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Early one Sunday morning, Eleanor Kindree woke up with a nagging ache between
her shoulders. The 62-year-old resident of the Bahamas figured she must have
pulled a muscle, so she headed for the medicine cabinet. But the two aspirin she
took didn’t even begin to touch the torment she was feeling. Her back pain
grew more severe with each passing hour.
The next day, a weary Kindree headed straight to her chiropractor’s office
to get the spinal adjustment she was sure would ease her aching back. But
instead of an adjustment, the mother of two received a shock: she had suffered a
heart attack.
"I never dreamed it was a heart attack," she recalls many weeks
later. "Heart attacks usually mean pain in the chest. Or down the left arm.
One moment, I thought I had a backache. The next thing I knew I was having
bypass surgery."
A higher-risk procedure for women
Developed in the 1960s, coronary artery bypass surgery was a revolutionary
procedure that transformed the field of cardiac surgery. In 1967, Cleveland
Clinic cardiothoracic surgeon René Favaloro, M.D., credited with pioneering the
procedure, grafted a vein removed from a patient’s leg to the patient’s
diseased coronary arteries to increase blood flow to the heart. From this single
operation, hundreds of thousands of lives have been saved, making coronary
artery bypass surgery one of the most successful means of treating heart
disease.
The success of this treatment, however, has not been equally shared. Studies
show that women undergoing traditional bypass surgery, as a group, do not fare
as well as men. Women have higher mortality rates, stay longer in intensive care
units, and continue to suffer more heart problems after the procedure.
"One of the reasons why women don’t do as well as men is because, on
average, they come into the hospital in worse condition," says Mercedes K.C.
Dullum, M.D., a cardiothoracic surgeon at Cleveland Clinic Florida Weston.
"These women generally have other health problems, including high blood
pressure, diabetes, kidney disease, elevated cholesterol and heart failure. This
makes the surgery a higher-risk procedure for women than it is for men."
Off-pump: A better option
These are just some of the reasons why Dr. Dullum prefers to use a newer
type of bypass surgery, called "off-pump" or "beating heart"
surgery, for her high-risk patients, particularly women. During traditional bypass surgery, the patient’s heart is stopped, making it easier for the
surgeon to work on it. The patient’s blood is shunted to a machine that pumps
and oxygenates that blood. Once the procedure is done, the surgeon restarts the
heart and finishes the surgery. In off-pump surgery, the heart never stops
beating. Instead, surgeons use newly developed, clamp-like devices to flatten
and stabilize small portions of the heart’s surface while they work. The
devices can be moved to wherever the surgeon needs to bypass a blocked coronary
artery.
Dr. Dullum is a pioneer in the development and use of off-pump surgery. She
is one of only a handful of female cardiac surgeons in the United States and the
only one in south Florida. "The benefits of beating heart surgery are many,
particularly in high-risk patients," Dr. Dullum says. "A Cleveland
Clinic study comparing the results of on- and off-pump coronary artery bypass
surgery demonstrated fewer cognitive side effects with off-pump patients, as
well as less red blood cell usage. There are fewer chest incision infections in
the off-pump patients and there is lower mortality in women who undergo this
kind of bypass surgery." The Clinic study also noted less kidney failure
requiring dialysis after off-pump surgery.
There are cosmetic advantages too, according to Dr. Dullum. The procedure
leaves only a two- to three-inch scar, which may be covered by the breast. Older
women have the option of a small incision near the lower end of the breastbone
-- making the procedure even less painful.
In addition, new developments in vein harvesting contribute to bypass surgery
becoming more woman-friendly. In Eleanor Kindree’s case, small incisions were
made in her leg to remove a vein to graft into the artery. So instead of the
traditional cut down the leg that leaves a painful scar, Kindree has only two
small incisions that healed quickly. Two weeks after her quadruple bypass,
Kindree was able to fly back to her home on Grand Bahama Island.
According to Dr. Dullum, bypass surgery will continue to improve. "We’re
constantly enhancing the surgery, and the benefits will become even more obvious
in years to come. This is a life-saving improvement for women cardiac patients
everywhere."
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