By Ida Brown / ibrown@themeridianstar.com
The Meridian Star
MERIDIAN —
At first glance, Pete Aniel doesn't look like someone who recently underwent heart surgery.
"I guess you were expecting me to look all weak, and walking around toting an oxygen tank," said Aniel, smiling broadly and – just 12 days after surgery – is neatly dressed in his work uniform.
"Can you believe this?" he says, still amazed himself at the possibility. "I was riding a bicycle in my neighborhood with my wife and grandson just this past Sunday. I tell everyone if you've got to have heart surgery and you're a candidate for this type of procedure, go for it!"
The procedure Aniel refers to is robotic heart surgery performed with the da Vinci Surgical System. The surgery was performed by Dwight Hand, M.D., Ph.D., a cardiothoracic surgeon at Rush Foundation Hospital. Hand is one of two surgeons in Mississippi trained to perform robotic heart surgery, and Aniel is the first patient to undergo the procedure at a Meridian hospital.
In addition to having suffered a heart attack in 2002, Aniel, 54, also has a pacemaker. So when he began to experience sensation in both hands and across his shoulders, he had it checked out.
"I hadn't had a stress test since my heart attack. I passed the stress test, but I didn't pass the EKG, which was extremely abnormal," Aniel said. "When I had a stint put in eight years ago, my cardiologist told me I had some blockage in a spot where they couldn't put a stint; it was like 60 or 70 percent blockage. When I told Dr. Hand about it, he said that was where the stress was showing up. It turned out to be 95 percent blockage in what they call 'the widow maker.'"
Hand talked to Aniel and his wife, Linda, about the robotic heart surgery.
"When he was telling us about it, he was so confident and put us at ease. I knew that it was what I wanted to do," Aniel said.
Even after learning that he would be the first to undergo the minimally invasive heart surgery in Meridian, Aniel was confident that it was what he wanted.
"When I was told I would be the first one to have the surgery here you would think I would have been scared," he said. "But I wasn't ... I knew I was in good hands with Dr. Hand."
Robotic surgery
Robotic heart surgery is a minimally invasive procedure that uses a set of small ports, instead of cutting the chest open and splitting the breast bone.
"Basically, it is a robotic assisted coronary artery bypass procedure," Hand said. "The graph we did (for Aniel) was a left internal mammary artery, to a left anterior descending coronary artery bypass – a single-vessel coronary bypass."
A small incision is made between the ribs, beneath the left breast.
"When it's done robotically, all we need are three ports: one camera port, and two instrument ports. Those ports are about the size of a dime," Hand said. "The chest remains closed through the procedure, but we can see with a three-dimensional camera."
The procedure is performed off-pump, alleviating the use of a heart-lung bypass machine. The heart and lungs continue to work through the whole operation.
The standard procedure involves a big incision through the middle of the breastbone, usually done with the heart-long bypass machine. The heart is stopped during the procedure and machine takes over the function of the heart and the lungs, pumping the blood and oxygenating the blood, Hand said.
Patients who undergo a minimally invasive procedure such as robotic heart surgery typically experience shorter recovery times than those who have open heart surgery.
"Healing is faster, there is less blood loss, fewer complications and usually less pain because incisions are much smaller." Hand said. "But most importantly, patients are able to resume their normal activity and return to work much sooner."
Recovery with robotic heart surgery is one to three hospital days, about two weeks back to work; open heart, four to seven hospital days, six weeks back to work six weeks.
It usually takes about six weeks for the breast bone to heal in patients who have open heart surgery. And, during that time, they are not allowed to drive or perform any upper body activity.
"If the bone doesn't heal or become infected, it can cause severe complications, and sometimes even death," Hand said.
Unfortunately, not everyone is a candidate for minimally invasive surgery.
"The main criteria is that the operation can be done robotically, so the patient has to have lungs that are healthy enough for us to deflate one lung while we work inside of the chest and do the bypass," Hand said.
The ideal candidate for the surgery is a patient who has blockage in the first part of the left anterior descending coronary artery, or one of its branches on the chest wall on the anterior surface of the heart.
"If someone has multiple blockages and multiple arteries on the right side of the heart or the other left circumflex coronary artery distribution, they are not as good candidates because more exposure is usually required to bypass those vessels," he said.
Life after surgery
Since his surgery on Aug. 17, Aniel has been unstoppable.
"I'm getting better every day," he said. "I have friends who had bypass surgery three months ago (standard procedure) and they're still not over their sternum being slit open."
Aniel, a supervisor with Pepsi Cola for 29 years, has become the center of attention among family, friends and co-workers, who marvel at his quick recovery.
"I live in the best day and age for modern technology," he said. "I can't say enough about it all. I bet I tell the story 15-20 times a day, but it's a story I like to tell. It's got a happy ending to it."
