State of the Heart

Following in the footsteps of legends like Michael DeBakey and Denton Cooley, Texas doctors are perfecting “minimally invasive” alternatives to coronary bypass surgery. And the beat goes on- with a lot less pain.

IN JUNE 1997 SARAH CLAIR BURKE OF MONAHANS got just about the worst results a patient can get from a heart-stress test. Moments after stepping off the treadmill at Medical Center Hospital in Odessa, she began suffering severe chest pains. Burke thought it was indigestion, but her doctor was worried about angina. He gave her nitroglycerin and ordered more tests. During a thallium scan—an imaging technique that allows doctors to study blood flow through the heart muscle—Burke suffered further symptoms of a diseased heart, including intense aching in her arm muscles and jaw. Finally, doctors conducted an angiogram and found six severely obstructed blood vessels in her heart.

At 64, Burke was no stranger to the knife, having undergone a C-section, throat surgery, and a hysterectomy. But the prospect of open-heart surgery—the only sure solution for this degree of coronary-artery disease—concerned her. Coronary artery bypass graft ( CABG, or “cabbage”) is one of surgery’s most successful and venerated procedures but also one of the most barbaric. Burke knew that firsthand from having observed what the operation had done to her husband, William, back in 1989. “He had a lot of pain afterward,” she recalls, “and he was depressed.”

Her cardiac surgeon, Sudhir Srivastava of Cardiac Surgical Associates in Odessa, proposed an alternative, one that had not existed when her husband had undergone open-heart surgery: minimally invasive, port-access coronary artery bypass surgery. The procedure, which had been sanctioned by the Food and Drug Administration for less than a year, promised a patient like Burke the needed revascularization of her heart with considerably less of the invasiveness, trauma, and post-operative pain associated with CABG. Instead of splaying the patient’s chest out with a foot-long sternotomy to perform the necessary vessel grafting, the surgeon operated with customized instruments through a small four-and-a-half-inch port, cut out of one of her ribs on the left side of her torso.

Benign as it sounded, port-access CABG was not without risks. Some of Srivastava’s colleagues at Medical Center Hospital and representatives of the technique’s inventors, Heartport, a biomedical device company in Redwood City, California, were nervous about using it for the quintuple bypass Burke required. The technology (trademarked by Heartport as Port-Access) had never been applied so ambitiously. Could even a skilled surgeon like Srivastava accomplish a successful quintuple bypass through an incision shorter than the length of his hand?

The 49-year-old native of India believed so. He understood the worries but thought that Burke was still a perfect candidate. Despite the number of clogged arteries she would have to have bypassed through grafts, the blood vessels in her legs and stomach were sturdy enough to withstand the complex catheterization required by the procedure. Also, as a diabetic, whose wounds tend to heal slowly, she would benefit from the diminished trauma. Beyond that, Srivastava—who had gone through the training but not yet performed the operation—believed the procedure could handle five-vessel sur-gery. “It’s like with all new techniques,” says the surgeon, echoing the sentiments of an earlier generation of groundbreaking Texas heart surgeons like Michael DeBakey and Denton Cooley. “There always comes

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