Coronary bypass patients recover faster, have lower hospital bills and suffer much less pain if doctors fix their hearts through a tiny slit in the chest instead of splitting open the rib cage, the standard approach the past 30 years, a study has found.
Surgeons have been experimenting with the new approach, called keyhole surgery, for about two years. On Monday, they released the first head-to-head comparisons with the traditional operation, which is performed on more than 400,000 Americans annually.
So far, doctors are using keyhole surgery on patients with single blockages - only about 5 percent of all bypass patients. But the field is moving so quickly that experts expect more complicated operations will be done this new way within a year or two.
“This is just the beginning,” said Dr. Renee S. Hartz of Illinois Masonic Medical Center in Chicago.
In a presentation at the annual scientific meeting of the American Heart Association, Dr. James A. Magovern of Allegheny University of Health Sciences in Pittsburgh compared 48 patients who had keyhole surgery with 55 who underwent the usual operation.
“It’s fair to say patients get better at least twice as fast with this procedure,” Magovern said. Instead of the typical two to three months for recovery, he said, many people feel completely normal within only two weeks.
Among the other differences:
Of the standard-surgery patients, 40 percent needed blood transfusions compared with only 8 percent of keyhole patients.
Standard-surgery patients required an average of seven days in the hospital compared with only 3-1/2 for keyhole patients.
Keyhole patients’ hospital bills were 40 percent lower.
Another study by Dr. James Fonger of Johns Hopkins University found that keyhole surgery costs $10,000 compared with $17,000 for the standard operation.
Bypass surgery is done to reroute blood around blocked heart arteries.
Typically, doctors make a foot-long cut in the chest, saw through the breastbone and then pry apart the rib cage with a steel retractor, exposing the heart. Then the heart is stopped with medicines and a machine pumps the blood while doctors sew in the new pieces of artery.
The wide chest opening makes recovery slow. And patients often complain of pain even when they laugh or cough.
In the new operation, doctors make a 3-inch slice in the fold underneath the left breast. They cut between the ribs in just the right spot so they can see the surface of the heart as well as remove the artery they need to make the grafts.
The operation is the latest example of what doctors call minimally invasive surgery. This approach first came into widespread use in 1990 after doctors found they could take out gallbladders by operating through tiny slits in the abdomen.
Doctors also are using the new approach to replace damaged heart valves, a common operation that also typically has meant splitting open the chest.
“We were amazed to find a truly great reduction in patients’ pain and improvement in their mobility,” said Dr. Lawrence H. Cohn of Brigham and Women’s Hospital in Boston. He called the new approach “a major breakthrough.”
But Hartz said that while the new approach has strong advocates, many surgeons have been highly skeptical.
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