Nation/World

Smaller Incisions The Cutting Edge For Some Patients Minimally Invasive Surgery Gains In Popularity

George Johnson’s heart wasn’t bothering him, but it occasionally missed a beat.

The 90-year-old Mead man learned last summer that his aortic valve had worn out. He was told he needed valve surgery. He didn’t want it.

“I said, ‘Well, I don’t think I can have an operation because I’m too old,”’ Johnson recalled. “I said, ‘If you have a Model-T Ford, you’re not going to put in a new carburetor.’

“At my age, I didn’t think it was necessary to open my chest.”

But a surgeon gave Johnson a pig’s valve without fully lifting his hood. Dr. Mandya Vishwanath performed the surgery through a smaller incision, part of a growing trend in minimally invasive surgery.

The movement started in 1990 when doctors found they could remove gallbladders through tiny slits in the stomach.

Now, it’s moving to the heart. Some of the most common open-heart procedures are starting to be performed through smaller cuts than in the past.

Vishwanath started repairing and replacing heart valves through smaller incisions on select patients about eight months ago.

On Monday, four surgeons performed the first smaller-cut heart bypass surgery in the region. Led by Dr. Roberto Amado-Cattaneo of Spokane, they used special equipment and techniques that allow surgery on a beating heart.

Doctors traditionally split the chest open and stop the heart to perform bypass surgeries, which reroute blood around blocked heart arteries.

The patient, a 60-year-old man, was talking and awake in Sacred Heart Medical Center late Monday afternoon.

“It went very well,” said Vishwanath, one of the surgeons helping Amado-Cattaneo.

Some doctors are skeptical about the new wave of minimally invasive surgery, but national studies show those surgeries offer less risk, less pain and faster recovery times at a lower cost than traditional surgery.

A Johns Hopkins University study released last fall found that minimal-incision bypass surgery costs $10,000, compared with $17,000 for the standard surgery.

Heart surgeons have been experimenting with the new approaches for more than two years in certain hospitals worldwide.

The new valve surgeries can only be performed on patients who meet specific technical requirements, including access to the troubled valve.

The new bypass surgeries can only be performed on a bypass of one artery, although experts predict the technique ultimately will be used for multiple bypasses.

“The No. 1 consideration here is patient welfare,” Vishwanath said.

In the new bypass surgery, doctors make a 3-inch cut beneath the left breast between the fourth and fifth ribs, expose the beating heart, suspend the artery with stabilizing clips and perform the bypass.

Traditionally, doctors slice open the chest, saw through the breast bone and pry open the rib cage. The heart is stopped, the patient’s hooked up to a heart-lung machine and doctors sew in new pieces of artery.

In traditional valve surgery, the breast bone also is split in half, leaving a scar stretching from the neck to the stomach.

Vishwanath can now perform an entire valve surgery through an incision about 3 inches long using traditional equipment and a heart-lung machine.

Already, a half-dozen patients in Spokane have received new aortic or mitral valves, the most common types of valve surgery.

Johnson was walking around the hospital two days after his surgery on Oct. 7. He would have been a high-risk patient for a traditional valve surgery, Vishwanath said.

Last week, Johnson ran his fingers over the pink scar. He said he never felt any pain.

“It never did bother me,” he said. “After the operation, the only thing that ever happened was a muscle spasm. This thing was never much of a pain at all.”

, DataTimes ILLUSTRATION: Photo Graphic: New heart surgery techniques



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