Advanced tools, techniques may allow coronary patients to avoid open heart surgery

Western Iowa native Chuck Jenkins spent the bulk of his 36-year career as the leader of a 16-member team that pushed the products of one of the world’s largest manufacturers of agricultural machinery through the heart of the US farm belt.

“It was a good run,” Chuck says. “The company has grown by leaps and bounds since I first started with them, and they treated us very well. It was reciprocal, though. We worked hard for them.”

Chuck’s hard work allowed him and his wife to retire to Florida, where Chuck spends most of his time doing “typical retirement things,” including daily bike rides and weekly golf games. However, a serious heart issue recently put those activities on hold.

“I’ve had a lot of heart issues over the years, and this one developed in the summer of 2021,” Chuck relates. “It started with me experiencing a lot of chest pain, which I thought would go away on its own after a while. But it didn’t. Then things got worse.

“Before long, I couldn’t do much of anything without becoming fatigued. Just walking out of the house to get the mail was a chore. I had to stop at the mailbox and wait for a while before I came back to the house. That’s how easily I got tired.

“I was like that for a couple of months, which I know is way too long to wait to have something like that checked out. During that time, I pretty much lived a sedentary lifestyle, because the only time I didn’t have issues was if I was sitting and doing nothing.”

Complex Intervention

When he finally agreed to visit his cardiologist, Chuck learned that the cause of his pain and fatigue was a 99 percent blockage of his left anterior coronary artery, which needed a stent to restore normal blood flow.

It wasn’t the first time Chuck received such a diagnosis. He had previously undergone open heart surgery and been fit with several stents. This artery was so clogged with calcium, however, that his cardiologist could not open it to place the stent.

Luckily for Chuck, his cardiologist knew a surgeon who could drill through the calcium and place the stent. Chuck was immediately referred to Jeffrey E. Rossi, MD, FACC, FSCAI, a specialist with the Structural Heart Team at Manatee Memorial Hospital.

Dr. Rossi specializes in complex coronary intervention, an area that requires advanced techniques and tools to restore blood flow through the arteries and normal function to the heart.

In treating Chuck, Dr. Rossi used several of those tools, including the Impella® Heart Pump, a tiny device that maintains proper blood flow through the heart during complex coronary interventions.

Guided through a catheter that is fed from the groin to the heart through the femoral artery, the Impella device is delivered to the heart’s primary pumping chamber, the left ventricle. Once in place, the Impella draws blood from the ventricle and pushes it into the aorta.

“It has a rotary motor that takes over for the heart and pumps blood to the rest of the body,” Dr. Rossi explains. “It’s like a percutaneous bypass machine that allows us to do a lot of stressful things like fix arteries without opening up the chest.”

The avoidance of open heart surgery allows patients to recover quickly from their procedures, Dr. Rossi notes. Some even go home the same day, he says, and it limits the possibility of complications from open heart surgery.

After the device has been delivered and activated, a second catheter is fed through the femoral artery. That catheter delivers the tools and stents needed to repair the coronary artery.

One of the tools Dr. Rossi used in repairing Chuck’s artery is a drill that is capped with a diamond-studded burr. This special drill pulverizes the calcium clogging the artery into tiny particles that can easily pass through the bloodstream and out through the kidneys. 

In Chuck’s case, the left anterior coronary artery was blocked at the place where it branches into two arteries that feed other arteries to the heart. Because of that, Dr. Rossi had to employ an advanced repair technique.

Immediate Impact

The technique involves the placement of two stents, one in each branch, as well as the insertion of a balloon into each stent. The balloons are then inflated simultaneously to expand the stents and the artery. After expansion, the balloons are removed. 

“This technique creates the perfect bifurcation anatomy, so it’s a great way to reconstruct someone’s main artery,” Dr. Rossi says. “When we performed this technique on Chuck, he immediately began to feel better.”

That’s not an exaggeration. Patients undergoing this procedure are semiconscious during the procedure, and Chuck distinctly remembers the moment when the balloons were removed and his artery began functioning normally again.

“I felt better immediately,” Chuck confirms. “And I mean immediately. Right there on the operating table, I felt better. Just like that, my chest pain was gone. And now I’m back to doing the things I love to do and without all that chest pain and fatigue.”

Chuck, who went home a day after his procedure, lauds Manatee Memorial Hospital for its commitment to providing patients with advanced heart care. He’s also thankful he was referred to Dr. Rossi. 

“When it comes to offering interventional cardiology procedures, Manatee Memorial Hospital is right there at the top,” Dr. Rossi concludes. 

“At Manatee Memorial Hospital, we have the equipment, facilities and staff necessary to offer very sick patients such as Chuck very complex therapies. I feel very comfortable doing some very complicated procedures at Manatee because they are performed there almost every day.” ■

© FHCN article by Roy Cummings