NEW HEART SURGERY SYSTEM OFFERS SHORTER RECOVERY TIME AND LESS PAIN

A new minimally invasive cardiac surgery being used at St. Francis Medical Center offers patients improvement in the pain and recovery time for heart valve surgery, according to the surgeon using the system.

Cardiac and thoracic surgeon Dr. Edward Bender is using the Port-Access system to perform heart valve repair and replacement and atrial septal defect (hole in the heart) surgery on select patients.

"The Port-Access system offers the ability to do heart surgery with a smaller incision than traditional heart surgery," Bender said.

With Port-Access equipment, surgery is done through a three- to five-inch incision off to the side of the breastbone or with a partial breastbone incision, Bender said. Normally, open-heart surgery is performed by making an incision the length of the breast bone (15 to 20 centimeters) then spreading the rib bones apart to allow access to the heart, he said.

With the system, the heart is stopped. Instead of routing blood to a heart-lung machine through tubes placed directly into the major blood vessels around the heart, as done in open-chest surgery, the Port-Access system uses catheters threaded to the heart through blood vessels in the thigh and neck. Small incisions are then made in the chest wall between or through the ribs and the operation is done with minimally invasive instruments.

The advantages of using smaller incision surgery for the patient, Bender said, are less need for pain medication and shorter recovery time.

Post-operative pain is less with the procedure, so less narcotic medication is needed, Bender said. Narcotic medication can cause drowsiness and nausea in patients.

"If you can diminish the requirement for narcotics, patients get active more quickly," Bender said.

Recovery time with the minimally invasive system is about one month as opposed to two months with heart surgery that opens the sternum, he said.

But the surgery is not for everyone, Bender said. At this time he expects to use the Port-Access system on less than 20 percent of the heart surgeries performed at St. Francis.

"It's for a select group of patients," Bender said, adding he expects to do 50 to 60 such surgeries per year, though that may increase if he decides to expand the types of surgeries performed using Port-Access.

Southeast Missouri Hospital is not using a minimally invasive cardiac surgery system for heart valve surgery at this time, said Dr. Darryl Ramsey, a cardiac and thoracic surgeon at Southeast.

He said the added safety in the wide expanse created using traditional open-heart incision at the sternum is worth a longer scar.

If an emergency should arise, it is easier to deal with through the larger incision, Ramsey said.

Plus there were some safety issues with early versions of the Port-Access system that Ramsey noted were reported in a May 1999 article in "The Wall Street Journal."

"A heart port system may eventually be developed that we will use," Ramsey said.

Bender said the problems were with first generation equipment and have since been corrected. "I think we're up to the fifth generation now," he said.

Bender got his training in the use of Port-Access equipment at New York University, which he said has done more surgeries using the system than any other hospital in the country.

"They have had none of the problems mentioned in that article," Bender said.

The main problem mentioned in the article was with a catheter through which blood went from the heart to a heart/lung machine. Some doctors claimed in the article that the catheter, which is threaded through an artery, could cause artery ruptures. The company has since made improvements in that catheter.

Bender admits he approached using the Port-Access system with trepidation. "But then I saw the results and how the technology allowed such good visibility of the procedures," Bender said. "Only when I saw how well the system works, how it cuts recovery time, how safe it was, did I decide to use it."

Bender said he has done two procedures at St. Francis using the Port-Access system and was pleased with the results.