Genesis Offers Less-Invasive Procedure in High-Risk Area of the Heart - An Alternative to Open-Heart Surgery   (Posted 2/21/06) 


Mildred Cunningham felt like she'd been run over by an 18-wheeler after quintuple heart bypass surgery 10 years ago.  It took more than three months for her to feel like herself again after the extensive open-heart surgery.  

What a difference a decade makes.

A couple of months ago her cardiologist discovered another blockage - this time in a high-risk area of the heart called the left-main artery.  Thanks to new technology and skilled cardiologists at the Genesis Heart Institute, 76-year-old Cunningham had the blockage opened less invasively in the Genesis cardiac catheterization lab. 

"It was a cinch," she says.  "I had absolutely no pain and went home the next day." 

Cunningham of Rock Island is still counting her blessings.  Blockages in the left-main artery are very serious and for decades signaled the need for bypass surgery for those patients who could withstand it.  This time around, she wasn't a surgical candidate. 

"I'm so fortunate to live in a place where this option to surgery is available," she says.  "It would have been very hard for someone my age to travel to another area."  

Advanced Heart Care
Cunningham's case illustrates the leading-edge heart care being done at Genesis Medical Center, Davenport, using less-invasive techniques.  Previously, people with a blocked left-main coronary artery - a high-risk area that supplies blood to a large portion of the heart - had few options but bypass surgery.  

Today, cardiologists in the Genesis catheterization lab are routinely opening blockages in the left-main coronary artery and propping them open with small metal coils called stents. 

Most hospitals have done very few left-main artery stenting procedures, if any.  At Genesis, cardiologists have done more than 160, says Shauna Roberts, M.D., Medical Director of the Genesis Heart Institute. 

"Left-main stenting began as a way to offer desperate patients some kind of hope because there were people who couldn't withstand a big heart operation with a chest incision," Dr. Roberts says.  

"Most heart programs that do this have done only four cases . . . eight cases . . . 12 cases.  At Genesis, we've done more than 160 - or 88 in the first nine months of 2005 - and prevented patients from needing heart surgery.  Left-main stenting at Genesis evolved and grew out of the fact that we have such high volumes and exceptionally skilled interventionalists."  

One of those skilled interventionalists is Cunningham's cardiologist, Jon Robken, M.D., of Cardiovascular Medicine, P.C.  In two decades, he has seen the evolution of angioplasty and technological advancements that have paved the way for stenting in the left-main artery, which supplies about two-thirds of the blood to the heart.  

Advancements in Angioplasty

Ironically, Dr. Robken was undergoing his residency in Michigan in the late '70's when he heard Dr. Andreas Gruentzig of Switzerland lecture about clinical trials involving coronary angioplasty on humans.  (Angioplasty involves threading a slender balloon-tipped tube - a catheter - to a trouble spot in the heart and inflating the balloon to open the blocked artery.)  The work of Dr. Gruentzig forever altered the role of cardiologists in treating coronary artery disease.  

Since the mid-'80's, angioplasty has been a relatively simple, inexpensive and safe alternative to bypass surgery.  But is has had one significant drawback:  up to a 40 percent chance that scar tissue would grow and re-block the artery.  

"At the forefront of research for years has been the question: How do you keep the artery from re-narrowing so you don't have to do the procedure again?"  says Dr. Robken, who has done more than 20,000 procedures in the catheterization lab during his career. 

This re-narrowing of the artery, called restenosis, previously made the left-main artery a poor candidate for stents.  "The left-main artery is a very important location, so you're not willing to accept a 30 percent chance that the blockage will come back," Dr. Robken says. 

He adds, "If the left main artery closes, you usually don't survive because about two-thirds of your heart just stops working.  A cardiac arrest occurs."

Over the years, Dr. Robken and his colleagues have attempted to tackle the restenosis problem using everything from lasers to vaporize plaque in the arteries to scrapers to shave off the plaque.  The introduction of bare-metal stents in 1995 lowered the restenosis rate to 30 percent.  However, it wasn't until the advent of drug-coated stents three years ago that stenting in the left-main artery became a much better option for patients. 

The stents are coated with a drug that stifles the growing and dividing of cells that leads to restenosis.  Re-narrowing of the artery occurs only about 4-8 percent of the time. 

"We've always done left-main angioplasties and stents on those patients who were not candidates for bypass surgery," Dr. Robken says.  "However, the numbers have expanded significantly now that the restenosis rate is at a nice reasonable level.  We're now doing left-main artery stenting on patients who also are good candidates for surgery." 

Of every 100 patients who undergo heart procedures at Genesis, only about 8 require a more invasive procedure that requires a chest incision.  Other hospitals nationally are reporting that 20 to 30 of every 100 patients - or three to four times the number at Genesis require chest incisions to restore blood supply. 

Although Genesis performs the highest number of open-heart surgeries in the region, Cunningham can vouch for the fact that less-invasive heart care is far easier on the patient.  Her bypass surgery required a chest incision; opening the rib cage; time on a heart-lung machine, and 10 days in the hospital.  

"Bypass surgery is not a lot of fun and the recovery period was long," Cunningham says.  "Having a procedure in the cath lab was far easier.  I'm lucky and pleased to live in a time where things like this can be done."  

-- Story by Linda Barlow, Genesis