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School of Medicine Surgeon Performs Pioneering Robot-Assisted Triple Bypass Heart Surgery

Friday, April 10, 2009

 Professor of Surgery Johannes Bonatti, M.D., is a pioneer in the field of minimally invasive heart surgery.

Patient was able to leave the hospital four days after bypass surgery

Cardiac surgeons at the University of Maryland Medical Center in Baltimore have performed a rare triple bypass heart surgery using robotic assistance. This procedure, which does not require any large incisions, presents a durable alternative to open-heart surgery for patients with multiple blocked coronary arteries. With this minimally invasive procedure, patients can have a much shorter recovery time and return to their normal life much sooner.

The University of Maryland Medical Center is only the second place in the United States to have performed robot-assisted triple bypass and the first in the world to achieve the triple bypass using an advanced, minimally-invasive heart-lung machine. The medical center's first patient to benefit from robot-assisted triple bypass is 67-year-old Ronald A. Bress, from Cheektowaga, New York, near Buffalo, who had his surgery on March 31. He left the hospital four days later and was able to fly home just nine days later.

"The majority of patients who require bypass surgery have more than two blocked arteries going to the heart," says Johannes Bonatti, M.D., a cardiac surgeon at the University of Maryland Medical Center and professor of surgery at the University of Maryland School of Medicine who performed the pioneering surgery. "Our ability to bypass three vessels now means that many more patients can benefit from this minimally invasive, robot-assisted heart surgery."

With traditional open-heart surgery, in which the sternum or chest bone is cut open to reveal the heart, three or more bypasses are routine. People who undergo such open-heart surgery typically require two or three months to heal. They also face a higher risk of infection.

By contrast, robot-assisted surgery offers several key advantages over traditional open-heart procedures, including no need to split the chest open and no incisions: just three or four dime-sized openings to insert robotic tools and a camera. Recovery is usually a two-to-three week period with a quick return to normal activities, as well as reduced risk of infection and other complications.

Mr. Bress was seeking an alternative to open heart surgery when he learned about the innovative robot-assisted bypass approach offered at the University of Maryland Medical Center, where dozens of patients have had either single or double bypasses performed that way. He had gone into cardiac arrest while at a gym in the Buffalo area on March 16 and was rushed to a local hospital. Doctors there told him he needed open-heart surgery to bypass his blocked coronary arteries. He was aware of the long recovery that some of his friends had endured after traditional open-heart surgery. So Mr. Bress decided to do some research on the Internet, hoping for another option. He found information about robot-assisted heart surgery at the University of Maryland Medical Center's Web site and booked a flight to Baltimore.

"When I got to Baltimore, I was so impressed with Dr. Bonatti and everyone else on his team. I am grateful that I was able to avoid open-heart surgery. I feel good. I've been doing a lot of walking around the (Baltimore) Inner Harbor since I've been discharged. In fact, I have even walked from the hotel back to the hospital — about ten blocks," said Mr. Bress just nine days after his triple bypass.

His wife, Christine Bress, said, "This is an amazing place. They took excellent care of Ron and me, too, and they were always kind and respectful. I am so glad that he was a good candidate for this."

Dr. Bonatti is one of the world's most experienced surgeons in using the daVinci robot for heart surgery. The technique is sometimes referred to as "totally endoscopic coronary artery bypass" because there are no incisions. Until now, technical issues had limited robot-assisted bypass surgery to a maximum of two bypass grafts. The major impediment was a technical one — how to enable the robotic instruments to reach the underside of the heart.

Dr. Bonatti and his team have been working to overcome those barriers with improved techniques and new instruments that lift the heart up from the chest to provide access to blocked vessels on the back of the heart. Dr. Bonatti also uses a new type of heart-lung machine specially designed for use with robotic heart surgery, which is connected to the patient through an artery in the groin. A traditional heart-lung machine requires an opening in the chest.

"When the patient is on the heart-lung machine, and the heartbeat is stopped, we can sew extremely tight and accurate sutures with the robotic system. Research indicates that this technique adds to the longevity of the bypass, in contrast to other approaches in which the heart is kept beating," according to Dr. Bonatti.

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