Two Mid-South surgeons with Baptist Medical Group now are using the skills learned in cardiovascular and thoracic surgery fellowship training in Boston to offer alternatives to open heart surgery which in some cases save lives and enhance patients’ recovery from surgery.
John Craig, MD, a cardiovascular surgeon, and Christopher Mutrie, MD, a cardiac thoracic surgeon, are performing minimally invasive procedures and treatments not available a decade ago for adults with chest, heart and lung issues.
The two physicians met during their cardiothoracic fellowship at Massachusetts General Hospital in Boston in 2010 and established a strong friendship. Craig, a native Memphian, relocated to Memphis in 2012 and began a cardiothoracic practice with Baptist Medical Group. He recruited Mutrie, a native of Boston, to the practice in 2013.
The two physicians offer a unique set of skills that are rare in the Mid-South.
“These procedures and treatments are being performed in major cities in the U.S., but to my knowledge we are the only physicians to offer them in the Memphis area,” Craig said.
Mutrie performs the Nuss procedure, which is a minimally invasive technique that treats pectus excavatum, a deformity in which the chest wall is concave. It is the most common chest wall deformity in the United States.
“It is generally considered a cosmetic deformity, but it can cause chest pain, shortness of breath, fatigue and fainting episodes in patients,” Mutrie said. “It can be upsetting for the patient psychologically as well. Most patients are born with the deformity and it worsens over time, so it gets harder to fix as the patient ages.”
The procedure involves inserting an infection-resistant titanium bar through two small incisions on either side of the chest. Another small incision is made to insert a camera to allow the surgeon to see the inside of the chest during the operation.
According to Mutrie, the operation takes between an hour and an hour and a half to perform, and the patient is in the hospital for four to five days. The patient wears the bar for two years as it reforms the chest wall.
“The bones remodel and reshape, and a normal chest wall is achieved,” Mutrie said. “After two years, the bar is removed and the patient goes home the next day. The patient can resume a normal life with exercise without endangering the chest wall.”
Mutrie said that traditionally surgeons performed the Nuss procedure only on children, but due to technological advancements within the last 10 to 15 years, surgeons can perform the procedure on adults. According to Mutrie, the incision is much smaller, the hospital stay is shorter and the patient experiences less scar tissue than before.
“This procedure has gotten more popular in the last 10 years because we have learned more about the deformity, and technology has gotten better,” Mutrie said. “This procedure is a good alternative to reconstructive surgery and avoids excessive scar tissue. There are other ways to reconstruct the chest wall, but this is the most minimally invasive way. ”
After Mutrie learned the procedure as part of his fellowship training in 2010, he brought this knowledge with him when he was recruited by Craig to relocate to Memphis. He performed 12 Nuss procedures last year. Other Mid-South cardio thoracic surgeons refer their patients to him because he performs the procedure.
“This is a fairly rare procedure, but it's a good technique to have,” Mutrie said. “With technological minimally invasive improvements, more surgeons are learning about the procedures in fellowship training. In time, you will see more surgeons perform the procedure.”
Craig performs a procedure with a device called an AngioVac system, which removes blood clots in the circulatory system. According to Craig, before the device was first used in 2009, the only other option to extract blood clots from the heart or lungs was through open-heart surgery, which involved opening the chest and stopping the heart.
“It works like a big vacuum cleaner and removes blood clots and other dangerous material from the heart,” Craig said. “Retrieving a clot used to require open heart surgery, resulting in longer hospitalization, recovery and rehabilitation times compared to this minimally invasive approach. It optimizes a patient’s quality of life and reduces the chance for infection.”
The AngioVac device employs large suction catheters capable of filtering all of the blood in the body through a cardiac bypass machine in as little as one minute. It removes blood clots and other foreign matter and returns the purified blood back to the patient. The entire procedure usually takes a couple of hours to perform, and the recovery time is minimal.
“Most patients are back at work within two to three days, whereas prior it would have been two to three months,” Craig said. “We can accomplish the same results and now patients can walk the same day, are often home in less than 24 hours and fully recover in a few day’s time.”
Craig was introduced to the AngioVac system during his fellowship at Massachusetts General Hospital, which was one of the first test centers in the world to use the device and train surgeons to perform the procedure.
Craig performs five to 10 procedures with the AngioVac system per year, and while that is not many, Craig says he is the only physician currently using the device in the Mid-South.
“This technology is new, and the device is used in only a few major cities across the United States,” Craig said. “I hope that more physicians will learn about this new technology and its advantages.”
In addition to the AngioVac, Craig is trained in extracorporeal membrane oxygenation, or ECMO, which is a technique that provides both cardiac and respiratory support to patients whose heart and lungs are unable to work on their own.
“These patients are profoundly sick, and this is a last-ditch salvage attempt,” Craig said. “There is no other way to save them. At least 80 to 90 percent of the patients we support with the machine would die without it. It saves lives.”
ECMO works by removing blood from the patient’s body and artificially removing the carbon dioxide and oxygenating red blood cells.
“Typically, it is used to support patients with severe heart or lung failure due to an acute illness such as the flu or a heart attack, for example, “ Craig said. “It performs the function of the patient’s own heart and lungs so failing organs can heal. It’s like a second-string quarterback coming in to play while the star quarterback is sidelined by an injury.”
According to Craig, a patient is on the machine usually for three to five days for heart support and 10 to 14 days for lung support. Craig says most adult ECMO centers see up to a 60 percent survival rate for lung failure and a 40 percent survival rate for heart failure in patients who would have otherwise died of their illness. Most survivors expect to make a full recovery.
“In some cases, ECMO gives patients a chance to heal so they can undergo major heart surgery and be strong enough to survive,” Craig said.
Traditionally used on children, the technique is now being used more on adults with cardiac and respiratory failure. He projects to treat 15 to 20 patients this year and has been using ECMO since he joined Baptist Medical Group in 2012.
“This is not a common treatment and has only been used with consistent success in adults for the last five to 10 years,” Craig said. “It is done so infrequently that not everyone knows it is available. Through education, we hope to raise awareness of this life-saving technology.”
RELATED LINKS:
Baptist Medical Group, www.baptistdoctors.org