Celebrating a Half Century of Heart Surgery Success

Open heart surgery has been a Lehigh Valley Health Network stronghold for half a century. Clearly much has changed since Antonio Panebianco, MD, performed the Lehigh Valley’s first open-heart surgery, a coronary bypass at the former Allentown Hospital, 17th and Chew Streets, in April 1970.

Still, the magical core of this life-saving craft – human hands repairing another human’s heart by passing a clogged artery – remains at the center of a flurry of technological, medicinal and procedural options that makeup the once unthinkable routine.

“The advances have been quite incredible,” says Ronald Freudenberger, MD, Physician in Chief of Lehigh Valley Heart Institute, which opened in 2018. “The outcomes are much better. But the basics of bypass surgery are really similar.”

The Heart Institute, a collaborative resource Panebianco dared not even dream about in the early ‘70s, when many scoffed at the idea of offering heart surgery in the Lehigh Valley as being costly and duplicating services found in Philadelphia, now celebrates five decades and counting of success.

In many ways the best is yet to come.

In the beginning

“In my family there was history of heart disease on my mom’s side,” he says. All but one of her six brothers died in their 50s, and the survivor (who lived to 67) encouraged Panebianco’s interest in the field.

“There were a lot of problems in trying to get the program going,” says Panebianco, now 84 and no longer practicing.

Philadelphia heart surgeons feared losing Lehigh Valley patient referrals, he says, other Allentown Hospital surgeons expressed concerns about losing access to operating rooms for their own work, and some insurers threatened to refuse reimbursements.

Panebianco appealed to Clifford Trexler, MD, then chief of surgery at Allentown Hospital, who allowed the heart surgeons to use his OR. Panebianco got his medical degree in Catania, Sicily, and knew Trexler had served on the Italian island during World War II.

Soon support grew. An open-heart surgery program was launched in 1974 in Salisbury Township at what became Lehigh Valley Hospital Center and is now Lehigh Valley Hospital (LVH)-Cedar Crest.

A better technique

Panebianco also used his Sicilian ties to hone his craft, spending three days at the Cleveland Clinic with Rene Favaloro, MD, a renowned heart bypass surgeon and the grandson of Sicilians on his father’s side. Favaloro is credited with, in 1967, the nation’s first planned heart bypass surgery.

Cleveland Clinic surgeons used internal mammary artery grafts rather than saphenous (leg) vein grafts for bypasses because those arteries better resist the plaque buildup that leads to atherosclerosis. Panebianco used the mammary artery technique in Allentown.

Panebianco himself couldn’t escape his bad genes. In 1978 he underwent open-heart surgery, and in 1988 needed a second one. In between Panebianco did open-heart surgery on his brother, who today is 85.

Panebianco retired in 2012 after doing 5,000 open-heart surgeries

Evolution of Heart Surgery

In Panebianco’s early days, each surgery had the potential to be groundbreaking. Medical teams used hypothermia to lower body temperature and potassium to stop the heart while the surgeon severed and reattached critical blood vessels – literally bypassing clogged ones. Soon heart-lung machines were used to keep the patient’s blood oxygenated and moving during the procedure.

Today refinements to heart-lung machines reduce the risk of dangerous clots and disastrous strokes after the procedure. And with those advancements and the many options they offer come a team of specialists unimagined 50 years ago.

“Now there’s an entire field of perfusionists who run [heartlung machines, monitoring key metrics] while the surgeon does the bypass,” Freudenberger says.

Protocols for post-op exercise also are markedly different.

“Bypass surgery patients today are discharged in as little as three or four days,” Freudenberger says. “In the old days, they may have stayed in the hospital for weeks. And these days it’s: [Get] up and walking as soon as possible. Back then it was: Stay in bed.”

Saving lives with — and without — surgery

The option of sliding a balloon catheter to install a metal or plastic tube called a stent into a partially blocked artery to improve blood flow now lessens the number of routine bypass surgeries. Panebianco’s older brother had one added years after his own bypass surgery.

“Today we may be stenting one or two [clogged arteries] as opposed to bypassing three or four,” James Wu, MD, Chief, Division of Cardiothoracic Surgery, says.

The advances are making oncecomplex heart surgeries routine. That creates opportunities to do much more advanced procedures, helping patients who previously were not candidates for heart surgery.

“Today we can help patients who are much sicker, with much more complex diseases,” Freudenberger says, such as people with diabetes or kidney problems. “Those conditions make a heart bypass much more risky, but they are precisely the people who have the best outcomes.”

LVHN offers heart surgery at Lehigh Valley Hospital–Cedar Crest, LVH–Muhlenberg and LVH– Pocono facilities. LVH–Cedar Crest is the busiest hub, Freudenberger says, while LVH–Muhlenberg and LVH–Pocono each do about 100 bypasses annually.

Even before LVHN merged with nearby smaller hospitals, Freudenberger says, the Heart Institute “worked very hard” to be sure providers sending heart patients for care had the proper heart failure protocols and emergency standards in place.

Creating the Lehigh Valley Heart Institute three years ago cemented a team effort that involves eight cardiothoracic surgeons and more than 60 cardiologists.

“We became a Heart Institute to put the cardiologists and the cardiac surgeons in the same place,” Freudenberger says. “We all share the same outcomes. Cardiologists work from inside the blood vessel; surgeons work from outside.”

“We are more organized and collaborative between surgeons and non-cardio doctors” Wu says. “There’s better direction.”

The Heart Institute provides the region’s largest team of boardcertified, advanced heart failure specialists as well as the latest heart support devices to care for patients with complex heart disease.

“Today,” Freudenberger says, “we are one of the largest programs for heart attacks in the country.”

What’s ahead in heart surgery

Wu offered several reasons to remain optimistic about the future of LVHN heart surgery:

• New technologies will continue to transform difficult operations into easier procedures.

• The population in the Lehigh Valley will grow, services are available for these needs.

• LVHN will continue to offer a greater variety of services.

Freudenberger says one of the biggest changes in cardiac surgery is being able to do more without opening the chest.

That’s a far cry from the early days pioneered locally by Panebianco, when access was gained by cutting the sternum (breastbone) and spreading open the ribs.

“With TAVR, we can replace and fix valves without opening the chest. We had no ability to do that 10 years ago,” Freudenberger says. “That allows us to care for people who may not be able to withstand open heart surgery.”

And that means continuing LVHN’s proud tradition of savings lives by saving hearts.