The Community Hospital Performs Area's First Endoscopic Vein Harvesting Procedure for Coronary Artery Bypass Surgery

The Community Hospital in Munster, Indiana, is the first hospital in Northwest Indiana and the adjacent south Chicago suburbs to perform a new procedure that eliminates the long incision in the leg required to remove a vein for open heart surgery.

The surgical advancement may reduce the postoperative pain and recovery time associated with coronary artery bypass surgery, one of the most frequently performed surgeries nationwide.

"We are extremely pleased to bring this advancement to our community," said Edward P. Robinson, administrator of The Community Hospital. "The endoscopic vein harvesting is just the first of the new minimally invasive heart surgical procedures the Heart Center at Community will offer in the coming months.

"The benefits of these new procedures can be tremendous for patients: less pain and trauma, shorter hospital stays, a quicker return to normal activities, and a better cosmetic outcome," Robinson said.

The first surgery to feature the new endoscopic procedure was performed by Dr. Bradford Blakeman, M.D., and Dr. J. Michael Tuchek, D.O, physicians from Cardiac Surgery Associates who recently joined the hospital's medical staff and opened an office at the Heart Center at Community. This group of board-certified heart and vascular surgeons maintain teaching affiliations with Loyola University Medical Center in Maywood, Ill.

"Much of the pain from coronary artery bypass surgery is actually caused by the incision in the patient's leg, not the incision in the chest where the bypass procedure is performed," Dr. Blakeman said. "These lengthy leg incisions have, in the past, been the source of many post-operative complications and consequently, hospital readmissions."

In the new endoscopic procedure, only one or two incisions, 2-3 inches in length, are made in the patient's leg. This compares with the conventional method of making an incision from the groin to the ankle in one or both legs. These incisions are needed to remove a surface vein known as the saphenous vein that is used to make a new "route" for the blood to travel around clogged coronary arteries, improving the flow of blood and oxygen to the heart.

A single, small incision made during the endoscopic procedure now facilitates the use of special surgical instruments. A miniature camera mounted at the end of a surgical instrument makes it possible for the surgeon to view the inside of the leg on a fiberoptic television monitor. Special surgical instruments are used to snip both ends of the vein and pull it through a small incision.

"These smaller incisions, made possible through the use of an endoscope, can significantly reduce the swelling, irritations, wound infections and other complications associated with the previous groin-to-ankle incision," Dr. Tuchek said. "And, the majority of heart bypass patients may be candidates for this new procedure."

"This procedure is less traumatic to the patient than the traditional vein harvesting method," Tuchek said. "Besides the unsightly scar left by the older method, the lengthy incision posed some real problems for patients, including a greater chance for wound infection, bleeding and pain."

The first patient to benefit from this advancement was Mary Nalepa, 60, of Griffith, Ind., who underwent heart bypass surgery on May 15. Feeling "zero" pain today as she undergoes cardiac rehabilitation, Nalepa said she was thrilled to be the first patient. She said she knew from others who underwent traditional vein harvesting "how bad the pain is in the leg." She said she didn't want to face a similar experience.

Endoscopic Saphenous Vein Harvesting is just one of the new minimally invasive cardiac surgery techniques brought to Community Hospital under the leadership of Dr. Bradford Blakeman, M.D., Medical Director of the Heart Center at Community and a Professor and Vice Chairman of Thoracic and Cardiovascular Surgery at Loyola Medical Center.

Other minimally invasive heart procedures this group will offer include Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) and Heartport Port-Access™ Minimally Invasive Surgery. MIDCAB, known as the "beating heart" surgery, enables the physician to operate directly on the beating heart through a small incision in the chest. The patient does not have to be put on the heart-lung machine and can resume normal activities in a week or two. The HeartPort Port-Access™ procedure also allows the physician to operate through a small incision while the patient is on the conventional heart-lung machine that circulates the blood through the body while the heart is stopped. Heartport Port-Access™ technology enables physicians to do valve repair and replacement and multiple bypasses.

Pioneers of minimally invasive cardiac surgery, Drs. Blakeman and Tuchek are joined at Community Hospital by six other surgeons from Cardiac Surgery Associates, who in addition to performing coronary artery bypass operations, bring their expertise in heart valve repair and replacement, high-risk cardiac surgery and heart transplantation.

"Endoscopic saphenous vein harvesting is not widely available, but as more surgeons receive training in the technique, we expect more and more procedures will be performed this way because of the significant quality of life benefits to the patient," Dr. Blakeman said.

Until the recent development of the new minimally invasive endoscopic approach to saphenous vein harvesting, there had been no significant changes in vein harvesting since the inception of the procedure in the 1960's. Saphenous vein harvesting for coronary artery bypass is one of the most frequently performed procedures in the United States today. More than 300,000 people nationwide undergo coronary artery bypass surgery each year.

While not all patients are candidates for minimally invasive heart surgery, many can benefit from these new advancements. To new learn more about the new procedures offered through the Heart Center at Community, call (219) 852-6495 or 1-800-331-1924.