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Getting to the Heart of It

Minimally invasive surgery can heal your heart with fewer complications

Minimally invasive surgery at Providence Spokane Heart Institute and Sacred Heart Medical Center can heal your heart with fewer complications.When it comes to heart health, Providence Spokane Heart Institute stands as a leader, with one of the largest and most experienced teams of surgeons and cardiologists in the region. They rely on the latest equipment and techniques to perform every possible cardiac surgery. As more and more procedures shift from conventional techniques to minimally invasive approaches, sometimes only the tiniest cuts are required.

While most patients still require conventional surgery to perform complex or multiple procedures on the heart, minimally invasive heart surgery currently accounts for more than 20 percent of all heart surgery at Providence Sacred Heart Medical Center. The facility is the only medical center in the inland Northwest to perform some of the most complex procedures. Patients from across the United States come to Sacred Heart Medical Center for this expertise.

New Options for Heart Patients

According to Leland Siwek, M.D., a cardiothoracic surgeon at Providence Northwest Heart & Lung Surgical Associates, many heart problems requiring surgery can be addressed with minimally invasive options. In fact, people who undergo transcatheter aortic valve replacement (TAVR) may be able to avoid heart surgery altogether.

Talking TAVR

One of the most common minimally invasive procedures, TAVR treats aortic stenosis (AS), a narrowing of the aortic valve opening. Affecting mostly older people in their 70s and 80s, AS restricts blood flow in the valve and causes symptoms such as breathlessness, chest pain and heart pounding.

Without valve replacement, about 50 percent of AS patients die within two years. Because conventional open heart valve replacement would be too risky for some patients, until recently they had no surgical option to address the condition.

But five years ago, TAVR became available for higher risk patients in the U.S. and at Providence Spokane Heart Institute, initially through participation in an FDA research trial. Like all minimally invasive procedures, TAVR requires only a very small incision. Surgeons insert a catheter-held, animal-tissue valve through the groin or chest into the large artery and thread it up to the heart. Then they gently push the damaged valve aside and implant the new one—all without opening the chest or stopping the heart.

Dr. Siwek, along with cardiovascular surgeons Brandon Reynolds, M.D., and Matthew Forrester, M.D., and interventional cardiologists Michael Ring, M.D., Braden Batkoff, M.D., and Steven Thew, M.D., with support from the Providence Spokane Heart Institute surgical team, have performed more than 250 TAVR procedures.

Another Heart Advancement

Increasingly, surgeons are turning to robots to do jobs that only conventional open heart surgery did in the past: repair the mitral valve, close up holes and remove tumors. Robots also help perform coronary bypass grafting without stopping the heart. More than 1,000 robotic open heart procedures have been performed at Sacred Heart over the past 12 years.

With robotic surgery, small incisions are made in the chest. These serve as entryways for the robot’s instruments, including a camera. One surgeon stands by the patient while another sits at a computer console, which gives a close-up, three-dimensional view of the inside of the heart. Here, the surgeon can control the robot’s instruments, reaching and turning nimbly in ways that no human hands can. Sometimes, the robot joins catheter-based and other minimally-invasive techniques in Providence Spokane Heart Institute’s advanced hybrid operating suites.

“With minimally invasive surgery, many patients are receiving lifesaving treatment they otherwise couldn’t get,” Dr. Siwek says. “And robotic surgery can be as effective or better than many conventional open heart procedures.”

Patients have less pain, quicker recovery and smaller scars after minimally invasive heart surgery than after more invasive procedures.

“Knowing how these patients would struggle through open heart surgery and then seeing them bounce back so quickly is very gratifying,” Dr. Siwek adds.

The next two developments on the horizon are TAVR for patients before they get very sick and transcatheter mitral valve replacement (not just repair).

Meanwhile, as technology for minimally invasive surgery marches forward, Providence Spokane Heart Institute promises to keep doing what it does best: improving and extending the quality of life for its patients.

Educated Decisions

Procedures Side-by-Side

The experts with the Providence Spokane Heart Institute Minimally Invasive Heart Surgery program can help you decide whether a minimally invasive procedure is right for you.

  Traditional Surgery Minimally Invasive Surgery
Anesthesia   General General
Average length of procedure   5-6 hours 2-5 hours
Entry incision site   In chest, through breastbone In leg or between ribs 
Incision length   8-10 inches 1-2 inches
Chest trauma   Higher Lower or none
Average hospital stay   5 days 3 days 
Recovery time   2-3 months Days to weeks