There’s a new heart surgery being performed that is less invasive to patients.
It wasn’t the prospect of weeks of recovery, or a zipperlike scar from chin to navel, that worried Glenn Moseley about his looming open-heart surgery.
What troubled the 49-year-old resident of Hurst, Texas, was that to repair a clogged artery, surgeons would have to cut him open and stop his heart.
“The part about being split wide open bothered me more than anything,” Moseley said. “Just the idea, and the recovery.”
Then Dr. David Carter at Harris Methodist H.E.B. hospital in Bedford, Texas, told Moseley about a new type of heart surgery: minimally invasive direct coronary artery bypass, known as MIDCAB.
With the procedure, surgeons would have to make only a fist-size incision between the ribs below the left breast. They could then operate on his heart while it was still beating.
“It sounded like the best way to go,” Moseley said.
The prospect of simpler, less intrusive surgery has patients clamoring for MIDCAB, despite its relative newness as a procedure.
Since the surgery was first performed in the United States in 1995, 15,000 to 20,000 have been done, physicians estimate. Carter has done more than 50.
“This is patient-driven,” he said. “The patients will tell us whether it’s right for them or not. Right now, they’re saying yes.”
But MIDCAB also is criticized as being an experimental technique that is just starting to come into its own.
The problems, critics say, include the lack of the 20 years of surgeons’ experience with traditional open-heart surgery, the decreased access because of the small incision, and the absence of the bypass machine, which takes over for the heart and the lungs and acts as a failsafe if the heart stops beating.
MIDCAB has an estimated 95 percent success rate, comparable to that of open-heart surgery, said Michael Mack, a heart surgeon at Medical City Dallas who is among five U.S. physicians known for their research of MIDCAB.
The absence of the bypass machine also means the absence of the machine’s risks — long-term neurological damage being the main hazard, said John Osborne, a cardiologist at Medical City Dallas.
MIDCAB offers significant savings in time and money, which is especially beneficial as managed-care providers pressure hospitals to cut costs.
MIDCAB is faster than open-heart surgery by at least three hours. Patients typically stay in intensive care one day rather than two or three, and their hospital stays are also shortened. The procedure allows for a recovery time of less than two weeks, compared with six or more weeks for the traditional surgery.
“It costs significantly less, in the range of $4,000 to $5,000 less,” Carter said. The surgery also requires fewer instruments and fewer blood units.
Although physicians estimate that MIDCAB can be used in 10 percent to 30 percent of heart procedures, it doesn’t work for patients who are obese, need multiple bypasses, are on radiation therapy or are extremely frail or sick.
“It’s not applicable to all types of cases,” said Michael DeBakey, 89, a world-renowned Houston heart surgeon who was a consultant on Russian President Boris Yeltsin’s heart surgery.
The trend toward minimally invasive surgery accelerated in the late 1980s, as managed-care providers pressured hospitals to reduce costs.
At the forefront of this trend was development of laparoscopic gall bladder surgery, which utilized a tiny tool and ‘scope. This allowed a surgeon to operate through a tiny incision and to “see” what was going on inside the patient’s body through the ‘scope lens–almost like a video camera.
Soon to follow were minimally invasive obstetric, lung and thoracic surgeries. Then came the challenge of transforming open-heart surgery, the most invasive procedure of all.
“As early as 1991, people started thinking about it, wondering if it could be done,” Carter said.
Osborne said, “The problem with heart surgery is that the techniques required are much more delicate, and it’s much more technically challenging than some of the abdominal procedures.”
The biggest challenge of MIDCAB is in keeping the tiny part of the beating heart still long enough to operate smoothly, surgeons said. Medical technology companies “have been ingenious in coming up with ways to stabilize the heart,” Carter said. “They’ve come up with devices that, while the heart’s still beating, will make parts of it stand completely still.”
