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VASCULAR DISEASE: WHAT YOU NEED TO KNOW
by Chris Valentine
Colorado Springs Living Well Magazine Winter 2012
(To read, click on the
Medical Voyce Magazine, Feb. 2012
Penrose Cardiac, Thoracic and Vascular Surgery
Colorado Springs Business Journal, Oct. 15, 2010, Amy Gillentine
Doing so, they say, saves money and lives."Whenever you have to use blood transfusions, you increase the chance the patient will die," said
Dr. John Mehall
, who is part of the cardiovascular and thoracic surgical program at Penrose. "Not only do we limit donations, we also limit blood loss." The practice also reduces the cost of surgery, because providing donated blood can be expensive, he said. He estimates Penrose saved $500,000 this year by using fewer blood products during cardiovascular surgeries.
"We use half the national average for transfusions," he said. Mehall is one of only a handful of doctors in Colorado who practice "minimally invasive" surgery as a way to get patients back on their feet as soon as possible. Using robotic tools, he can repair hearts through tiny incisions in the patient's side. He's been so successful that the coronary bypass surgical program at Penrose has been named in the top 49 nationally by the Society of Thoracic Surgeons. The award is considered truly prestigious, he says, because it comes from people actually performing the surgery. "It's not one of those awards based on Medicare records," he said. "They have a list of protocols and only 49 other hospitals met those protocols." Those protocols include avoiding high mortality rates.
"This is very focused on open-heart surgery," he said. "Nothing else. It's the difference between providing good care and providing exceptional care. You have to do that extra 10 percent. It's tedious, but it's essential." Mehall and the two other surgeons,
Dr. Matthew Blum
Dr. Martin Beggs
, performed about 600 bypass valve and aortic surgeries last year.
BRIAN NEWSOME, THE GAZETTE
December 02, 2009
A healthy young woman walks into the emergency room short of breath, suffering from swine flu. Soon her organs begin to fail and she goes into cardiac arrest. Only one machine can save her, but the hospital doesn't have one, and she's too unstable to go a medical center that does. So, in a desperate effort to save her, some members of her medical team build the machine as the others perform CPR to keep her alive. It could be an episode of "Grey's Anatomy" or "ER," but this drama was very real for a patient at Penrose Hospital, who is now recovering at a Denver hospital.
Although Penrose officials won't reveal her name or age because of privacy laws, they were willing to share the amazing tale of her life-saving treatment - an almost perfect blend of expertise, timing and luck.
A heart infection
The woman, who is in her 20s, walked into the ER about a week and a half ago. She'd had flu-like symptoms for a couple of days, and her breathing was becoming more difficult. After being examined, she was given medication. Respiratory complications resulting from serious cases of H1N1 flu - she later tested positive for the virus - are not uncommon, after all.
What wasn't apparent, though, was that the virus had attacked her heart. Her breathing suffered, because the lungs were filling with fluid as her heart failed. Within eight hours, the woman went from walking to dying. Her lungs and kidneys failed, according to Dr. John Mehall, the hospital's director of cardiothoracic surgery. She went into cardiac arrest, and was brought back with CPR.
Myocarditis, in which a common virus unexplicably turns on the heart of an otherwise healthy person, is rare but serious. Mehall said patients suffering from it usually face two options: specialized life-support that can pump their heart until the infection passes, or a heart transplant. Penrose was equipped to do neither. Mehall's plan was to get the woman to the University of Colorado Hospital at Denver, which does heart transplants. As he explained this to her husband, a second cardiac arrest occurred.
"The only options were for us to put her on mechanical life support here or pronounce her dead," Mehall said.
The problem was, such life support for adults - known ECMO - is found only at a handful of hospitals in the country. Penrose has mechanical heart-and-lung equipment for surgical patients, but they're designed only to work for the hours needed to perform surgeries, not the days needed to outlast a severe infection.
After an hour of CPR, the woman's heartbeat was restored once again and she was taken to the operating room and hooked up to one of the surgical heart-and-lung machines, which temporarily stabilized her. By now, more than a dozen people had become involved, including three doctors, 10 nurses and three profusionists -technologists who specialize in life-support equipment. While some of the staff kept watch over the patient, Mehall and others began the unusual task of trying to build an ECMO machine. "What we basically did was use the existing parts of heart/lung technology and reconfigured them into a machine that could support this girl," Mehall said.
The woman benefited from two strokes of luck. About a month earlier, Penrose had ordered special parts for an ECMO, and the hospital's profusionists had taken a dry run at assembling one in anticipation that an H1N1 patient's lungs might fail, Mehall said. That first attempt made building it in a time of crisis much smoother. Secondly, Mehall, had experience with both heart transplants and the ECMO device in children before coming to Penrose, a skill set that's rare for a community hospital.
Once the patient was stable and taken to the Intensive Care Unit, blood markers were taken to assess the damage to her heart. They were about a thousand times higher than those of a heart attack victim - numbers Mehall never thought possible. The patient was later taken to the University of Colorado at Denver in case the heart could not recover, Mehall said, but so far that hasn't been the case.
Mehall has treated thousands of patients, but few of their stories are as gratifying and dramatic as hers, he said.
"You have a young, healthy person who you are able to save their life in a time of acute crisis and who has the opportunity to recover and return to a normal life again," he said.
By Brian Newsome, Colorado Springs Gazette
April 17, 2008
A Penrose Hospital surgeon is believed to be the first in Colorado and one of about a dozen nationwide to perform double bypass surgery without opening the chest.
Sawing apart the breastbone is the most debilitating part of bypass surgery, the most common kind of heart surgery. The breastbone takes two months to heal, during which patients can lift no more than 5 pounds. By avoiding this step, patients return to their routines much faster.
Cardiovascular and thoracic surgeon Dr. John Mehall performed the first minimally invasive double bypass on Feb. 21 and has completed two more since then. He is an expert in robotic-assisted surgery, in which tiny instruments and cameras essentially replace the doctor's hands. The doctor operates from a console across the room using a video screen and finely tuned controls. The instruments slide between the ribs and are maneuvered by robotic arms.
Penrose surgeons have used the $1.3 million machine, The da Vinci Surgical System, since December 2005 for procedures such as prostate surgery. Mehall was hired in summer 2007 to direct a heart-surgery team using the technology.
His first nonopen-heart double bypass was performed on Michael Greeno, 53, a Type I diabetic who needed the surgery after his second heart attack.
"I was not so much apprehensive as just amazed by the process," Greeno said. "I was given the option, and it sounded like the perfect solution for me."
Greeno became a paraplegic from a blood clot on his spinal cord about nine years ago. He relies on his upper body for independence, from pushing his wheelchair to getting in and out of bed.
For him, eight weeks of light lifting would have meant being bed-bound.
Instead, with just a few small puncture wounds to show for his ordeal, Greeno was able to return to his daily life a week after leaving the hospital.
"The biggest thing is it allows patients who need surgery to have the procedure and get back to their lives much more quickly," Mehall said.
Mehall performs the surgery with the heart beating, rerouting the mammary artery under the breastbone to the coronary artery. The procedure bypasses the blockages in the vessel, he said, like rerouting traffic around a broken bridge.
The surgery is more difficult to perform than an open-heart bypass, Mehall said, but there are the same, if not fewer, risks. Risks in bypass surgery include the need for a blood transfusion, infection or an irregular heartbeat.
Not everyone is a candidate for robotic-assisted surgery. People with severe lung disease, for example, may not be able to endure having one of their lungs deflated as the surgery requires. In rare cases, patients undergoing robotic-assisted surgery may have to have their chests opened.
Many people who need bypasses opt for less-durable treatment such as stents, because the stent procedures are quick to perform and require little recovery time. Yet stents, which are inserted into blood vessels to keep them open and flowing, are less effective over time.
More than half of patients with stents need another procedure within two years, Mehall said. To compare, about 5 percent of patients who have bypass surgery need another procedure in a decade.
Mehall said he hopes removing the long recovery time will encourage more people in need of bypasses to have them.
By BRIAN NEWSOME, THE GAZETTE
September 18, 2007
Heart surgery the old way: A saw rips through the breastbone, cutting it in half. Industrial tools crank apart the rib cage. Like a mechanic peering under a hood, the surgeon goes to work on an exposed heart.
The new way: A few probes with tiny cameras and instruments are slid between the ribs. Across the room at a console, the surgeon performs the same work as before - but with no power tools required.
Penrose Hospital is the only one in Colorado and one of about 20 nationally using robotic technology to take the "open" out of open-heart surgery, said Dr. James Stewart, a cardiovascular and thoracic surgeon who has used the machine for heart and thoracic surgeries. The state-of-the-art approach significantly reduces a patient's recovery time and allows surgeons to operate more precisely.
"I've had patients that have done this procedure and that played golf two weeks later," said Dr. John Mehall, a cardiovascular and thoracic surgeon and expert in using the machine for heart surgeries.
The $1.3 million da Vinci Surgical System has been used at Penrose for abdominal and chest surgeries since December 2005, Stewart said. Penrose purchased it as part of a long-term plan to make its surgeries less invasive. Mehall was hired this summer to direct the cardiovascular robotic and minimally invasive surgery team for the hospital and has performed about five heart surgeries using it since arriving. About 580 people had openheart surgery at either Penrose or city-owned Memorial Hospital last year.
The most common procedures are coronary bypasses, valve replacements and repairs or corrections of irregular heartbeats. Recovery from the bonebreaking tactics needed to access the heart requires a weeklong hospital stay and about a month without driving or picking up objects that weigh more than 5 pounds. The breastbone is held together with wires to heal. The surgery also leaves a 6-to 7-inch scar.
The robotic-assisted surgery reduces the average hospital stay to just three days, Mehall said, and patients quickly return to a normal routine. Scarring results only from a few puncture marks an inch or less in size. There's also less blood loss. A speedier recovery is especially important for some patients, such as a truck driver who depends on getting behind the wheel for a paycheck or a mother who needs to lift a small child into a high chair. The technique can also produce better results, especially in hard-to-access areas.
Dr. Jeffrey Ferguson is a local urologist who has used the da Vinci machine at Penrose for prostate surgeries for two years. He said it's improved the precision with which he can remove cancerous tissues and increased the likelihood of preserving urinary and erectile functions. "I don't think it's an overstatement to say this has revolutionized the management of prostate cancer," Ferguson said.
A surgeon using the machine sits several feet across the room from the operating table at a console roughly the size of an arcade game. The doctor sticks his or her face into a viewfinder and sees a three-dimensional color image fed by cameras attached to robotic arms that respond to the movement of the surgeon's hands and arms. The doctor's hands control the robotic arms by pinching index fingers and thumbs inserted into cuffs. When the doctor pinches, metal surgical pincers at the operating table do, too. With the tap of a foot pedal, the doctor's hands can switch from using surgical instruments to controlling cameras that can capture almost any angle with clarity. "I can't always see what I want to see the way I want to see it," Ferguson said of traditional surgery.
The machine is calibrated to respond to the hands' delicate movements. Mehall, in a demonstration of the machine last week, deftly sewed sutures the size of a human hair through a rubbery mold using tiny pincers. Earlier this summer he used the same approach on Jim Swihart, a 37-year-old tech sergeant at Peterson Air Force Base.
Mehall used the da Vinci device to remove lymph node tissue from Swihart for a biopsy, a procedure that otherwise would have required a lengthy incision and one to two broken ribs. Swihart was pleased with the speed of his recovery from surgery, although the biopsy tested positive for cancer that is now being treated with chemotherapy. He left the hospital at 9 a.m. the next morning with three small incisions.
"They gave me two weeks off work but it really wasn't necessary," Swihart said. "I went home and just took it easy, but it was really nothing." He took over-the-counter Motrin for the pain.
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