Mazankowski sur­geons work at the cut­ting edge

Edmonton Journal - - FRONT PAGE - KEITH GEREIN

Less scar­ring, quicker re­cov­ery times and fewer days in the hos­pi­tal are among the ben­e­fits of a new pro­gram that is chang­ing the way car­diac surg­eries are per­formed at the Mazankowski Al­berta Heart In­sti­tute.

The min­i­mally in­va­sive surgery pro­gram has been up and run­ning at the in­sti­tute in Ed­mon­ton since May, with 10 pa­tients now hav­ing un­der­gone suc­cess­ful pro­ce­dures to fix valves or re­pair de­fects.

Tra­di­tion­ally, such surg­eries are per­formed by cut­ting open a pa­tient’s chest to give the sur­geon ac­cess to ma­nip­u­late the heart di­rectly with his or her hands.

The min­i­mally in­va­sive ap­proach uses a much smaller in­ci­sion through the ribs. Sur­geons insert a tiny cam­era, which trans­mits images of the heart on a video screen be­side the op­er­at­ing ta­ble. A set of long, slen­der tools are then used to reach into the pa­tient’s body and com­plete the pro­ce­dure.

“It’s the same open heart surg­eries we would do on a daily ba­sis, but we leave the chest closed,” said Dr. Jee­van Na­gen­dran, one of three car­diac sur­geons at the Mazankowski now us­ing the tech­nique.

“The end of the in­stru­ment ends up be­com­ing your fin­ger­tips, so you have to learn to get that tac­tile feed­back from the in­stru­ment it­self rather than be­ing able to touch (the heart).”

Na­gen­dran said the min­i­mally in­va­sive ap­proach has been around for 15 years but did not gain wide­spread ap­peal un­til re­cently.

Fa­cil­i­ties in Montreal and Lon­don, Ont., have been Canada’s lead­ers in us­ing the tech­nique. Se­lect cases are also done in Calgary and Vancouver, but Na­gen­dran hopes the Mazankowski will soon be­come the top cen­tre for such surg­eries in Western Canada.

The goal is to start per­form­ing about 50 such pro­ce­dures a year be­fore even­tu­ally ramp­ing up to as many as 100 per year.

Racha Ka­mal, 27, was the first pa­tient to get the pro­ce­dure at the Mazankowski on May 25, when sur­geons re­paired a hole in her heart.

Af­ter­wards, Ka­mal spent one night in the in­ten­sive care unit and three days in a hos­pi­tal ward be­fore she was al­lowed to go home, a shorter visit than the five- to seven-day stay open heart surgery pa­tients typ­i­cally need.

“Any­thing you do that is the first, that kinda makes you a lit­tle ner­vous,” Ka­mal said. “But it went well. I think it would have been a lot harder to re­cover, a lot harder to get back to nor­mal life with the other surgery. And I would have had a scar for life.”

Three months af­ter Ka­mal’s pro­ce­dure, Mazankowski sur­geons used the min­i­mally in­va­sive ap­proach for the first time on a pa­tient need­ing an aor­tic valve re­place­ment.

“Every day I think how lucky I am that I was cho­sen for this, be­cause I know I wouldn’t be feel­ing this good if it was done the other way,” said Anne Rocko, 81, who was the pa­tient.

A spokes­woman for the Univer­sity Hos­pi­tal Foun­da­tion said the or­ga­ni­za­tion paid for $500,000 worth of equip­ment for the pro­gram, and also funded three years of Na­gen­dran’s re­search.

SHAUGHN BUTTS

Dr. Jee­van Na­gen­dran, left, a car­diac sur­geon at the Mazankowski Al­berta Heart In­sti­tute, ex­plains a min­i­mally in­va­sive surgery pro­gram that en­ables sur­geons to avoid open­ing the chest when per­form­ing ma­jor, open-heart surgery. As­sist­ing Thurs­day is reg­is­tered nurse Dar­ren Melby.

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