Beating Heart Surgery Keeps Hearts Beating

More than half of the bypass surgeries performed at Providence today are beating heart procedures
More than half of the bypass surgeries performed at Providence today are beating heart procedures

Richard Taylor has been fascinated with trains for as long as he can remember.

In fact, he grew up to become a railroad engineer - not the kind of engineer who drives the train, mind you, but the kind who plans where train tracks are going.

Photographs and paintings of trains line the walls of his office at Wilbur Smith Associates, the global transportation consulting firm headquartered in downtown Columbia.

And for 37 years, he enjoyed a perfect marriage of career and hobby.

Then one afternoon last year, the engine that drives Richard's life ran out of steam.

He had a heart attack.

Today his life is back on track, thanks to Dr. W. Baker Allen, a cardiovascular surgeon at Providence Heart Institute, and an extraordinary procedure called beating heart surgery.

During conventional coronary artery bypass surgery, the patient's heart is stopped while he or she is placed on a heart-lung machine that works in place of the heart and lungs to provide blood flow to the whole body.

With beating heart surgery (also known as "off- pump" surgery), the surgeons limit the movement of only a small portion of the heart at one time, so that the heart and lungs can continue to perform their normal functions.

Beating heart surgery is technically more demanding that traditional bypass surgery, but it generally results in easier recoveries and fewer major complications.

"Being on a heart-lung machine is not a natural state," says Dr. Allen.

"Although it has allowed us to do many things that we couldn't have done otherwise, it does not mimic normal physiology."

As a result, Dr. Allen explains, some heart surgery patients may experience adverse side effects that can be eliminated or minimized by avoiding exposure to the heart-lung machine.

"Our current measuring stick shows that neurological complications seem to be less using beating heart surgery," he continues.

"The incidence of stroke also seems to be less when we do beating heart surgery as opposed to traditional bypass surgery."

A number of heart centers around the nation have reported an advantage in terms of earlier discharges from the hospital with beating heart surgery, while surgeons at Providence Heart Institute have not seen a difference.

"We have not experienced a big difference that could be attributed solely to the use of beating heart surgery," says Dr. Allen. "But that's because our hospitalization at Providence is pretty short anyway, generally three or four days after surgery, although that's not written in stone. People who are a little older often need longer to get their sea legs under them, so we don't rush it just to prove we can send somebody home earlier than somebody else."

Being at the forefront of cardiac care has been an important part of the mission at Providence Heart Institute for more than a quarter of a century, and Providence surgeons began performing beating heart surgery in 1995.

In those early days, beating heart surgery cases were limited to a select few instances that were, as Dr. Allen says, "fairly easy to do."

Of course, to Michelangelo, painting the Sistine Chapel was also "fairly easy to do," and the analogy to fine art is quite appropriate. Providence heart surgeons who perform this kind of incredibly delicate procedure are often compared to artists because of their remarkable motor skills and painstaking attention to detail. "

A lot of it is a mindset of getting in rhythm with the heart," explains Dr. Allen. "You kind of have to go with it. You can't make the heart come to you - you have to go with the rhythm of the heart, like musicians who feel the music instead of just hearing it or playing it."

As the experience level of the Providence surgical teams has grown over the past eight years, they have been able to do more and more beating heart procedures each year. And, as is the case with any sophisticated medical procedure, experience is the single most important factor in successful outcomes. The total bank of experience at Providence exceeds 1,300 beating heart procedures to date, and more than half of the bypass surgeries done at Providence Heart Institute today are beating heart procedures.

"Today we're routinely doing some cases that would have been pretty scary back in the early days," says Dr. Allen. "The results have been very favorable, and we're very pleased with what the future holds."

Richard Taylor is pleased with what the future holds, too.

"It's amazing to think about somebody operating on your heart while it's still beating," says Richard, "because I'm familiar with how the traditional heart surgery process works. I really had a very easy recovery, and I believe it was due to the beating heart surgery.

"It really gives you a different perspective on life. It's like you get a second chance at living, and you want to make better use of that second chance than you made of the first one."