PATIENT GOING STRONG 15 YEARSW AFTER AREA'S FIRST OPEN-HEART SURGERY

Fifteen years ago this month Cathy Haven became the first person to have open-heart surgery performed in Southeast Missouri.

Haven, who lives in Portageville, is still going strong as is Southeast Missouri Hospital's Regional Heart Center, where she was the first patient to have open-heart surgery. The date was Oct. 1, 1984.

Since then more than 4,200 patients have had open-heart surgery at the heart center, and at St. Francis Medical Center, which began its open-heart surgery program last year. Doctors performed open-heart surgery on 300 patients last year and expect to do more than 300 this year.

Much has changed since Haven's operation, as outlined by Cardiothoracic surgeon Dr. J. Darryl Ramsey at a program celebrating Southeast's 15 years of performing open-heart surgery.

The most common reasons for performing open-heart surgeries are for bypasses, where an artery or vein is grafted on the heart to bypass diseased arteries or damaged areas of the heart, and to repair diseased or plaque-chocked valves, Ramsey said.

Much of the progress that has been made in heart surgery over the years, Ramsey said, is a result of a motto that heart surgeons share with NASA: faster, cheaper, better.

"We keep looking for ways to do the job as well, but faster and cheaper," he said. This includes getting patients out of the hospital more quickly, using fewer blood transfusions and using methods to extend the life of the valves and grafts to keep patients from having to have open-heart surgery again.

When Haven had her surgery 15 years ago, she was in the hospital seven days, which Ramsey said was average.

These days patients often go home three days after heart surgery, Ramsey said.

Fifteen years ago, nearly all patients needed a blood transfusion during open-heart surgery. These days one-third to one-half of patients need no transfusions.

Research on bypass surgery has found that arteries last longer than veins. So, Ramsey said, doctors try to use arteries. When veins must be used, there are procedures to make them last longer.

With valves, advances have been made in both mechanical and tissue valves to make them last longer.

The whole idea is to do an operation where the results will last longer, Ramsey said.

Another way to do this is better control of risk factors after surgery, Ramsey said.

Today, most postoperative heart patients take drugs to lower cholesterol, take daily doses of aspirin, are put on a low-fat diet and are advised to stop smoking.

"These all help keep the grafts open longer to keep the patient from coming back and having another operation," Ramsey said.

Two major trends in open-heart surgery are toward smaller incisions and performing "beating heart" surgery, Ramsey said.

He said he doesn't use smaller incisions often, at least not yet.

"I don't feel the techniques and equipment are developed to a point that I feel comfortable with," he said.

The standard large incision, which generally extends from the base of the throat to the bottom of the breast bone, allows doctors to see the whole heart, which a smaller incision doesn't allow, he said.

But doctors locally are increasingly using beating heart surgery, which eliminates the need for a coronary bypass machine, Ramsey said.

The bypass machine, which was invented in the 1950s, is a medical miracle, Ramsey said. It allows doctors to stop a patient's heart so it can be operated on by routing the patient's blood through a machine.

But the patient's immune system reacts to the machine's plastic tubes and membranes, causing inflammation, fever, chills and sometimes blood clots.

While developments in technology have reduced this reaction considerably in the last 40 years, Ramsey said, patients get well faster if surgery can be done without using the bypass machine.

The "beating heart" surgery is an example of how computers are being used in medicine.

Ramsey explained the procedure: The surgeon wears virtual reality goggles connected to a computerized camera that senses the motion of the beating heart and eliminates that motion in the image sent to the doctor through the goggles. The image the doctor sees of a still heart. The doctor goes through the motions of repairing the heart using an instrument connected to a computer. The motions are replicated by a computerized instrument that takes into account the heart's movement and repairs the actual heart.

At this time, the procedure can be used with patients requiring as many as four bypasses, Ramsey said.

Ramsey foresees continued advances in open-heart surgery to make it cheaper, faster and better. But no matter how advanced techniques get, the reason for doing the surgery remains the same.

"The reason to do heart surgery is to prolong the patient's life and make quality of life better," Ramsey said.