Taking the 'open' out of open heart surgery

A (minor) cut above the rest Gundersen is one of only a handful of places in the country performing complete heart revascularization for patients using a minimally invasive technique. What does that mean? The Gundersen surgical team can perform up to triple and quadruple bypasses through a three-inch incision between the ribs. Most other heart centers perform only single bypass using this technique.

Michael Boehde, who underwent minimally invasive heart surgery at Gundersen Lutheran earlier this year, said he was motivated in rehab to return to his running routine.
Michael Boehde, who underwent minimally invasive heart surgery at Gundersen in 2010, said he was motivated in rehab to return to his running routine.

In February 2010, Michael Boehde went for a short run on the treadmill. A 2-3 minute run doesn't seem like much for an avid runner who's competed in half-marathons, but for Michael and the staff in the Gundersen Health System Cardiac Rehab area, those three minutes were pretty amazing. Just 18 days prior to his run, Michael had quadruple bypass surgery at Gundersen.

Michael was able to give running a try because doctors didn't have to crack open his chest for the surgery. Instead, Gundersen heart surgeon Prem Rabindra, MD, used an innovative technique called minimally invasive coronary surgery (MICS). He performed Michael's surgery through a less than four-inch incision between the ribs. That meant no bones needed to heal after surgery, just Michael's heart. While the Cardiac Rehab team asked him to hold off on running again for a few more weeks to give his heart more time to heal, the speed of his recovery is surprising to most people. Most people, that is, except for the Gundersen Heart and Vascular Institute team.

"Because they have a much smaller incision than patients who have traditional open-heart surgery and no broken bones, minimally invasive patients experience less pain, take less time to recover and spend less time away from work and other activities," Dr. Rabindra says.

He continues, "In fact, just like we did with Michael, we often have to tell our patients to 'slow down!' It's not something I'd expect to say to patients right after major heart surgery, but they try to do too much too soon because they feel good."

A shocking diagnosis

Looking at Michael, it's hard to believe he needed any kind of heart surgery, let alone quadruple bypass. It came as a shock to the 54-year-old Trane engineer from Onalaska, too. He'd struggled throughout the late summer and early fall of 2009 with longer training runs, often feeling short of breath. It wasn't until after a race in October, when he had to slow down to a walk at times, that he knew he needed to see his doctor.

Even though a stress echo and MRI showed no obvious problems with his heart, a family history of heart disease made his Family Medicine physician suspicious that something was wrong and he sent Michael to the Gundersen Heart Services. Gundersen cardiologist Kristen Andresen, MD, believed Michael had coronary artery disease and ordered a cardiac catheterization, which gives doctors a look at the heart arteries from the inside. It was there doctors discovered one of Michael's arteries was 95% blocked; another was 90% blocked. Bypass surgery was his only option.

"I couldn't believe it. I had no symptoms other than the shortness of breath. But, I'm very fortunate they were able to find the problem before I had a heart attack," he says.

No need for a ‘zipper'

Michael's next thought turned to the surgery itself. His parents both had previously had open-heart surgery, and he remembered their long recoveries and their "zipper-like" scars. Then, he got unexpected news. "Dr. Rabindra told me about minimally invasive surgery and I immediately thought, ‘This sounds like a good deal,'" Michael recalls.

"People wonder, ‘How in the world can you do multiple bypasses through such a small incision?' It truly is possible and, importantly, has been shown to be as safe and effective as the traditional bypass operation," shares Dr. Rabindra, who now routinely performs the MICS approach to coronary artery bypass grafting (MICS-CABG).

"It is important to note, however, that while there are advantages to minimally invasive bypass surgery, it's not right for everyone. Fortunately, Michael was an ideal candidate," he adds.

Making a strong recovery

Michael went in for surgery on Monday and was home for lunch on Thursday. Within the week, he was walking 15 minutes a day. Six weeks after surgery, he was officially back to running again under the watchful eye of the Cardiac Rehab team. And, in May, just a few weeks after "graduating" from Cardiac Rehab, he ran the 5K in the La Crosse Fitness Festival.

"I count my blessings every day, and I'm thankful I was able to have minimally invasive bypass surgery at Gundersen," Michael says. "I feel like I have a second lease on life."

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