When Robbin Cohen, assistant professor of surgery, was brought in on the case of Marie Jackson, there weren’t many options: the 59-year-old Pasadena resident needed open heart surgery to replace a faulty mitral valve. But as a Jehovah’s Witness, she had religious objections to receiving donor blood.
Since 30 to 40 percent of patients undergoing open heart surgery need transfusions, the best alternative Cohen could offer was a relatively new procedure called port access surgery – where the valve could be replaced through a small four inch incision, or “port,” on the side of the chest between the ribs. No sawing through the breastbone, no spreading the rib cage to reach the heart, and, most importantly for Jackson, no blood transfusion.
The grandmother of 16 and great-grandmother of two opted for the minimally invasive procedure in March. In her case, it worked.
The case brought Cohen a flood of attention and phone calls. Patients, he noted, are demanding it – driven in part by media stories touting shorter recuperation times and medical center promotional materials hailing their latest surgical advances.
But the physician, who began doing port access heart surgery only six months ago, cautioned that the procedure is still so new and there is so little data about outcomes that “this so-called movement has caught on pershaps too quickly.”
Worldwide, he noted, “only 1,000 cases have been done. Whereas there are 1,000 basic coronary bypass operations happening every day.”
Cohen is enthusiastic about the procedure’s potential. Minimally invasive surgery, he says, could cut patient morbidity, reduce recuperation time and cut costs. “If it gets to a point where patients can return to work after two weeks instead of after six weeks, you’re talking about a significant savings,” he noted.
In addition, as a cardio-thoracic surgeon, he’s been doing minimally invasive thoracic surgery (video-assisted thoracic surgery) for a while now and feels that “this is a natural progression.” He has been working with a team from Stanford University that has developed the Heartport system, which modifies the way in which patients are placed on the heart-lung machine, which is needed for this type of minimally invasive heart surgery.
Cohen said the technique is still in its investigational stages and should only be used for selected patients. Those who have vascular disease or complex combined cardiac problems, for instance, are not good candidates at the present time. “But as we get better and better at this, it’s possible those patients will be eligible as well.”
For now, “We want people to know we’re on top of the technology and have assisted in developing some of it. It is available to patients who are candidates. As we see it’s working out, we’ll offer it to more and more people.”