Robotic-Assisted Totally Endoscopic Coronary Artery Bypass (TECAB)

This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Welcome to our show. This is your weekly dose of wellness. I'm Deborah Howell, and today's guest is Dr. Jeffrey Lee. Dr. Lee is the medical director of robotic and minimally invasive cardiac surgery at the MemorialCare Heart and Vascular Institute at Saddleback Memorial Medical Center. Dr. Lee has been practicing cardiac and thoracic surgery for over 20 years and has performed more than 2,000 cardiac surgeries. Coronary artery disease is the number one cause of death for men and women. When coronary arteries become damaged or diseased, blood flow to your heart can become blocked, causing a heart attack. Dr. Lee is here to talk to us about robotic-assisted, totally endoscopic coronary artery bypass, or TECAB for short, a breakthrough approach to coronary bypass surgery. Welcome Dr. Lee.

Jeffrey Lee, MD: Thank you, Deborah.

Deborah Howell (Host): Right off the bat, what is coronary artery disease?

Jeffrey Lee, MD: Deborah, coronary artery disease is a disease afflicting millions of Americans and is the number one cause of death in the United States. And it's the cause of, the result of plaque that builds up in your coronary arteries, which are the blood vessels supplying the heart with blood. And over time, these blood vessels become progressively narrower and the heart becomes starved of oxygen and other vital nutrients. Over time, these patients start to develop symptoms such as chest pain or shortness of breath and usually at the beginning of the stage of this disease, it occurs only with exertion and that's what we call exertional angina. However, as the symptoms and then narrowing gets worse and worse, they start to have pain even at rest, which is called rest angina, which is a more advanced and dangerous stage of the disease. When the arteries become completely blocked, then they get what's called a myocardial infarction or a heart attack, the heart muscle, and the patient can die.

Deborah Howell (Host): So your first symptoms may be you're walking up a flight of stairs and you feel sort of a gripping or what would you feel?

Jeffrey Lee, MD: Most patients notice pressure or heaviness in the chest, associated shortness of breath, and sometimes they develop sweating, nausea, even vomiting, and generalized weakness.

Deborah Howell (Host): Okay, very good. And what are the consequences of not seeking treatment?

Jeffrey Lee, MD: At the earlier stages, the patients are having chest pain and angina, chest pressure, but over time as heart muscle is lost from progressively having small myocardial infarctions or heart attacks, the patients can start to lose heart muscle function, which leads to what's called congestive heart failure. When it's severe enough, certainly heart attacks and death can occur.

Deborah Howell (Host): Okay, let's get into your area of specialty now. What are surgical treatment options?

Jeffrey Lee, MD: First of all, I want to let our patients know that only a minority of patients will ever need surgery for coronary artery disease. Most of the time, because of our great medical colleagues and cardiologists, these things can be treated very well with medications, cholesterol agents, and percutaneous options such as angioplasty or stenting. Surgery is only reserved for patients with more severe versions of the disease, such as patients with multiple vessels involved, patients with diabetes or some more severe blockages. And then they would traditionally have, in the past, what's called coronary artery bypass grafting surgery or CABG surgery, which usually involves a large incision in the midline, splitting the breastbone with a bone saw, and then using the veins from the legs and the arteries from the chest to bypass these blockages.

Deborah Howell (Host): That sounds pretty major.

Jeffrey Lee, MD: It's pretty major. Yes.

Deborah Howell (Host): So on the flip side, what is totally endoscopic coronary artery bypass or TECAB?

Jeffrey Lee, MD: Robotic TECAB is a wonderful new innovative procedure currently performed in very few facilities in the world. I really know of only five or six other programs in the world currently performing this modality of therapy and certainly none in the state of California. And in this procedure we use the Da Vinci surgical robot to delicately perform the bypasses that would be required in a traditional surgery through a big incision. We just do it through tiny keyhole-sized incisions. So there's really no incisions, no breaking or cutting of any bone. Patients have a much better, quicker recovery and the benefits are significant.

Deborah Howell (Host): There's got to be other benefits.

Jeffrey Lee, MD: Right. Using this type of procedure, we do one or two vessels and we work hand-in-hand with cardiology colleagues to perform what we call a hybrid revascularization where we will perform one or two vessel bypasses and they will do the angioplasty and stenting of the other vessels. In that way the patient get fully revascularized, meaning all the blood brought back to the heart the way it should be with only a few tiny keyhole incisions.

Deborah Howell (Host): And that happens at the same time?

Jeffrey Lee, MD: Same time or usually in a month later.

Deborah Howell (Host): I see, okay. And what comes first?

Jeffrey Lee, MD: Usually the surgery goes first.

Deborah Howell (Host): Okay, all right. Are there other benefits of TECAB?

Jeffrey Lee, MD: Besides the obvious benefit of no large incisions, it's been shown that TECAB, robotic totally endoscopic coronary artery bypass, usually has much less blood loss, much less pain, and significantly shorter time spent in the hospital, usually two to three days. The biggest benefit, certainly in this tough economy, where patients really need to get back to their normal lives and work quicker, is traditional open heart surgery where we've split the whole breastbone, we usually don't let the patients go back to work or go back to their normal activities such as driving, golf, weightlifting for at least two to three months. But after a robotic TECAB, because we don't have that big incision, we don't have that big broken bone, patients can get back to work and their normal activities usually within two weeks.

Deborah Howell (Host): Just no, probably push-ups for a while.

Jeffrey Lee, MD: Even push-ups, weightlifting can be done in two weeks after a robotic TECAB. Certainly you can drive.

Deborah Howell (Host): That is impressive. So who is a candidate for the TECAB approach?

Jeffrey Lee, MD: Really almost anyone needing open heart surgery, heart bypass surgery, or potential candidates. And it's on a case-by-case basis that we have to carefully select the right patients. We are not doing this procedure currently for patients who've had prior heart surgery.

Deborah Howell (Host): Okay, all right. Okay, now also what advice could you give to someone who is researching their options on where to get their heart surgery performed and also what kind of surgery to have.

Jeffrey Lee, MD: This is advice I give all patients regarding any innovative procedure you might read about in the newspaper or on the internet. You really should ask your surgeon number one if they do this procedure but don't ask him or you know significantly suggest that he actually do it unless they have extensive training in it or are very comfortable with that procedure. You know I've had the unique privilege of having trained in two fellowship programs for robotic heart surgery, one at the University of Maryland and one at the Cleveland Clinic. So most of my colleagues do not have that type of specialized training, but I want to make sure that patients receive the safest surgery in the individual surgeon's hands. So if you're comfortable with that surgeon and he feels that you're best served by regular heart surgery, let him do what he knows how to do best. Of course, we would welcome in consultation anyone needing heart surgery has the opportunity to come to Saddleback for a comprehensive evaluation because we do offer minimally invasive or robotic approaches for almost any type of heart surgery such as heart bypass, AFib, atrial fibrillation, even heart valve surgery, in most cases can be done with a less invasive approach.

Deborah Howell (Host): Unbelievable. It's a great day. Thank you so much, Dr. Lee, for being with us and congratulations on all the success and the progress that you're having with TECAB.

Jeffrey Lee, MD: I want to mention that we have a website. If anyone needs to have further information, it's called www.miniheartsurgery.com.

Deborah Howell (Host): Again www.miniheartsurgery.com. Is that right?

Jeffrey Lee, MD: That's right.

Deborah Howell (Host): Alright, thank you so much Dr. Lee. We appreciate you being on the show today.

Jeffrey Lee, MD: Thank you so much.

Deborah Howell (Host): And to learn more or to listen to a podcast of the show, please visit memorialcare.org. I'm Deborah Howell. Join us again next time and bring your heart, your healthy heart, with you as we explore another weekly dose of wellness. Have yourself a fantastic day.