Jill Schramm/MDN Dr. C. Etta Tabe uses a heart model to illustrate the purpose of a bypass.

Tremendous strides are being made in the field of cardiothoracic surgery, and Trinity Health is beginning to bring those advancements to Minot.

Dr. C. Etta Tabe, a cardiothoracic surgeon at Trinity, said new minimally invasive techniques are having a noticeable, positive impact on patient care when compared with traditional open heart surgery.

“It’s dramatic, and you are really impressed when you see it,” he said.

Although open-heart surgery, requiring a long chest incision and division of the sternum, still is commonly used in medicine, Tabe adopted a different approach to coronary artery bypass operations involving more than one blood vessel. Making a much smaller incision on the left side of the chest, a healthy vessel can be grafted to bypass a blocked coronary artery. It does not require dividing the sternum or use of a heart-lung machine.

“You have to feel comfortable doing beating heart surgery because you are not stopping the heart,” Tabe said.

Two surgeons, working with the medical company Medtronic, developed instruments and procedures to be able to perform minimally invasive bypass surgeries involving multiple blocked vessels. Practicing in New Mexico before coming to Minot, Tabe gained experience in this type of surgery. Because of the equipment and staff training involved, Trinity has not yet implemented this approach to multi-vessel bypass surgery, but Tabe said the goal is to do so within the next two years.

Another procedure, called transcatheter aortic valve replacement or TAVR, is predicted to change the way surgeons operate on aortic valves, which control blood flow from the heart.

With TAVR, surgeons run a catheter through the femoral artery from the thigh area. Instead of removing the existing aortic valve, the surgeon threads a crimped valve through the catheter, wedging it into the old valve’s place. Once the crimped valve then expands, it pushes the old valve out of the way and takes over its job.

The surgical technique was developed for patients who were high risk and not good surgical candidates, Tabe said. Trials showed TAVR mortality was low and patients did well, he said. A study with patients of intermediate risk had the same good results. Trials now are being conducted on patients of low risk, which could lead to the surgery becoming generally available to all patients in the United States, as it already is in Europe, he said.

“All these things that are on the horizon, that’s the one being looked at the most because that’s going to change again the landscape for surgery. Just as coronary stents changed it for CABG (coronary artery bypass graft), this surgery is changing it for aortic valve replacement,” Tabe said. “That’s going to be the big game changer in terms of patient care.”

Because of the extensive criteria required to offer TAVR, it may be three to five years before Trinity will be able to implement the changes needed to offer the program, he said.

Another innovation is thoracic endovascular aortic/aneurysm repair or TEVAR. The operation also uses a thigh or pelvic catheter. The surgeon delivers an expandable stent graft through the catheter to an area of aneurysm within the artery. An aneurysm is an abnormal ballooning of an artery caused by weakening of the artery wall. The stent graft provides a substitute avenue for blood flow through the artery, protecting the aneurysm from pressure that can lead to damage.

Trinity is using TEVAR to treat certain types of aneurysms.

Tabe said researchers also are looking into minimally invasive methods for offering mitral valve replacement, making additional advances in surgical procedures likely in the not so distant future. In addition, small improvements, such as a new device that ties and secure sutures, hold potential to simplify surgical tasks and shorten operation times.

The end result is patients who bounce back from surgeries more quickly. Traditional surgery that opens the chest commits a patient to six to eight weeks of reduced activity with no heavy lifting. Minimally invasive surgeries get them back on their feet faster.

“Looking at patients afterwards, it’s night and day. They are sitting up, drinking two hours after the operation,” Tabe said. He compared that recovery with traditional surgical patients who may still be on ventilators two hours after surgery and not eating until the next day.

“Patients can go back to work sooner. They can go back to their normal lifestyles,” he said.

The advances occurring in cardiothoracic surgery show that minimally invasive operations aren’t limited to general surgery, where those new procedures have seen rapid adoption, but can apply to all areas of medicine, Tabe said.

“We are realizing we can do it. You just have to have the training,” he said.