Minimally Invasive Bypass Surgery Speeds Patient's Recovery
Robotics for cardiac surgery patients
Until recently, open-heart surgery meant a long operation followed by a lengthy recovery. That is changing now, thanks to new medical technology provided by Scottsdale Healthcare. Through the use of the daVinci Robotic Surgical System, surgeons can now make precise incisions in a highly magnified, three-dimensional, high-definition field.
The high tech system includes a four-armed robotic arm which is directed by the surgeon who sits at a computer console located a few feet away from the patient. Using a high-powered camera, the surgeon is able to guide and rotate the robotic arms.
The system is being used in a variety of surgical procedures, including heart surgery for mitral valve repairs. And, that has made a huge difference for patients like Phoenix resident, Armin Shafai.
Last year, Shafai underwent minimally invasive surgery with the daVinci Robotic System. Because the surgeon repaired his mitral valve using the robot instead of replacing the valve, Shafai was able to retain his job as a commercial airline pilot.
“You can’t keep your pilot’s license if you’ve had a valve replacement,” said Shafai , 41 and father of two. “But you can if you have a valve repair.
I just didn’t want a replacement,” said Shafai. “Not only would I lose my pilot’s license, I knew they’d have to crack open my chest, too, and it would take me a lot longer to recover.”
Scottsdale Healthcare Shea Medical Center brought this new technology to Arizona in 2001, becoming the state’s first hospital to use the daVinci robot in the operating room. Acquired with philanthropic donations, Scottsdale Healthcare is now the region’s leader in robotic surgery.
The repair surgery with the daVinci robot avoided having to open the chest to reach the heart. Instead, Shafai’s cardiothoracic surgeon, Michael Caskey, M.D., used the robot to help him make only small incisions.
With conventional minimally invasive heart surgery, “you still have to cut the muscles between the ribs and spread the ribs,” said Dr. Caskey. “When you use the robot, you don’t have to spread the ribs.”
Avoiding that step can save the patient about two weeks’ recovery time. Typically, open-heart surgery requires six weeks just to recover from breaking the breastbone, said Lynn Maliza, nursing supervisor of the heart team at Scottsdale Healthcare Shea Medical Center. Shafai spent five days in the hospital after his surgery, and with each passing day, his pain level diminished. “My pain level had dropped drastically by the time I left the hospital,” Shafai said. “And as the pain was reduced, my energy level increased.”
Shafai is grateful for this new medical technology. “I have a more efficient, stronger heart now, and I have more endurance than I did before the operation. I’m so glad I was able to have the kind of surgery that I did.”
Young Woman Succeeds in Overcoming Heart Problems
It took a move to Arizona and a job at Scottsdale Healthcare, but for Felicia Windsor, the young Scottsdale woman was at the right place at the right time for the medical attention she needed.
Felicia recently had a third cardiac ablation at Scottsdale Healthcare Osborn to correct heart problems that initially showed up when she was 15 years old.
(In “ablation,” a form of energy renders a small section of damaged tissue inactive. This puts an end to arrhythmias that originated at the problem site.)
At age 19, she was diagnosed with Inappropriate Sinus Tachycardia, a very fast beat in an otherwise normal heart rhythm.
Growing up in California, Felicia had two ablations by the time she was 21. But complications that developed with the second procedure caused her distress. “I felt I was going to die,” she remembers.
Daily restrictions to her life continued and she had to put up with many medications which proved to be a hassle. Moving to Scottsdale in 2006, she took a job in Scottsdale Healthcare’s Medical Staff office a year later, which proved fortuitous. Her assignments matched her with cardiovascular physicians and specialists, and as a result, she got to know the best.
“I knew if anything happened again, I would be in very good hands,” she says.
One day at work, something did happen again. She began feeling ill – shaky and unable to catch her breath. “It was like I was running a marathon, only I was sitting down,” she explains.
After a doctor’s visit she was admitted to the Telemetry Unit at Scottsdale Healthcare Shea. She received anti-arrhythmic medication but that made her feel foggy. She was so exhausted she had a hard time functioning.
Later, after another cardiologist visit, Felicia began considering a recommended third ablation. “I learned so much about Scottsdale Healthcare’s EP/Arrhythmia Center of Excellence that I knew I didn’t want to return to California,” she says. “I thought I had the best technologies, skilled talent and facilities right here in my own backyard.”
She scheduled the next ablation at Scottsdale Healthcare Osborn. While doctors were performing the procedure, they determined she needed a pacemaker. Today, she’s living a normal life, off the medications and taking advantage of mountain biking and other outdoor activities popular in Arizona.
She has pacemaker monitoring checks every three months. “Other than that, I have no restrictions,” she reports. “I finally feel young and ready to take on life.”
A Heart Warming Story
Cory Schoonover’s Amazing Recovery
Cory Schoonover loves to play football. The 20-year-old Gilbert resident is a wide receiver for the Tempe Predators. When he’s not on the field, Cory works at his family’s business, FNF Construction.
Cory’s family serves as his cheering squad – now and during his amazing recovery from a near-fatal accident two years ago.
In the summer of 2007, Cory was hard at work when a freak accident left him crushed between two conveyor belts. He was transported via rescue helicopter to Scottsdale Healthcare Osborn Medical Center. At first, physicians determined that he had suffered a cardiac contusion – a bruise to the heart. However, after a day in the hospital for observation and testing, his condition rapidly deteriorated. He experienced increased breathing problems and his kidneys and liver started to shut down. Cory’s physician, cardiothoracic surgeon, Dr. Robert Riley explains, “On the outside, everything looked ‘normal.’ There was a small bruise to the chest. This was a perplexing case – we could not determine why his condition was worsening. We knew that his tricuspid valve had sustained some injury, other than that there was no explanation for his condition. It was a dire situation – we knew that we had to perform surgery in order to save his life. Nothing prepared for us for what we found once we were in the Operating Room (OR).
Before I went into the OR, I did some quick research and found that there were only 13 reported cases similar to Cory’s with this extent of trauma to the valve; little did I know then that Cory was about to make medical history!”
While Dr. Riley prepared for the one-of-a-kind-surgery, Cory’s friends and family kept a close vigil at the hospital. “It was nerve wracking,” says his mom, Julie. “We were in shock, one minute you have this healthy, strong young man and the next, he’s fighting for his life.”
“I went into the surgery with the intent of replacing his valve; then I discovered three additional conditions,” says Dr. Riley. Cory had suffered massive trauma- his heart had been crushed by the accident and had ruptured causing the tricuspid valve to tear away creating a hole in his heart. In addition, an artery literally ripped off the aorta.
I was amazed at how much of the heart was destroyed,” comments Dr. Riley. “Each time I found one condition and repaired it, something else popped up, we went in for one operation and ended up doing four!”
Fast-forward to today and Cory has few memories of the accident and the surgery. “The doctor told me that my heart exploded, it looked like someone had stomped on it! I realize how lucky I am.” After leaving the hospital, Cory received cardiac rehabilitation for two months and came to terms with the after effects of the accident.
Thanks to his heart wrenching experience, Cory and his family have a new outlook on life. “We don’t take anything for granted,” says Kevin, Cory’s dad. Each day is a blessing and we are thankful for everything.”
“Everything has changed for me,” Cory says, “My family and I are closer now, I play football which is something I wasn’t able to do before. I realize that through this experience, I really want to help other people. I’ve never been through anything like this, I took things for granted. Not any more!”
Cory and Dr. Riley were recognized at Scottsdale Healthcare’s Galleria of Fine Hearts- an annual program designed to highlight the amazing stories of heart patients and recognize the work of their physicians and the nursing staff. Awards were presented in several different categories, Cory has the distinction of being the most decorated of all the heart patients, receiving awards in four categories - “Youngest Patient,” “Most Surgeries in One Case,” “Least Likely to Survive,” and “Patient Story Which Reminds Us Why We Come to Work Every Day.”
Wise beyond his years, Cory looks ahead to a bright future “I tell everyone, never give up, if I can make it through this, you can too; there is always hope.”
"Time is Muscle"
Dan Klingenberg was saved by good timing. In this case, it was quick timing, but it also occurred at the right time.
The Scottsdale resident had just finished an exercise class when he collapsed in a locker room in 2005 with a heart attack.
He had no warning and paramedics had to resuscitate him twice on a defibrillator on the way to the hospital. Since then he has had several stent and angioplasty procedures at Scottsdale Healthcare.
Today, Dan leads an active and healthy life. He enjoys outdoor activities and his life has returned to normal. But he remains vigilante about his health. “I was very close to expiring. Once you have heart damage,” he said, “you’re vulnerable, so I am very careful.”
Dan benefitted from a process known as “Door to Balloon (D2B).” It features a 90-minute guideline from American College of Cardiology and the American Heart Association for the time it takes for a patient entering a hospital to receiving balloon catheterization inflation to restore blood flow to the heart.
Here’s how it works: People like Dan who suffer an ST segment elevation myocardial infarction (STEMI) – a specific type of heart attack – require a visit to the cardiac cath lab when they reach the hospital. There, doctors insert a catheter, usually into the femoral artery in the right groin area, and feed it through to the heart. Medical dye helps identify the blockage on an X-ray. After poking a thin wire through the clogged area, the doctor inserts and then inflates a tiny balloon that spreads the vessel open to restore blood flow. This is known as angioplasty.
Research shows that the greatest benefit is received within 60 minutes of opening the vessel. The benefit begins to decline after 120 minutes. So, someone who receives treatment in 90 minutes has a much higher chance of returning to normal activities, not just a lower risk of death, according to Scottsdale Healthcare Emergency Department physician Kurt Solem MD.
To stay healthy, Dan exercises, watches his diet and gets plenty of rest and sleep. “My doctor jokes that I’m a poster boy,” he said.
Scottsdale Healthcare joined the D2B Alliance in July 2007 and has seen steady progress in reducing treatment times. During the first month, D2B times were around 80 minutes at both the Osborn and Shea campuses. By November they had dropped to 66 and 64 minutes. Most recent figures show times averaging 60 to 70 minutes at those two hospitals.
“Door to Balloon” is a cooperative community effort. The hospitals work in tandem with the Scottsdale Fire Department’s Emergency Medical Service to coordinate communication about patients who have called 9-1-1 because of chest pain. When en route to the hospital, paramedics can identify changes in a patient’s 12-lead ECG and notify the emergency department before arriving at the hospital. This helps the emergency department to better prepare for a patient’s arrival and alert the cardiac cath lab of a potential STEMI.
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