Making strides in fight against heart disease

AAMC launches open heart surgery program with new cardiothoracic surgeon

Charles Benil never had heart problems in the past. He hasn’t stepped foot in a hospital since his last child was born.

So when the healthy 74-year-old had trouble breathing on a short walk to his mailbox, he attributed it to asthma. But then he failed a cardiac stress test. Doctors at Anne Arundel Medical Center performed a catheterization exam, weaving a thin tube from an artery in his wrist through his heart’s coronary arteries. The results were a stunning diagnosis for Benil: all five arteries in his heart were partially obstructed, and two arteries were severely blocked.

He would need quadruple bypass surgery as soon as possible.

Benil, who lives in Kent Island, was told he could get open heart surgery at

established centers in Washington, D.C., or he could become one of AAMC’s first heart surgery patients at their long-sought program that officially launched in late December.

Benil didn’t want his wife, Janis, to have to drive far and through a city to visit him. The couple hasn’t slept apart in 42 years. Having to suddenly go through a major surgery and be away from his wife was too much for Benil. He opted to get his surgery in Annapolis with the hospital’s new cardiothoracic surgeon and program director Dr. Daniel Lee.

“Having the center local was just a super benefit for the family, for me, for comfort,” Benil said. “The people there, when we met them and talked with them, we just had this feeling that was just overwhelming that this was absolutely the right thing for us to do.”

Heart disease is responsible for about one in four deaths in Anne Arundel County, outpacing the national average and ranked the second leading cause of death for county residents in 2017, according to the hospital, which is owned by Luminis Health.

One reason for the prevalence of heart disease among county residents is because of its aging population, Lee said. Heart disease is also linked to diet and genetics. The high rate of death by heart disease speaks to the need of having a cardiac surgery program in the county, he said.

AAMC applied for a certificate of need from the Maryland Health Care Commission in 2015 to start a cardiac surgery program but its bid was met with opposition by the University of Maryland Baltimore Washington Medical Center. BWMC said University of Maryland was looking to expand the geographic scope of a cardiac surgery program run by Prince George’s Hospital Center. The opposition was later dropped.

The hospital upgraded two operating rooms into specialized surgical operating suites and intensive care recovery rooms for a relatively low $2.5 million. In its 2015 application, AAMC projected that it would perform 241 surgeries in its first year of the program, 337 in the second year and 387 in the third year. Adult cardiac surgery programs are obligated to meet 200 open heart surgery cases in the second full year of operation, according to the memo.

Lee performed his first surgery at AAMC the day before Christmas Eve. He’s completed 22 cases since.

Lee was brought on AAMC’s staff as chief of cardiac surgery in July. As a cardiothoracic surgeon, Lee previously worked in Texas, where he started a center for aortic disease at Baylor Scott and White Texas A&M Health Science Center. He boosted patient volume at his center and entered patients in national clinical trials. Lee also enhanced the surgery program by introducing new cardiothoracic surgery methods and technologies, a longterm goal he has for AAMC’s program.

He graduated from the University of Chicago Pritzker School of Medicine, performed his residency at Yale University School of Medicine, received his thoracic surgery training at Memorial Sloan-Kettering Cancer Center and his cardiothoracic surgery training at Weil Medical College of Cornell University.

Coronary artery bypass surgery is a cardiac surgeon’s bread and butter. Surgeries are long, around eight hours from start to finish, and complex. Veins and arteries are taken from a leg or the chest and used to replace diseased arteries in the heart. A patient’s chest is cut open, their ribs spread and their heart essentially stopped while a perfusionist monitors a bypass machine pumping oxygenated blood through the body.

The first day or two after open-heart surgery requires close monitoring in an intensive care unit. Recovery takes months.

Improvements in technology advanced cardiothoracic surgery to fix blocked arteries in ways beyond open chest repair. Surgeons are using smaller incisions and even robotic, minimally invasive procedures. Robotic tools are used in procedures like mitral valve surgery that prevent blood from leaking into the wrong heart chamber.

And for blocks that don’t require surgery, a cardiologist can place a stent to improve blood flow or implant a pacemaker to control irregular heartbeats with electronic signals.

Lee is skilled at these surgery advancements, including now-common transcatheter aortic valve replacements, known as TAVR. The method uses a smaller chest incision than open repair and a catheter tube inserted in a blood vessel and guided to the aortic valve to position a replacement valve in the heart.

His subspecialty is repairing the aorta, the body’s largest blood vessel, that’s weakened by an aneurysm. To treat aneurysms before they rupture, which can be fatal, Lee uses a hybrid approach that combines open surgery and minimally invasive repairs. The procedure is called thoracic endovascular aortic repair, known as TEVAR. This method uses a stent to widen a bulge in the heart caused by an aneurysm, effectively sealing the aneurysm and routing blood out of the bulge.

“All of those are things that we want to expand into with this particular program,” Lee said. He also hopes to start a center for aortic disease at the hospital similar to his Texas center.

The hospital is drafting construction blueprints to create a hybrid suite this summer where Lee can start advanced noninvasive procedures. AAMC is looking to hire another heart surgeon and has staffed around 40 clinicians since July to work in the heart program. The hospital has also received national recognition for its heart care services.

“I think AAMC definitely has the potential to become a major regional player,” Lee said. “And if we stay on the cutting edge, getting involved in cutting edge research, we could also have a global footprint with new information that could be disseminated from the program.”

For Benil, the local surgery center meant his wife and children wave to him from a parking garage outside his hospital window in Annapolis. AAMC made a special exception to their limited visitors policy during the coronavirus pandemic to let Janis Benil visit her husband the weekend before his surgery and once after during his week-long hospital recovery.

“I’m in the grocery store; they call me and say, ‘You can come see him if you want.’ I threw my groceries away and rushed to the hospital before they could change their minds,” Janis Benil said. “The staff was just so amazing.”

After a tough three weeks following the January surgery, Benil is in cardiac rehabilitation, recovering slowly and smoothly, he said.