For Immediate Release Contact: Gina M. DiGravio May 19, 1997 Steven Hatch
(617) 638-8491
Cardiac Surgeons Use Cutting Edge Technique with Less "Cut"
Within the past ten years a revolution in surgery has been taking place, as procedures have become less and less invasive. Now doctors at the Boston Medical Center are at the forefront of this revolution, pioneering minimally invasive techniques on the body s most vital organ: the heart.
In the past year, Richard Shemin, MD, Vice Chair of Surgery and Chief of Cardiothoracic Surgery, has been performing coronary artery bypasses and valve replacements on patients without opening the rib cage (a procedure known as a sternotomy ). By avoiding the physical trauma of the sternotomy, minimally invasive operations are believed to lessen post-operative discomfort, decreasing the time the patient needs to make a full recovery.
In some cases we send patients home in two days, and they return to work in one week, said Shemin. Typically, a hospital stay for cardiac surgery requires four to six days in the hospital.
One type of minimally invasive surgery involves performing a coronary artery bypass while the heart is still beating. Traditionally any surgery done on the heart requires stopping it and placing the patient on a
heart-lung machine, which essentially performs the heart s work. The drawback to using the heart-lung machine, however, is that patients are at higher risk of developing a stroke, possibly due to bits of plaque that are dislodged from the artery walls when the heart is stopped. Using a coronary-artery stabilization technique along with equipment designed by the California-based CardioThoracic Systems, the experimental surgery can decrease this risk. Shemin currently performs this procedure for single and double-bypass operations.
More complex operations, such as valve replacements and multiple-bypasses, are likewise feasible using the minimally invasive model.
These operations do need a stopped heart, which until recently required a sternotomy to have access to the entire heart and the surrounding blood vessels. But another California-based company, HeartPort, has designed catheters which stop blood flow to the heart from the inside of the blood vessels, avoiding the need for access to the entire heart and surrounding blood vessels. Thus the need for a sternotomy is unnecessary.
The catheters are inserted through the neck and leg and circulate the blood from there to the heart-lung machine. HeartPort s equipment therefore allows surgeons to perform a wider array of minimally invasive procedures.
Shemin s team is fluent in both techniques. His most recent operations with the new equipment include a combination valve replacement/coronary artery bypass and complex operations such as human heart valve transplants and aorta replacements. He believes that the success of the new techniques have significant benefits to patients undergoing surgery: If the short-term results are the same as traditional surgery, I suspect the benefits of less postoperative pain, shorter hospital stays and more rapid recuperation will allow less invasive surgical approaches to become the norm instead of the exception in cardiac surgical practice.
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