Beating heart surgery leads to quicker recovery, lower costs
Researchers at the Medical Center have discovered that patients whose hearts are left beating during heart surgery recover quicker than those whose hearts were stopped. This quicker recovery time leads to lowered costs because it reduces patients' hospital stays.
In a small study of heart patients, researchers found that performing surgery on a beating heart can reduce intensive care unit stays and costs. In addition, the study found a significant decrease in the average cost of patients' respiratory care services.
Conventional heart surgery is performed by cooling down the patient, stopping the heart and re-routing the blood through a heart-lung machine. While most surgeons prefer to operate on a still heart, there are downsides to the process. The blood's exposure to the heart-lung machine's foreign surface can increase the risk of stroke and system-wide inflammatory responses.
"Signficant advances in beating heart surgery have evolved in the past three years," said Assistant Professor of Anesthesiology Dr. Katherine Grichnik, noting that the development of better
During surgery with these new devices, a portion of the heart's surface roughly the size of a half-dollar coin is kept still and operated upon while the rest of the heart is still beating.
"In theory, there is a benefit of not going to the [heart-lung machine], if it can be done safely," said Associate Professor of Anesthesiology Dr. Mark Newman, adding that performing surgery on a beating heart puts a greater demands on the surgeon's expertise and skill. If work is needed on the side heart vessels, for example, surgeons have to slowly lift and rotate their patient's heart. "There is a tendency to have to work a little faster if there is work needed on the side heart vessels," he said. "As the heart comes out of the chest it might not pump so well."
Newman explained that the study's ultimate concern was to determine whether beating heart surgery can provide better or equal results to still heart surgery, regardless of cost.
The decision on whether to perform a beating versus still heart surgery will remain with individual surgeons. Some surgeons are comfortable performing on still hearts, while others would prefer to not expose their patients to the heart-lung machine if it is not necessary. A patient's anatomy is another important factor in this decision. Patients with extensive coronary disease and those who have already had heart surgery are not eligible for the beating heart operation.
The study is a product of the researchers noticing that high-risk patients were doing remarkably well after beating heart surgeries. Although Grichnik acknowledged that the 62-patient sample size of the experiment is small, she added that this is only an initial study-the question of beating heart surgery still requires a larger investigation. Grichnik is currently heading a 400-patient study that she believes will show a decrease in the length of hospital stay when beating heart surgery is performed.
The initial study's findings were presented last Friday at the annual meeting of the International Society for Minimally Invasive Cardiac Surgery.