New heart surgery never skips a beat

Robert Henry Becker Arizona Summer Wildcat Robert Aslin, seen here with a scar from bypass heart surgury, had a low risk operation that re-routed the mamary artery into the coronary artery, which reduced the complications associated with traditional bypass surgury.

Aslin received the low-risk coronary bypass in May at the Arizona Health Sciences Center.

Aslin's surgery took only 21/2 hours to complete and he was released from the hospital 48 hours after surgery.

He said his doctor was amazed at the rate of recovery.

Aslin, a seasonal resident of Sun City Tucson, began experiencing chest pains in 1995, and his doctor determined he needed to have both the right and left arteries to his heart reconstructed.

Last December, Aslin had two angioplasties, which are reconstructions of blood vessels, but one was unsuccessful, leaving his left artery still 90 percent closed, he said.

"I knew the best thing to do would be a single bypass," Aslin said.

Aslin, who used to be on a hospital board in Milwaukee, reads up on medical developments as a hobby.

"I always wanted to be a doctor," Aslin said.

He read about a new, minimally invasive coronary artery bypass surgery technique and told his doctor, Dr. Michael Jerman, he wanted to do it.

Aslin said Jerman contacted Dr. Jack Copeland at the Arizona Health Sciences Center and arranged the surgery.

"He has an excellent reputation in all types of bypass surgery," he said.

Aslin said Jerman "grounded" him from playing golf 4 to 5 weeks before his bypass operation because of the fear that Aslin may have had a heart attack in the Arizona heat.

Coronary bypass surgery is performed on patients with blocked or narrowed arteries as a result of clotting. Surgeons take a piece of vein or artery from another part of the patient's body and sew it around the area of blockage, bypassing the clot.

Copeland, professor of surgery at AHSC, said the standard surgery requires an 8- to 12-inch incision and requires the sternum be divided to reach the heart.

The surgeon then stops the patient's heart and directs the blood flow through a heart-lung bypass machine, which oxygenates the blood.

The procedure poses complications for patients like Aslin who have a pacemaker.

Copeland said with the new technique, the patients' hearts do not have to be stopped, their blood does not have to be subsequently oxygenated, and the whole operation is performed through a smaller incision.

Copeland and his team operated through a 7- to 8-inch incision, using a specially designed instrument that was inserted between Aslin's ribs, allowing for the sternum to stay intact.

"The patient misses the physiological insult he would have had through the heart/lung machine," Copeland said.

Copeland used new equipment designed by the U.S. Surgical Corporation.

A disposable, plastic retractor holds the incision open for the surgeon. Three special retractors are attached to the main retractor, each performing its own function:

one holds a fiber optic light to help the surgeon see the clogged artery the second holds a carbon dioxide blower, which keeps any bleeding out of the surgeon's way the third looks like a fork with out the middle two prongs holding the artery being bypass ed in place while the surgeon sews the vessels around it.

AHSC has performed seven operations using the new technique since Aslin's operation.

Copeland said because the patient spends less time in the operating room the hospital recovering, the cost is significantly reduced. Standard bypass operation patients spend five to seven days in the hospital.

However, Copeland said only 10 percent of heart patients might benefit from this new bypass technique. The procedure is limited to patients who need bypass surgery for only one or two vessels.

"As we become more comfortable with the procedure and moving the heart around while it's still beating, there may be more bypass surgeries," Copeland said. "But not in the near future."