Less Invasive Procedure Opens Blockages
Thomas Khoury, MD, a general/vascular surgeon at Southern Ohio Medical Center, was selected by medical device developer Boston Scientific to participate in a research trial on placing stents in carotid arteries.
This procedure is used to open restricted blood pathways to the brain and prevent strokes. The research trial was conducted in Ohio at sites including SOMC, Cleveland Clinic, Riverside Methodist Hospital, The Ohio State University and Grant Medical Center.
“By using a catheter inserted through an artery in the groin, we can compress the fatty deposits and place a stent (a hollow tube) in the restriction that allows better blood flow to the brain,” Dr. Khoury explains.
“This procedure is much less invasive than conventional surgery, offering lower risk and discomfort to the patient in a process that can be done without having the patient stay a long time in the hospital,” Dr. Khoury says.
The risk factors for carotid disease are the same for coronary and lower extremity vascular disease, Dr. Khoury explains. “These include smoking, diabetes, high cholesterol/triglycerides, family history and hypertension,” he says.
Dr. Khoury has already been performing the procedure on patients at SOMC.
“The typical patient is someone who has presented symptoms indicating a stroke may be forthcoming, or in which certain testing has revealed a restriction in the carotid artery,” he says.
“We conduct tests to reveal the current state of the patient’s arteries and reveal blockages and strictures to blood flow. If the patient meets certain criteria we can perform a carotid stent procedure as opposed to conventional surgery. This is often an excellent alternative for individuals who are not good candidates for surgery.”
During the procedure, a membrane is temporarily placed beyond the point where the stent will be placed, serving as a filter to catch any debris that may break off during the process. Without this important filter, if debris breaks loose it can travel toward a smaller arterial branch and block blood flow, causing a stroke.
“We are constantly monitoring the patient’s status during the procedure, so the patient stays awake and is asked periodically to squeeze a rubber ball or toy,” Dr. Khoury says. “This way we know the patient is alert and responding.”
Dr. Khoury has performed more than 400 carotid endarterectomies and more than 2,000 angiograms and endovascular procedures locally.
Innovative Hybrid Cardiac Surgery: An Ideal Procedure by the Ultimate Team
When SOMC designed its new Heart & Vascular Center it planned for the future. In 2008 SOMC opened the first hybrid operating room in the region. Chief of Cardiothoracic Surgery, Henry Childers, MD and Chief of Interventional Cardiology, Daniel Jovanovich, MD have put together the ultimate team and helped design a state-of-the-art hybrid cardiovascular operating room.
This special operating suite allows a cardiothoracic surgeon and interventional cardiologist to work together in the same room. By accommodating both doctor’s needs it reduces the amount of time required to correct a heart problem and the amount of emotional and physical stress placed on a patient or their family – which translates into less pain, less scarring and a faster recovery time.
The hybrid procedure combines bypass surgery and stenting in a customized plan of treatment by both the cardiologist and the cardiothoracic surgeon to meet the needs of each patient. Previously a patient would have to undergo two heart procedures on different days. The hybrid procedure allows the surgeries to be combined into a single procedure on the same day.
The hybrid approach is used so that the internal mammary artery can be placed by minimally invasive surgery. After the bypass graft is completed, the remaining vessels that are not blocked enough to require bypass, are stented using angiography.
Off-Pump Beating Heart Open Heart Surgery
At SOMC, our cardiothoracic surgeons perform many of their heart surgeries without using cardiopulmonary bypass. This sophisticated surgical technique is called off-pump bypass or “beating heart” surgery.
Off-pump open heart surgery or coronary artery bypass does not utilize the traditional cardiopulmonary bypass machine. Technological advances and specialized surgical equipment allows the cardiothoracic surgeon to stabilize certain areas of the heart so that they can bypass the blocked artery while the rest of the heart continues to beat and circulate blood and oxygen to the rest of the body.
Off-pump or Beating Heart Surgery is performed approximately 75% of the time at Southern Ohio Medical Center as compared to approximately 20% of the time throughout the rest of the country. Off-pump surgery can be ideal for certain patients who are at increased risk for open heart surgery, such as those patients with a prior stroke, pulmonary disease, renal disease, or profuse vascular disease in the aorta or carotid arteries. Studies conclude that off-pump bypass surgery produces better outcomes for patients.
Southern Ohio Medical Center is leading the way in advanced heart technology by becoming the only organization in the region to perform minimally invasive procedures during heart surgery.
“Minimally invasive heart surgery allows the patient to undergo a heart procedure without the extensive opening necessary to get to the areas that need repair. It also allows the patient a much faster recovery time,” said Henry Childers, M.D., cardiothoracic surgeon of SOMC Heart and Vascular Services.
Minimally invasive heart surgery is performed through a small incision (no more than four inches) made in the patient’s chest cavity. By using this procedure, no bone or muscle is cut and the patient incurs a smaller incision area, which reduces pain and scaring. This process also reduces the risk of infection, causes less bleeding and decreases the length of stay in the hospital.
“Because we don’t cut bone during the procedure, recovery is drastically reduced from the average time of eight-weeks during traditional heart surgery,” Childers explained. “With this procedure, recovery time is as little as two weeks and we’ve been able to get patients back on their feet in as little as 24-hours after their surgery.”
“I feel 100 percent better,” said Maxine Ruby, a recent recipient of the minimally invasive procedure. “I have a lot more energy. I can do my housework and can watch my grandson play ball. I couldn’t do that before the surgery.”
Childers explained that heart valve surgeries, including valve repairs and valve replacements, are the most common types of minimally invasive procedures; however, the process can also be used for coronary artery bypass graft (CABG) surgery, epicardial lead placement and atrial fibrillation.
“We are continually staying ahead of the pack on techniques and technology at SOMC,” he said.
Ruby said her recovery time was extremely fast. “I had my surgery on Tuesday and was home by Saturday. I was up and moving around and already felt great. I’m now in rehab and walking on the treadmill.”
Childers specialized in minimally invasive procedures during training at Cornell Medical Center in New York and at the University of Pennsylvania. He has continued to perfect this technique over the years, leading the way in the region. For more information on this procedure, please contact SOMC’s Heart and Vascular Associates at ext. 8772.
VNUS ClosureFAST Varicose Vein Treatment
SOMC surgeon Dr. Henry Childers is now providing a new approach in varicose vein treatment, using radio waves in a tube to shrink and close the diseased veins in a less invasive procedure. The tube is inserted (left), radio waves are emitted (center) to collapse the vein and the tube is removed (right).
Southern Ohio Medical Center has announced that Dr. Henry Childers is now performing a procedure that treats the underlying cause of painful varicose veins using radio waves to heat, shrink and close diseased large leg veins in approximately three minutes of RF treatment.
The entire ClosureFAST procedure, from insertion of the catheter to removal, generally takes less than 20 minutes with little pain or bruising for the patient, Dr. Childers said.
“Patients are very happy with this treatment approach and we’re very pleased to be able to bring it to our community,” Dr. Childers said. “Patients nationally who have had this procedure are amazed at how quickly the procedure is completed and how little discomfort they feel, and they’re pleased to be able to walk out after the procedure and resume normal activities the next day. The treatment outcomes are normally excellent – the procedure is successful in closing the vein, and their quality of life improves quickly.”
The ClosureFAST catheter received FDA clearance in August 2006, providing a treatment alternative for the nearly 25 million Americans who have varicose veins, many of whom suffer from pain, swelling, fatigue and disfigurement. The catheter is threaded into the diseased saphenous vein through a small puncture, and RF energy is transmitted to the device to heat and seal the diseased vein walls, forcing the body to re-route blood flow through healthier leg veins.
“Family history, pregnancy, excess weight and professions requiring extended standing are all risk factors for varicose vein disease, and the majority of patients are women,” Dr. Childers said. “We’re gratified to be able to offer this fast procedure as an outstanding alternative to traditional surgery for the many patients who have suffered from this disease.”
Dr. Childers has been the Chief of Cardiothoracic Surgery at SOMC since 2007. He came to Portsmouth following a successful surgical practice in Greensburg, PA.
A member of SOMC Heart & Vascular Associates, Dr. Childers can be reached at 1711 27th St., Braunlin Building Suite 206, Portsmouth. Telephone (740) 356-8772 for more information.