Changing the Face of Heart Bypass Surgery

Genesis Medical Center, Davenport is among an elite group of U.S. heart centers that are revolutionizing the way coronary artery bypass surgery is performed.

Leading the way with new technology, Genesis heart surgeons Nicholas Augelli, M.D., and Robert Fietsam, M.D., are using automated stapling devices instead of hand-sewn sutures to connect bypass vein grafts. The surgeries are performed "off-pump," while the heart is still beating and without putting patients on a heart-lung machine.
 
For patients, this means a quicker surgery, less anesthesia, a lower blood transfusion rate, fewer risks of complications like stroke, and about a day less in the hospital. If early studies hold true, it also means a better chance that the bypassed vessels will remain free of blockages over time.

1st in Iowa
Most recently, Drs. Augelli and Fietsam became the first in Iowa to use a self-closing, stainless steel clip to connect the bypass vein graft to the aorta, the largest vessel in the body. The Sept. 26 procedure done on patient Linda Reid, 61, of Burlington, Iowa represented only the second time that Cardica's PAS-Port® System has been used in the U.S. since Food and Drug Administration approval.

The technology is significant because surgeons can now connect bypass vein grafts on both ends.

During bypass surgery, one end is attached to the coronary artery away from the narrowing or blockage. The other end is attached to the aorta.

"With the PAS-Port System, we've made continued progress in automating vascular anastomosis -- the attaching of the end of a graft to a coronary artery during bypass surgery," Dr. Augelli says.

"A year ago, we began using an automated stapling device to connect the vein grafts to tiny vessels on the distal (or downstream end of the heart.) However, we still had to suture the other end of the bypassed grafts to the aorta (at the center of the heart.) This required clamping off the aorta, which risks dislodging plaque and has been directly linked to stroke.

"Now with the PAS-Port technology, we can use a stapling device on the proximal side that connects directly to the aorta and automate the entire process. We don't have to clamp the aorta, and thus, can decrease the risk of strokes. We can avoid the inconsistencies that suturing can bring."

Using the PAS-Port technology also is faster -- from 7-10 minutes on average to connect a vessel -- down to 3 minutes. That can ultimately reduce the time it takes to do a four-vessel, beating heart bypass from 3.5 hours down to two hours.

The PAS-Port uses technology that both cuts and removes a small section of the aortic wall and deploys a device that expands and forms an inner and outer flange that secures the vessel graft in place.

Cost-savings, patient benefits Last year, the surgeons were the first in the Quad Cities to use Cardica's C-Port system, a stapling device to surgically link coronary arteries to bypass a blockage. With the press of a button, 12 staples -- or 24 clips -- fire around the vessel. The artery opens as it simultaneously is connected to the vein in a single integrated procedure.

Total cost savings for 78 beating-heart procedures using the C-Port system was $131,000 or an average cost-savings per procedure of $1,650, a six-month economic analysis showed.
 
Most important, however, are the patient benefits. The automated process can be superior to traditional, technically demanding sutures because each connection is always the same length, the same size and allows the vessel to expand and contract with blood flow. Drs. Fietsam and Augelli now do nearly all of their bypass surgeries "off-pump" because of the advantages to patients.

"By using the off-pump technique, we've cut our blood transfusion rate in half. Length of stay is about a day shorter," Dr. Fietsam says. "While the heart's beating, the lungs are still being ventilated and the brain and kidneys are still receiving blood flow, which the organs seem to like better.

"Recovery time is faster --patients who have bypass surgery in the morning are reading a newspaper in the afternoon. After being on a heart-lung machine, they usually don't come around until the next day."

Dr. Fietsam adds, "In general, the beating-heart approach is considered better for women who tend to have a higher mortality rate with heart surgery and for patients with pre-existing heart conditions, such as vascular disease, previous strokes and kidney problems. Females with diabetes have shown significantly lower mortality and complication rates with off-pump."