devices to hold the beating heart still while they perform minimally invasive coronary artery bypass. (courtesy Medtronic Inc.)

New approach eases cardiac surgery

Kenneth Hensley, 61, of Gleason, Tenn., had significant blockage of his left main coronary artery, known as the “widow-maker” because of its high mortality risk if left untreated.

Not that long ago, the standard treatment was coronary artery bypass surgery by sternotomy, or cutting apart the breastbone.

Cardiac surgery, like most fields of surgery, has evolved toward minimally invasive techniques, and Hensley is the beneficiary of this new approach.

For a number of health reasons, including severe lung disease and a tracheostomy, Hensley was not a candidate for sternotomy. He had already received stents to open his arteries, but they clogged again.

He was referred to Vanderbilt Heart & Vascular Institute's Steven Hoff, M.D., assistant professor of Cardiac Surgery, who proposed an alternative bypass option.

Hoff operated on Hensley using a minimally invasive coronary artery bypass graft (MICS CABG) procedure. Instead of opening Hensley's chest through a sternotomy, Hoff performed a mini thoracotomy — or incision — on the left side of his chest near his rib cage.

While this procedure is gaining momentum at some medical centers for single vessel bypass, Vanderbilt is one of the few places using it for multi-vessel bypass.

New technology in the form of stabilizing devices has made this procedure possible.

These new devices hold the heart still and allow the surgeon to operate 'off-pump,' or without the use of a heart-lung machine. The patient receives the dual benefit of a smaller incision and avoiding the heart lung machine. Both contribute to a quicker recovery.

“We were impressed with this being the next step in off-pump surgery,” said Hoff, who, along with Stephen Ball, M.D., assistant professor of Cardiac Surgery, have performed four MICS CABGs over the last two months.

“We're using this for patients who probably could not have had this operation any other way. We have been impressed with the results. As we continue to gain expertise and see improved instrumentation, we'll be able to offer this to more and more patients,” Hoff said.

Sternotomy carries with it a small risk of bone infection, which is a significant, and sometimes fatal, setback requiring additional surgery to treat.

It also carries a six- to eight-week recovery time for patients to resume normal activity.

Patients undergoing thoracotomy, on the other hand, are able to do so in two to three weeks.

Despite the obvious benefits of a smaller, less invasive procedure, Hoff and Ball are selecting patients carefully and moving ahead cautiously.

“We feel it's critically important that the patients who get a thoracotomy are getting the same operation as those with a sternotomy, and we don't lose the effectiveness of the operation by trying to do it through a limited approach,” Hoff said.

Hensley, who was discharged three days after his surgery, is thankful to be on the receiving end of the latest technology.

“I'm very proud of Dr. Hoff. He's a very good doctor and he did a very good job. I'm going home; that's all that matters,” he said.