If you need coronary bypass surgery, would you prefer to have an innovative procedure performed through tiny incisions between your ribs? Or would you rather have your chest cut open, your heart stopped and your ribs retracted to provide access for a technique that is more than 50 years old?
That’s an actual choice at Baptist Health Miami Cardiac & Vascular Institute, which performs more minimally invasive cardiac bypass surgeries than anywhere in the country. The Institute’s chief of cardiac surgery, Joseph McGinn Jr., M.D., who is internationally renowned for pioneering this less traumatic approach, says too many people don’t realize they have options.
Joseph McGinn Jr., M.D., chief of cardiac surgery at Baptist Health Miami Cardiac & Vascular Institute, is internationally renowned for pioneering a less traumatic approach to cardiac bypass surgery
“Why have your chest cracked open and your heart stopped if you don’t need to? That’s the big question,” says Dr. McGinn. “You can bypass the pain, you can bypass the disability, you can bypass the big zipper incision to separate the sternum.”
Bigger and Better
Dr. McGinn’s technique, which is performed on the beating heart, dramatically reduces the time it takes for patients to recover. Most people usually return to their regular routines in less than two weeks, as opposed to the months it takes to bounce back from open heart procedures.
At Miami Cardiac & Vascular Institute, Dr. McGinn has worked on honing every aspect of his minimally invasive coronary artery bypass graft surgery, also known as MICS CABG. This includes redesigning instruments and refining techniques to trim the time patients are under anesthesia. He also has worked on making greater use of grafts from both mammary arteries in the chest so that blood vessels don’t have to be harvested from the leg, which can be quite painful.
“I’m always trying to tweak things and make the procedure a little better,” Dr. McGinn says. “A lot of what I’m doing right now is very technical, like how we place retractors, how we position the heart, how we manage the anesthesia. I have amazing patients and I want to make sure each one gets the most cutting-edge operation and the best result.”
“I’m always trying to tweak things and make the procedure a little better,” Dr. McGinn says. “A lot of what I’m doing right now is very technical, like how we place retractors, how we position the heart, how we manage the anesthesia. I have amazing patients and I want to make sure each one gets the most cutting-edge operation and the best result.”
Continual improvements mean the procedure can now be offered to more people than ever, Dr. McGinn says.
“We’re expanding it to more-sick patients, patients who would be turned down for surgery elsewhere. By treating those patients through a minimally invasive approach, we can help them survive and actually flourish,” Dr. McGinn says. “We can do that is because we have new technology, better techniques, better stabilizers. We are saving more people and seeing fewer problems postoperatively.”
Dr. McGinn estimates that 90 to 95 percent of patients who need a coronary bypass are good candidates for a minimally invasive procedure.
“We’ve always appealed to younger patients such as breadwinners who want a minimally invasive surgery because they need to get back to work, or people who want to resume travel or whatever else is going on in their life,” Dr. McGinn says. “But now we’re expanding it to very sick and older patients.”
Understanding Cardiac Bypass Surgery
Nearly 400,000 coronary bypass surgeries are performed each year, making it the most commonly performed major surgical procedure in the United States, according to the National Institutes of Health. The procedure is used to treat the narrowing of the arteries that supply oxygen and nutrients to the heart. Cardiologists may recommend bypass surgery if any — or all four — of the coronary arteries are so narrowed or blocked that the patient runs a high risk of a heart attack.
The traditional approach was developed in the 1970s and requires a huge incision, splitting the sternum and spreading the ribs in order to access the heart. It can be grueling for patients, who endure considerable pain and a recovery time of three months or longer. After witnessing how hard this can be on patients and their families, Dr. McGinn devised his technique to spare patients some of the discomfort, blood loss and risk. Instead of opening up the chest, Dr. McGinn accesses the clogged arteries through small, two-to-three-inch incisions between the ribs using special instruments.
“The concept behind this surgery is we don’t break any bone and we don’t cut any muscles, so the structural integrity of the chest remains intact. The recovery is considerably faster and the pain is less,” he explains. “This is important for people who can’t handle the trauma of the traditional approach, like elderly people or people who have other medical issues.”
As an example, Dr. McGinn says he performed a minimally invasive double bypass on a woman who had breast cancer. Her life-threatening heart condition was discovered only after she began chemotherapy and experienced chest pain.
“Here’s a situation where the patient had no choice. No one is going to cut open the sternum of a patient who is that debilitated, that susceptible to infection and unable to heal wounds because of the chemotherapy,” he recalls. But he refused to give up on her. “Taking a minimally invasive approach was a great solution,” he says, adding that the woman was able to resume chemotherapy a few weeks later and successfully completed her breast cancer treatment. “She did fantastic.”
Expanding the Reach
Dr. McGinn has taught his technique to cardiac surgeons around the world and he continues to lead workshops and educational programs in an effort to make the procedure accessible to more people.
Every month or so, visiting physicians from around the country descend on Miami Cardiac & Vascular Institute to watch Dr. McGinn in action. “It’s a very comprehensive program,” Dr. McGinn says. “I help them through the learning curve.”
To accommodate the demand, Dr. McGinn is looking forward to expanding the MICS CABG program to Baptist Health’s hospitals in Palm Beach County — Boca Raton Regional Hospital and Bethesda Hospital East. The planned expansion will be overseen by a very well-trained cardiothoracic surgeon: his son, Joseph McGinn III, M.D.
Cardiothoracic surgeon Joseph McGinn III, M.D., will oversee minimally invasive cardiac bypass surgeries at Boca Raton Rgional Hospital and Bethesda Hospital East, both part of Baptist Health
“We want to increase our capacity,” Dr. McGinn says. “Every day, there are a lot of people in South Florida getting their chest opened, and for no reason. These people are here already; they don’t have to get on a plane to reach us.”
If Dr. McGinn could say one thing to people facing bypass surgery, it would be this: Patients have choices.
“Without question, my message to people is to look a little bit more into things, because you don’t have to have your chest cracked open. You don’t have to be laid up for three months. You don’t have to have all the complications associated with that, and the pain. It’s just not necessary,” he says. “You don’t have to go through all that trauma.”
Every month or so, visiting physicians from around the country descend on Miami Cardiac & Vascular Institute to watch Dr. McGinn in action. “It’s a very comprehensive program,” Dr. McGinn says. “I help them through the learning curve.”
Despite that, few hospitals in the country have invested in the instruments or teams required to do this procedure routinely, especially for patients who need multiple bypasses. And that means many people who want a minimally invasive approach often have to come to Miami. “We’re getting patients from all over the country — all over the globe really,” Dr. McGinn says. “We get a lot from Caribbean, South America, Central America and almost every state in the country.”
To accommodate the demand, Dr. McGinn is looking forward to expanding the MICS CABG program to Baptist Health’s hospitals in Palm Beach County — Boca Raton Regional Hospital and Bethesda Hospital East. The planned expansion will be overseen by a very well-trained cardiothoracic surgeon: his son, Joseph McGinn III, M.D.
“We want to increase our capacity,” Dr.McGinn says. “Every day, there are a lot of people in South Florida getting their chest opened, and for no reason. These people are here already; they don’t have to get on a plane to reach us.”
If Dr. McGinn could say one thing to people facing bypass surgery, it would be this: Patients have choices.
“Without question, my message to people is to look a little bit more into things, because you don’t have to have your chest cracked open. You don’t have to be laid up for three months. You don’t have to have all the complications associated with that, and the pain. It’s just not necessary,” he says. “You don’t have to go through all that trauma.”
