Ronald Wright
Coronary artery disease can result in chest pain known as angina. This occurs when the heart muscle is not supplied by sufficient blood flow to allow normal metabolism and function. Although there are several potential causes of angina, the majority of cases are due to blockage in the blood vessels of the heart that supply the heart muscle itself. The amount of blood flow required by the heart muscle is dependent on how much work the heart muscle must perform, and therefore, the amount of blockage that may cause angina can vary significantly between individuals.
At 59-years-old, Ronald Wright is one individual that knows the symptoms of angina all too well. Due to his chronic angina, Ronald underwent an open heart bypass surgery four years ago in Butler, PA. Unfortunately, his condition did not improve after the surgery. “I still couldn’t walk a hundred feet without having to take nitro,” Ronald said. Nitroglycerin is a medication that is used to treat angina by opening blood vessels to improve blood flow.
Frustrated with his condition and frequent need for medication, Ronald went to The Ohio Heart & Vascular Center upon moving to Cincinnati. His physician, Geoffrey Answini, M.D., a cardiovascular surgeon, knew that Ronald’s chronic angina and prior unsuccessful bypass surgery made him a perfect candidate for a new procedure known as Robotic TMR, which had not yet been performed in Ohio at the time. “Open-heart surgery or angioplasties are not always options for patients with coronary artery disease,” said Dr. Answini. Robotic TMR may be a solution for these patients. Our goal is to give them a better quality of life.”
Robotic transmyocardial revascularization (robotic TMR) is a minimally invasive treatment for patients suffering from severe angina. This procedure utilizes both the da Vinci robot and the Cardiogenesis TMR laser. The da Vinci surgical system does not make decisions or place a robot in control of the surgery. Instead, it allows the surgeon to control the entire surgery by using master controls that work like forceps. As the surgeon uses the controls, the da Vinci responds to the surgeon’s input in real time, translating the hand, wrist, and finger movements into precise movements of very small instruments at the patient-side card. The Cardiogenesis laser creates channels through the wall of the left ventricle of the heart. These channels increase oxygen delivered to the heart which reduces symptoms of angina for the patient. The success rate using robotic-assisted TMR is 75 percent versus 30 percent using other treatment modalities.1
Dr. Answini presented the Robotic TMR option and Ronald was very excited. “I had learned about the procedure online and instantly told Dr. Answini that I wanted to do it,” Ronald said. After experiencing bad scarring and a long, unsuccessful recovery with his prior open heart surgery, Ronald thought the benefits of Robotic TMR sounded wonderful. Using the da Vinci robot allows for smaller incisions and better visualization during the procedure. Improved precision of the procedure creates better results such as less pain, less risk of infection, less blood loss, fewer blood transfusions, less scarring and shorter hospital stays.
At the Christ Hospital, Dr. Answini performed the first FDA-approved robotic-assisted TMR in Ohio on Ronald. He used the da Vinci robot’s “arms” to access the Ronald’s heart via an incision, approximately one cm in length, through his rib cage. This incision is half the size of traditional TMR. He then used a CardioGenesis laser to create 16 channels in the left ventricle of the heart. These channels are approximately one millimeter in diameter, and are placed approximately one cm apart. The channels increase the blood flow to the heart and promote angiogenesis (growth of new blood vessels). Angiogenesis provides damaged heart tissue with a better supply of oxygen and blood.1
The procedure was a success and Ronald is impressed with the short recovery time, the minimal appearance of the tiny incision marks, and most importantly– his improved condition. “My recovery didn’t take nearly as long as it did after my open heart surgery,” Ronald said. He is also grateful that he no longer needs nitroglycerin mediation to make it through his daily activities. By giving Ronald a better quality of life, Dr. Answini accomplished his goal.
1. Information provided by The Christ Hospital