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Health Care

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by Ann Bucy

SBJ Contributing Writer

Patients of St. John's Health System who are anticipating coronary artery bypass surgery can take heart. A new procedure is making the surgery less invasive, and generally, less expensive.

The process is called MIDCAB, which stands for minimally invasive direct coronary artery bypass.

According to Dr. Denton Stam, a heart surgeon with St. John's, this new procedure causes less bleeding, no arrhythmias (abnormal heart rhythms), no fluid retention, a shorter stay in the intensive-care unit and a shorter overall recovery time, which translates to lower cost for the patient.

Prior to MIDCAB, the usual hospital stay for a bypass patient was four to six days. With MIDCAB, the average hospital stay is cut to only two days.

For the most part, these advantages are related to the surgical method. MIDCAB allows the surgeon to operate on a beating heart through a small incision in the chest wall. There is no incision through the breast bone, which has usually been done in bypass surgery in the past, nor a leg incision to obtain vein grafts.

The surgeon doesn't use the cardiopulmonary bypass pump (heart-lung machine) because the heart doesn't have to be stopped during surgery. Also, the patient endures less pain and recovers faster because the area of trauma is limited to a 3- to 4-inch incision near the fourth rib, through a pectoral muscle in the chest wall. The entire surgical procedure is normally completed within two hours.

One patient, a man from West Plains in his late 40s, had the operation on a Thursday and went home that Saturday.

"For this patient, he was two days in the hospital, off the ventilator while he was still in the operating room: no bypass pump, less ICU, no blood usage (transfusion) and a rapid recovery," Stam said.

As with any kind of surgery, Stam said, he recommends the patient see his or her physician about the potential risks of the specific procedure.

But he added that he does believe there are three kinds of people who are most likely to qualify for MIDCAB. They are:

?"The younger patient who has a singular blockage at the front of the heart.

?"The elderly patient who can't tolerate bypass surgery.

?and "Someone with multiple vessels involved. A hybrid is performed using a balloon or stent (an expandable wire coil used to keep the artery open)."

Stam brought this new procedure to the Ozarks when he moved here last July. He was born in Australia and raised in Florida. He completed his cardiothoracic surgical residency at Hahneman University in Philadelphia, where he learned about MIDCAB.

INSET CAPTION:

The new procedure cuts the average hospital stay from 4 to 6 days

to 2 days.

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