Coronary Bypass Surgery an Easier Way: Sharon's Story

Sharon Jackson

Sharon Jackson is a tried-and-true believer in the newest method for heart bypass surgery: totally endoscopic coronary artery bypass (TECAB). She speaks from experience: In 2000 she underwent traditional open-heart bypass surgery, and in 2007 at the University of Chicago Medical Center she had the TECAB surgery. Both operations accomplish the same result: bypassing blockages in the arteries that cause chest pain and can lead to a heart attack. But, that's where the similarities end.

In 2000, Sharon's cardiac surgeon used the traditional open-chest method for coronary artery bypass graft (CABG) surgery, which involves cutting through the sternum (the flat bone on the chest, between the ribs) to reach the heart. Afterward, she endured a long, painful and difficult recovery. Sharon recalls, "The first time around, they chopped me up so much looking for a vein to use from my legs or arms. After the surgery, I was in the hospital for almost a month, and needed a lot of physical therapy and occupational therapy. Once I got home, I needed a nurse and housekeeper to care for me. And, I've got a long scar from where they opened my chest."

Despite the bypass surgery, Sharon had two more heart attacks over the next few years. Her cardiologist recommended a second heart bypass surgery to help prevent further heart attacks. "When my doctor told me I needed another bypass surgery, I couldn't see myself going through that again. I stalled for three years before finally agreeing to a second heart surgery." Fortunately, Sharon's experience with the second heart surgery was completely different.

Sharon's TECAB heart surgery in August 2007 resulted in a shorter recovery, significantly less pain, and a much quicker return to her normal activities. "I left the hospital four days after my surgery, and stayed at my sister's house for a week or so until my first checkup with Dr. Srivastava. I was in much less pain, and didn't need physical therapy, occupational therapy, or a nurse to take care of me. There is a small incision on the side of my chest -- small enough to cover with a band-aid." In less than six weeks, she was back to climbing stairs, lifting things and doing her normal activities.

Sudhir Srivastava, MD

Sudhir Srivastava, MD, a cardiothoracic surgeon at the University of Chicago Medical Center, is one of only two surgeons in the world with extensive experience in this method of complex multi-vessel heart surgery. He performed the nation's first beating-heart TECAB procedure in 2003. As of October 2007, he has performed nearly 300 TECAB procedures--more than any other surgeon in the world.

TECAB: What It Is and How It Works

Representing the latest frontier in heart bypass surgery, TECAB (totally closed endoscopic coronary artery bypass) is a completely closed-chest surgical approach that uses the da Vinci Surgical System for bypass surgery. The da Vinci Surgical System enables the surgeon to sit at a control panel console and manipulate four robotic arms and small microtools that are inserted into the chest through tiny incisions. On a monitor screen within the console, the surgeon sees magnified, 3-D images from inside the body. Movements from the surgeon's hand, wrist and fingers are translated into movements of the micro-instruments. Guided by the surgeon's motions, the system's robotic "fingers" perform the surgery with far greater precision, intricacy and dexterity than the human hand can.

How is TECAB Different from Other Types of Bypass Surgery?

Cardiac surgeons have been performing coronary artery bypass surgery (CABG) for decades, with much success. It is one of the most common surgeries performed. All types of bypass surgery involve the removal of a vein or artery from one part of the body and attaching one end of the vessel to the large artery leaving the heart (the aorta) and the other end below the blocked artery. This newly grafted vein or artery "bypasses" the blockage so blood can flow freely.

The da Vinci's robotic arms are extraordinarily agile. In this photo, Dr. Srivastava maneuvers the arms in preparation for surgery. During surgery, he will control the arms' movements while seated at the da Vinci console.

At most hospitals, surgeons use vessel grafts from the leg or arm, because it's easier to harvest these vessels. However, this approach can prolong and complicate recovery. At the University of Chicago Medical Center, surgeons typically use internal mammary arteries from inside the chest wall for grafts in TECAB and other types of bypass surgeries. Mammary arteries are among the most durable vessels in the body--much better suited to withstand blood pressure over time compared to vein grafts, thus reducing the chance for reoperation. Harvesting mammary artery grafts is a more technically demanding procedure--made easier and safer with the assistance of the da Vinci Surgical System.

Like Sharon Jackson, David Wunch had a TECAB. He traveled from Tulsa to Chicago for his care. » Read David’s story

In traditional open-chest bypass surgery, the surgeon cuts through the breastbone and spreads the rib cage to reach the heart. More recently, some surgeons have adopted a minimally invasive approach to heart bypass surgery. Minimally invasive bypass surgery is usually done through a 3- to 5-inch incision on the side of the chest -- rather than going through the sternum. Recovery from this minimally invasive approach is shorter and usually less painful than the traditional open method because the sternum remains intact. At the University of Chicago Medical Center, our surgeons offer the ThoraCAB approach--a type of minimally invasive bypass surgery developed by Dr. Srivastava that is an alternative to TECAB for some patients.

The robot-assisted TECAB procedure takes minimally invasive bypass surgery a step further. Dr. Srivastava describes it as a "truly closed-chest" procedure. TECAB is performed through four or five tiny incisions in the side of the chest. Each incision is as small as a dime. »Learn more about the full spectrum of bypass surgeries available at the University of Chicago

This newer procedure has been slow to gain widespread usage because TECAB requires a complete mind-shift from what cardiovascular surgeons have been doing for decades.

Dr. Srivastava has trained other surgeons on the newer procedure but, so far, few have much experience with it. One of the obstacles is that there is no sense of touch with the robot, so the surgeon cannot actually feel what he or she is doing. Because bypass surgery requires a high degree of precision, the loss of tactile feel can be unsettling to many surgeons. Another obstacle, from the perspective of surgeons who prefer the traditional CABG approach, is that they can't look directly inside the chest. With the robotic technology, a tiny camera inserted in the chest displays images on the computer monitor. To make it easier for the surgeon to see, the images are in 3-D and are magnified on the screen.

Dr. Srivastava's experience from performing nearly 300 TECAB procedures enhances his confidence and competence with this technique.

Less Blood Loss

Notably smaller incisions, less pain and faster recovery weren't the only benefits of TECAB that convinced Sharon Jackson to use this newer procedure. She also liked that TECAB meant much less blood loss during surgery, with limited or no need for blood transfusions.

"I am a Jehovah's Witness," she explains. "It's OK for us to get surgery, but we avoid the need for blood transfusions because of our religious beliefs." The Jehovah's Witness Hospital Liaison Program works closely with physicians and medical centers to find alternative ways to treat Jehovah's Witness patients without the need for blood transfusion. More than 4,500 congregational elders worldwide are trained to speak with doctors about strategies for "bloodless" surgery.

Sharon says, "An elder at my church got me in touch with Dr. Jeevanandam at the University of Chicago Medical Center." Valluvan Jeevanandam, MD, is chief of cardiac and thoracic surgery at the Medical Center, and has been identified by the Jehovah's Witness liaisons as a surgeon who opts for minimal blood loss when feasible. "Dr. Jeevanandam then referred me to Dr. Srivastava for this new type of surgery."

Even people who don't have religious reasons may prefer to avoid blood transfusions as a way to avoid potential complications related to transfusion. Patients undergoing the TECAB procedure have virtually no need for transfusions.

The Way to Go

Comparing her experiences with traditional open-chest bypass surgery and the newer, closed-chest TECAB technique, Sharon says the TECAB approach is "the better way to go, most definitely."

Adults who are considering the TECAB approach for heart bypass surgery may contact us toll-free at 1-888-UCH-0200, directly at (773) 702-2500 or request an appointment online. A comprehensive evaluation will help determine whether you are a good candidate for this surgery, or whether a different approach is more appropriate.