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An inter-disciplinary medical team at CSTAR (Canadian Surgical Technologies & Advanced Robotics) is seeing a marked increase in the number of referrals of patients from across Canada for a relatively new innovation to treat heart disease. In 2004, the team became the first in North America to complete two different procedures to clear blocked arteries, minimally-invasive robot-assisted heart bypass surgery and angioplasty with stenting, at the same time in the operating room.
Although the individual procedures are not new, the fact that they are combined into one episode of care is unique. Before the hybrid surgery, patients needing both procedures would have bypass surgery first and then angioplasty a day or two later, or vice versa. Advanced technology, such as 3-D imaging in CSTAR’s specialized Hybrid Operating Room/Angiosuite at the LHSC, one of a few such facilities in the world, has made this intervention possible.
“Combining heart bypass surgery and angioplasty in one operating room opens up an entirely new option to treat select patients with heart disease,” says Bob Kiaii, leader of CSTAR’s Robotic Coronary Artery Bypass research project and cardiac surgeon at LHSC. “The benefits of this new hybrid procedure include a reduced hospital stay by approximately two days compared to the traditional approach to treatment, and a faster recovery, which benefits patients as well as the health care system.”
With continued positive results for patients, the team has been able to successfully complete thirty “hybrid” procedures since September 2004 at London Health Sciences Centre. Dr. Kiaii says the number of referrals is continuing to grow as word of the procedure’s success spreads.
“Robotics has actually become 80% of my practice now with patients being referred to us from across Canada.”
Using the four-armed da Vinci robot, Dr. Kiaii bypasses a single blocked coronary artery through small incisions instead of cutting the breast bone in half.
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The surgery is also performed without stopping the heart as opposed to traditional bypass surgery where the heart is stopped and the heart/ lung machine is used to circulate the blood supply.
According to Dr. Kiaii, “When we use what we call an ‘off pump’ procedure, patients may experience a reduced risk of developing complications such as increased inflammation, neurological side effects and bleeding.” This procedure also avoids cutting the breast bone and reduces post operative wound complications and infections.
Dr. Bill Kostuk (left) and Dr. Bob Kiaii consult about a patient’s case prior to the angioplasty being completed by Dr. Kostuk in CSTAR’s Hybrid Operating Room. |
Immediately following the surgery, the intervention cardiologists complete the percutaneous coronary intervention (PCI) or angioplasty with stenting to open additional narrowed arteries. According to Dr. Kostuk, interventional cardiologist at LHSC, “The one procedure allows us to do a PCI on patients at a reduced risk.” PCI involves the advancing of a small tube (catheter) from the groin to the mouth of the artery. Through this tube a smaller catheter with a balloon on the tip is passed across the narrowed segment. The balloon is inflated, which presses the fat deposits against the artery wall and increases the opening. A stent (wire mesh) is then placed across the narrowed opening. The stent is pressed into the wall of the vessel by inflating a balloon. The end result is a wide open blood vessel and normal blood flow.
Patients who would be considered for the hybrid research protocol are those with blocked heart arteries who would benefit from a minimally-invasive bypass with robotic assistance and who also have blocked arteries not accessible through a minimally-invasive approach that would be treated with interventional cardiology.
Research at CSTAR is supported by grants from the Canada Foundation for Innovation and the Ontario government. CSTAR is a collaborative research program of London Health Sciences Centre and the Lawson Health Research Institute and is affiliated with the University of Western Ontario.
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