Laser heart surgery relieves otherwise untreatable chest pain

SAN ANTONIO (Sept. 18, 2008)—Warren Raye, 67, of La Vernia, Texas, knows a lot more about pool tables than the average person. Raye and his partner have restored at least a thousand of them as a business/hobby. Raye is an expert at replacing pockets and rails, stretching and stapling felt, and setting into place the 300-pound pieces of slate that make up the table tops.

He might have finished more tables, but chronic chest pain often diverted his attention to the craft. In 1994, two years after the pain started, Raye was forced to give up his primary lifelong profession, driving an 18-wheeler. In ensuing years, he had bypasses and open-heart surgery, but nothing stopped the chest pain and other symptoms.

Until this spring, that is. Raye is one of the first South Texas patients with life-limiting chest pain not eased by stents, medications and other therapies who is benefiting from another option—a procedure called sole therapy transmyocardial laser revascularization (TMR).

V. Seenu Reddy, M.D., M.B.A., director of thoracic aortic surgery at The University of Texas Health Science Center at San Antonio, performs sole therapy TMR at University Hospital, which is the only civilian center for the YAG laser technique in the city. The goal is to create circulation again in areas of the heart that are ischemic—cut off from oxygenated blood.

New vessels, more oxygen
Dr. Reddy aims a device called a YAG laser through a 6-inch incision in the side of the chest. Dozens of beams 1 millimeter in diameter delicately create small channels in the heart. Although the mechanism of action is not completely understood, it is believed that the small channel incisions stimulate angiogenesis, which is the growth of new blood vessels to serve the heart’s oxygen requirements.

The therapy is approved by the U.S. Food & Drug Administration for the treatment of angina and is endorsed by the American Heart Association, the American College of Cardiology and the Society of Thoracic Surgeons. “It is a validated therapy in carefully selected patients who have no other option,” Dr. Reddy said.

Dr. Reddy has performed the procedure in more than a dozen San Antonio patients with overall excellent results. The procedure can often be performed as an adjunct to conventional bypass surgery, either with or without the heart-lung machine.

Raye underwent the surgery on March 31, 2008. “I only have one major artery [bypass] going to my heart and it got partially blocked,” he said. “Dr. Reddy went in with the laser surgery and poked holes in me. I felt immediate relief.”

Advantages for patients
Because the procedure can be performed through a small side incision between the ribs, sole therapy TMR does not require splitting the breast bone, which is often a feature of traditional open-heart surgery. Recovery time and post-operative pain are greatly reduced, along with the potential for infection.

Raye got out of bed and walked the day after his surgery. He left the hospital in four days. A patient whose breast bone is divided may be more limited in mobility and recovery, and may not be discharged for five to seven days.

“They cut me underneath the left arm, so I was sore, but not like I was before,” said Raye, who years ago had the traditional type of heart surgery. “If you get your chest cut open, and you get a cough, you have to hold a pillow to your chest real tight, and it won’t hurt. If you don’t, it will hurt really badly. Sleeping is better with the new surgery, too.”

Now he is back to working on pool tables in his friend’s garage. “We are both retired, so we do it on the side, on request,” he said.

Even helping his partner with a piece of slate might not be out of the question. “The doctor says my heart is doing real well,” Raye said. “My other doctor says my lungs haven’t sounded so good in a long time. I am driving again. My wife, Debbie, drove for me for a while.”

Thanks to Dr. Reddy’s surgical skills and application of a technique that is new to the region, Raye is restoring pool tables once again. Rack ’em up!

 

 

 
The University of Texas Health Science Center at San Antonio is the leading research institution in South Texas and one of the major health sciences universities in the world. With an operating budget of $674 million, the Health Science Center is the chief catalyst for the $15.3 billion biosciences and health care sector in San Antonio’s economy. The Health Science Center has had an estimated $35 billion impact on the region since inception and has expanded to six campuses in San Antonio, Laredo, Harlingen and Edinburg. More than 23,000 graduates (physicians, dentists, nurses, scientists and allied health professionals) serve in their fields, including many in Texas. Health Science Center faculty are international leaders in cancer, cardiovascular disease, diabetes, aging, stroke prevention, kidney disease, orthopaedics, research imaging, transplant surgery, psychiatry and clinical neurosciences, pain management, genetics, nursing, allied health, dentistry and many other fields. For more information, visit www.uthscsa.edu.



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