(March 30, 2010; Henderson, Nev.). Cardiovascular surgeon, Robert Wiencek, at St. Rose Dominican Hospitals-San Martín Campus, is among just a few cardiologists in the world – and the first in Nevada – to perform minimally-invasive surgical coronary artery bypass surgery that causes less physical trauma to tissue and bone giving patients quicker, less painful recoveries.
“Surgeons such as Dr. Wiencek who provide patients the same cures through procedures such as this that are less traumatic than traditional surgery allow St. Rose Dominican Hospitals to continue offering the most technologically advanced care, said Rod Davis, president/CEO of St. Rose Dominican Hospitals. “The minimally-invasive surgical approach being used by Dr. Wiencek is a natural progression in cardiovascular surgery.”
The technique is called minimally-invasive cardiac bypass surgery/coronary artery bypass grafting – or MICS CABG (pronounced “mix cabbage”) for short – and involves accessing the heart through a three- to four-inch incision in the space between the forth and fifth rib. The ribs are then spread apart without having to cut through or break them. A thin metal tool called a positioner is inserted through a second, smaller incision in the abdomen. The positioner suctions to a small part of the heart allowing the surgeon to turn the heart to the desired position and stabilize it so that multiple coronary artery bypasses can be performed “off pump” which means without stopping the heart beat.
Using veins harvested from the leg, grafts are sewn on around the damaged portions of the artery to create detours. If needed, the positioners can then be used to turn the heart again so more bypasses can be created for the arteries embedded on the back side of the heart.
“Because the entry point for MICS CABG is small, we don't have to suture the outside of the skin once the procedure is finished which minimizes the amount of scarring, says Dr. Wiencek. “In fact, he says, “a woman’s MICS CABG scar is unlikely to be seen because the incision can be made in the natural fold of her breast.”
Coronary bypass surgery was introduced in the late 1960s as a revolutionary way to alleviate chest pain and restore blood flow through the arteries in order to reduce the risk of heart attack. Today, nearly a half million coronary bypass procedures are performed annually in the United States making it one of the country's most common major surgeries. It is also one of its most well studied procedures which has led to a series of surgical advancements that have decreased coronary bypass mortality rates to as low as 1 percent (or as high as four percent) depending on factors such as the health and age of the patient at the time of the procedure.
Traditional coronary bypass requires making a six- to eight-inch incision down the center of a patient's chest then cutting through the breast bone to open the chest and access the heart. Once the patient's blockages are bypassed and normal blood flow to the heart is restored, the breast bone must be wired together again. This highly invasive process takes a six- to 12-week recovery period but can prolong a patient's life from life from years to decades depending on their overall health and risk factors for other diseases. MICS CABG, on the other hand, can provide patients the same lifesaving – and life extending benefits – with an estimated recovery time of just four to six weeks.
“I believe that minimally-invasive surgery gives patients a psychological leg up, says Dr. Wiencek. “When they know they will experience less pain and fewer physical limitations after surgery, they tend to have less anxiety about having an open heart procedure and, after the fact, they are typically more willing to take part in programs like cardiac rehabilitation which help them recover and resume their normal activities sooner.”
MICS CABG is not the first or most common form of minimally-invasive coronary bypass. Another procedure called minimally invasive direct coronary bypass (MIDCAB) allows cardiovascular surgeons to make a small incision directly over the coronary artery to be bypassed. The surgery is, however, only applicable when repairing one or two blockages that are easily accessible. “MIDCAB is a worthy advancement but it is not an option for patients who suffer several serious blockages or blockages located on the segment of an artery that winds around and is embedded in the back side of the heart,” says Dr. Wiencek.
The benefits patients realize from minimally invasive procedures such as MICS CABG include less blood loss, fewer blood transfusions, reduced risk of post operative infections, less physical trauma and lower pain levels (no broken bones) and fewer lifestyle restrictions. As such, their hospital stays – and overall recovery times – are faster (many patients are discharged from the hospital within two to three days and can return to work within two weeks).
