ST. LOUIS – Open-heart bypass, a surgery that traditionally requires a 6- to 8-inch incision down the breastbone (sternotomy) and spreading the ribs to access the heart, now is being performed at SSM St. Clare Health Center via a 3-inch incision. This minimally invasive procedure means a significantly reduced recovery time for patients.
Over the past 50 years, coronary artery bypass graft surgery (CABG) – more commonly called open-heart bypass surgery – has helped an untold number of Americans survive coronary artery disease, the leading cause of death in the United States.
During a bypass procedure, surgeons take healthy vessels from elsewhere in the body and graft them in place, re-routing blood around narrowed or blocked coronary arteries. Traditional open-heart bypass is a major operation, which involves stopping the heart and using a heart-lung bypass machine to temporarily take over the functions of the heart and lungs. With this minimally invasive surgical technique, the heart continues to beat naturally.
Seiichi Noda, M.D., a cardiothoracic surgeon with SSM Heart Institute at SSM St. Clare Health Center, completed his first minimally invasive CABG in May. He is among a small group nationally to perform this advanced technique.
Within a month of surgery, Dr. Noda’s first minimally invasive patient was vacationing in Myrtle Beach, S.C. By contrast, a patient who undergoes traditional surgery typically faces a five- to seven-day hospital stay and three months of recovery time.
“The breastbone is what takes the longest to heal in a traditional procedure,” Noda explained. “In the minimally invasive technique, instead of cutting or breaking bones, we go in-between the bones. We don’t disrupt the rib cage.”
In the minimally invasive procedure, Noda makes a 3-inch incision in the chest wall between the ribs, under the left breast. He accesses the heart from the side rather than directly in front, which is the traditional open approach.
Once inside the chest, the minimally invasive procedure is similar to the traditional procedure.
Despite the large incision of traditional surgery, in reality, surgeons are only working on a small part of the heart. In both procedures, surgeons operate with the use of telescopes, working in a limited field of vision of about 3 inches.
“The best way I can think to describe it is that instead of operating through a wide open door, we are working through a window. The biggest change is getting accustomed to the new view,” said Noda. “As we are operating, we have to bring the target blood vessels into the window.”
However, a key difference is that it is not necessary to stop the patient’s heart and use a heart-lung bypass machine. Instead, a device stabilizes the affected part of the beating heart so the vessel bypass can be performed in a safe, controlled environment. “The physiological impact to the patient is much less,” Noda said.
Noda already is recognized nationally for his experience with the specialized off-pump technique for CABG surgery, which allows the heart to continue beating naturally during surgery. In the past 10 years, Noda has performed 1,400 such procedures. For the most part, only those surgeons skilled in the off-pump technique perform the new minimally invasive CABG surgery.
The off-pump procedure – also known as “beating heart” surgery – can reduce the need for blood transfusions and has been shown to lower the risk for bleeding, stroke and kidney failure associated with surgery. It may also reduce the risk of developing cognitive problems associated with the traditional procedure.
The advantages of the off-pump procedure coupled with the small incision of minimally invasive surgery add up to a much better experience for patients.
“We all go into medicine to help people,” said Noda. “Finding new and better ways to get people back to life that much quicker is very satisfying.”
Benefits of the minimally invasive CABG technique include:
• Shorter hospital stay
• Faster return to daily living (patients can go back to work in two weeks versus three months)
• Reduced risk of infection; no risk of sternal wound infection
• Smaller incision and less scarring
• Reduced risk for depression
• Fewer physical limitations
• Fewer post-operative lung problems
Not everyone is a candidate for minimally invasive CABG surgery. It is most appropriate for individuals who have one to three vessels that need to be bypassed. Also, the added time needed to complete the procedure limits its use when the surgery is being performed in an emergency situation.
However, because the procedure is less invasive, it presents an option for some patients who may otherwise be consider too high-risk or compromised to undergo the traditional CABG surgery. These include advanced age patients and those with chronic obstructive pulmonary disease.
To learn more about minimally invasive CABG surgery, call the SSM Heart Institute at 314-647-8269.
About Dr. Seiichi Noda
Seiichi Noda, M.D., FACS, earned a medical degree at the University of Chicago, Pritzker School of Medicine in 1990. He completed a general surgery residency at the Brigham and Women’s Hospital, Harvard Medical School in Boston and a cardiothoracic surgery residency at Washington University School of Medicine. Noda is certified by the American Board of Surgery and the American Board of Thoracic Surgery, and is a fellow of the American College of Surgeons. He spent a year as an instructor of surgery at Harvard Medical School.
About SSM Heart Institute
SSM Heart Institute is the region’s most experienced provider of comprehensive heart care. A team of more than 100 skilled cardiologists, electrophysiologists and cardiothoracic surgeons provides the most advanced treatments, leading-edge techniques and unparalleled experience for the best clinical outcomes. Combined with expert nursing and technical staff, this team offers a full range of services to prevent, diagnose and treat heart disease. SSM Heart Institute services are available at five locations across the St. Louis area: DePaul Health Center, St. Clare Health Center, St. Joseph Health Center, St. Joseph Hospital West and St. Mary’s Health Center.
About SSM St. Clare Health Center
SSM St. Clare Health Center, which opened March 30, 2009, is the first full-service hospital built in St. Louis County in 35 years. The 174-bed facility is a member of SSM Health Care-St. Louis, winner of the Missouri Quality Award. Located at the intersection of Hwy. 141 and Bowles Avenue in southwest St. Louis County, the hospital is one mile from I-44. The campus offers: the most advanced treatment for conditions affecting the brain and spine; a wide array of heart disease treatment options, including minimally invasive procedures; a comprehensive cancer center; emergency care; convenient outpatient imaging, testing and surgical services; general medical and surgical care; and the Family Birthplace and women’s services. SSM St. Clare Health Center has been recognized nationally for its design and advanced safety, comfort and convenience features, and has won the Premier QUEST High Performing Hospital award. To learn more about the health center, go to www.ssmstclare.com.
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