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TMCNet:  Minimal surgery, collaborative clinic advance heart care at University

[December 08, 2012]

Minimal surgery, collaborative clinic advance heart care at University

Dec 08, 2012 (The Augusta Chronicle - McClatchy-Tribune Information Services via COMTEX) -- Bobby Dunn, 75, of Evans was getting more tired and weak, and when he went to the doctor he found out he needed heart surgery. But he also learned he was a candidate for a new method at University Hospital that didn't require cracking open his chest.

"I decided that was probably the easiest way out," he said.

In his case, smaller was better.

Dunn received minimally invasive mitral valve repair/replacement. The move toward minimally invasive heart surgery was spurred in part by the push for robotic surgery, although robotics has turned out to be expensive and requires an operating room dedicated to it and longer times to set up and replace equipment, said Dr. Timothy Hunter, the director of cardiothoracic surgery at University. Instead, he is using a different minimally invasive approach.

The patient is put on heart/lung bypass, and Hunter makes a small, roughly two-inch incision on the right side of the chest. Using three-dimensional transesophageal imaging that gives him a "fantastic" view, he uses special long instruments to reach across the chest cavity to get at the heart.

Hunter goes across the deflated lung and through a small incision in the pericardium, the sac around the heart, to reach the mitral valve that separates the left atrium from the left ventricle. The one-way valve is supposed to prevent blood from leaking back into the left atrium but can become leaky or deformed over time, which can cause symptoms such as shortness of breath or fatigue. Often the surgeon will tighten up the valve by putting a ring around it, Hunter said.

"I always talk about it being like a gasket on a car engine," he said. "You are replacing the seal." In the case of repair, the surgeon tries to restore the valve as closely as possible to its intended form.

"It's almost like plastic surgery of the valve," he said.

A distinct advantage is that it does not require cutting through the sternum to open the chest cavity, which should mean less hospitalization and quicker recovery, Hunter said.

"People are going home in three days," he said, compared to five to nine days for the traditional surgery. "I've had one go home in two." And patients might bounce back more quickly.

"I did a 33-34-year old, and in less than two weeks he wanted to go golfing," Hunter said. "For a (standard operation), that just would be unheard of." The minimally invasive approach would not be right for some patients, such as those who also need bypass grafts as well as valve repair, and there is nothing wrong with the standard, open approach, he said.

"I think those people heal well and do very well," Hunter said. The open procedure might be a little quicker; the minimally invasive approach requires about a half hour more actual procedure time, he said.

The minimally invasive valve surgery would be just one option that patients might be offered as University moves to a more collaborative model of heart care in its structural heart program, Hunter said. Heart surgeons, vascular surgeons and cardiologists are collaborating through the clinic to evaluate patients and decide what is the most appropriate care, he said. The patient is actually evaluated by all three fields, Hunter said.

"The surgeon is there; the cardiologist is there; if we need the vascular surgeon, he will come down and see you," he said. "We say, 'What is the single best option for this patient Who meets criteria for what technology ' It really takes a multidisciplinary group to come to those conclusions. We want to make sure we are selecting the right patient for the right procedure." In Dunn's case, now, nearly a month after the surgery, he is seeing a difference.

"I'm doing real well," he said. "I'm recouping every day a little better, a little better. Having this surgery is going to get my energy level back up like it was." ___ (c)2012 The Augusta Chronicle (Augusta, Ga.) Visit The Augusta Chronicle (Augusta, Ga.) at Distributed by MCT Information Services

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