John D. Puskas, MD, left, with Samuel “Skip” Vichness, who in May received the totally endoscopic coronary arterial bypass (TECAB).
Mount Sinai Heart has become one of the few centers in the world offering an innovative heart bypass procedure without major incisions or cutting through the breastbone. The procedure, known as totally endoscopic coronary arterial bypass surgery (TECAB), is performed using only micro-incisions and offers eligible patients a much quicker recovery with less pain, scarring, and risk of infection.
Two TECAB procedures were performed in May at Mount Sinai St. Luke’s by John D. Puskas, MD, Chair of Cardiovascular Surgery at Mount Sinai St. Luke’s, Mount Sinai West, and Mount Sinai Beth Israel, and Director of Surgical Coronary Revascularization, Mount Sinai Health System, with Gianluca Torregrossa, MD, Associate Director of Robotic Heart Surgery, Mount Sinai St. Luke’s.
“This is a very technically demanding procedure, with few cardiac surgeons having the expertise or experience to perform it. Our cardiac team is equipped to handle such intricate, advanced procedures, and our modernized facility is outfitted with a state-of-the-art surgical robot to assist them,” says Arthur Gianelli, President of Mount Sinai St. Luke’s. “By offering this innovative bypass procedure, our team leaps ahead in coronary artery bypass grafting surgery in New York and the Northeast.”
Each of the TECAB surgeries—a single bypass and a double bypass—was performed through four fingertip-size “keyhole” incisions. The surgeons placed robotic instruments through the micro-incisions to harvest the mammary artery. Then, they used the Flex-A®, a highly specialized device made by Aesculap Inc., to connect the mammary artery to the coronary artery of the heart with a high degree of precision. In a traditional bypass procedure, the surgeon makes a large incision, up to 12 inches long, spreads open the patient’s chest, and sews the arteries together by hand.
“In a traditional coronary bypass, there is a lot of manipulation inside the chest, and a prolonged recovery time,” Dr. Puskas says. “Typically, patients are in the hospital for a week or so after surgery, and it may be two to three months before they can return to truly normal activities.” In contrast, after the closed-chest TECAB procedure, patients can go home in one to three days, and return to normal activities in a few more days. “This is a much less invasive way to achieve an arterial bypass, which is the longest lasting, most life-giving bypass that we can provide,” says Dr. Puskas, a leader in robotic coronary revascularization.
The best candidates for TECAB are bypass patients with only one or two blockages on the left side of the heart who want to avoid a traditional operation. Surgeons cannot perform TECAB on patients who have had previous heart surgery or radiation therapy to the chest.
The number of surgeons worldwide who now perform TECAB is “in the single digits,” Dr. Puskas says. “And that is unfortunate, because this procedure has the potential to take coronary surgery to an entirely new level.” As an example, he cited Samuel “Skip” Vichness, one of the two patients who underwent the TECAB procedure in May. Before the surgery, Mr. Vichness, 71, had severe angina and could barely walk across the room. One month later, “He is deliriously happy with how he is doing. He is back on the golf course and has resumed all full activities. He is back to work,” Dr. Puskas says.
Dr. Puskas sees a future in which TECAB might become a common therapy for blocked arteries, comparing its development with that of early coronary artery bypass grafting (CABG). “Thirty years ago, the use of the internal mammary artery graft as a bypass conduit was thought to be too difficult,” he says, “and there were many senior, famous surgeons who said, ‘This will never become commonplace.’” However, because of advances in technology and training, CABG with arterial conduits has become the standard of care for many patients. Dr. Puskas says, “I would like to think that we will make similar progress, perhaps faster progress, with the TECAB minimally invasive robotic procedure.”