Being a careful consumer, Luis Vicens makes sure he stays informed about his healthcare options. When he learned he needed cardiac bypass surgery for clogged arteries to his heart, he already knew he wanted to pursue the least invasive approach to address his problems.
His determination to get the care he wanted led him to Baptist Health Miami Cardiac & Vascular Institute and Joseph McGinn Jr., M.D., the Institute’s chief of cardiac surgery.
Joseph McGinn Jr., M.D., the chief of cardiac surgery at Baptist Health Miami Cardiac & Vascular Institute.
Dr. McGinn has earned international renown for pioneering an innovative approach to minimally invasive coronary artery bypass graft surgery. His procedure eliminates the need to cut open the patient’s chest or stop the heart, greatly reducing pain and recovery time. Known as the McGinn Technique, the very advanced surgery is currently performed routinely in only a handful of American hospitals.
In fact, when Mr. Vicens learned he needed multiple bypasses in addition to replacing his aortic valve, he says he was told at a hospital outside Baptist Health that a minimally invasive approach was not possible. The doctor insisted he had to open his chest, stop his heart and do both procedures at once. Mr. Vicens wasn’t buying it.
“Basically, the doctor said it was his way or the highway,” Mr. Vicens says. “Well, you know what? I can drive very well, and that’s exactly what I did. I took the highway.”
Finding the Right Doctor
Mr. Vicens, 77, spent his career working with computers before he retired, so he was very comfortable doing research online. He even found and watched instructional videos on YouTube of Dr. McGinn performing the surgery for other surgeons.
“The fact is that the alternative was there,” says Mr. Vicens, of Pembroke Pines. “There's a lot of information out there that is easily accessible if you look for it.”
Mr. Vicens was impressed with Dr. McGinn’s approach to making a difficult surgery less debilitating; but he was even more impressed with Dr. McGinn himself.
“My wife was with me. As soon as we met Dr. McGinn and discussed his philosophy, we knew we found the right doctor,” Mr. Vicens recalls.
Mr. Vicens appreciates that Dr. McGinn clearly outlined his options, but then left the decision up to him. “He asked me, ‘What do you want me to do? Which way do you want to go?’” Mr. Vicens recalls. It was refreshing. “I like the way he works, the way he presents things, what he tries to accomplish and how he does it.”
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 run a high risk of a heart attack.
The traditional approach 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 and performs his surgery on the beating heart using special instruments.
“You bypass the pain, you bypass the disability, you bypass the big zipper incision to separate the sternum,” Dr. McGinn explains. “Why have your chest cracked open, and your heart stopped if you don’t need to?”
Dr. McGinn notes that patients have the right to seek the care they want, even if their physician initially refers them elsewhere. “Most patients don’t know about this; they just go where their doctor tells them to go,” Dr. McGinn says. “Without question, my message to people is to look a little bit more into things, because you don't want 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.”
A Complicated Case
Mr. Vicens’ situation was complicated by the fact that he also had a narrowing of his aortic valve, making it harder for his heart to pump blood to the rest of his body. It was during a preoperative workup to replace this valve that his need for bypass surgery came to light, he says.
“I had a murmur for years, and it just kept getting worse,” Mr. Vicens explains.
It’s not unusual for patients to discover they have clogged arteries during preop evaluations for other conditions. That’s all the more reason to consider a minimally invasive bypass, so the person can quickly recover and receive treatment for the problem that brought them to the doctor in the first place, Dr. McGinn says.
In Mr. Vicens’ case, the valve problem was most severe and needed to be addressed first. It was replaced at Miami Cardiac & Vascular Institute by interventional cardiologist Nish Patel, M.D., using a minimally invasive procedure called transcatheter aortic valve replacement, or TAVR. It uses small incisions and a thin, flexible tube called a catheter that is threaded through a blood vessel — usually the femoral artery in the groin —to reach the heart. The improvement after the surgery was immediate, Mr. Vicens says.
“Stuff deteriorates over years, and you don't even realize it,” he says. “And then all of a sudden, with that TAVR, it was like flipping a light switch.”
About five weeks later, Dr. McGinn performed a minimally invasive double bypass using grafts of healthy blood vessel to create a new route, or bypass, so blood could get around the arterial blockage. The postoperative discomfort was reduced by using the mammary artery in Mr. Vicens’ chest as a graft rather than a vein from the leg or arm, as is usually done. Instead of months of pain from having his sternum split apart, Mr. Vicens experienced only mild discomfort and was back on his feet almost immediately.
After a few days recuperating at Baptist Hospital, Mr. Vicens went home. The only pain reliver he needed was Tylenol, he says. “Two days later, I drove my son, who had come down from Cincinnati for the procedure, to the airport. I didn’t have to wait three months to drive.”
Dr. McGinn explains that doing the procedures separately was the best strategy — one he will continue for other similar cases.
“If you look at the risk of using open heart surgery to replace a valve and do cardiac bypass at the same time, the risk is extremely high — like five times higher than the strategy that we're using,” Dr. McGinn says.
Making Big Plans
Dr. McGinn has been refining this particular technique for almost 20 years, developing new instruments and searching for innovative ways to make it safer and easier on patients. His use of mammary arteries as grafts, for example, is a relatively new approach to help reduce the physical trauma to patients. He has been exploring the possibilities at Miami Cardiac & Vascular Institute.
“I'm always trying to tweak things and make things a little better,” Dr. McGinn says. “I want to give the patients a great operation, a great recovery and the best result.”
Mr. Vicens says he respects that inclination to push the envelope, even though it might be easier to adopt the traditional approach. “I watched Dr. McGinn's video over and over again, and he explains that he does things this way or that way because it is better for the patient. That's what he always says. It is better for the patient.”
Mr. Vicens recovery has opened up the world to him and his wife of 48 years, Christine. They are planning a trip to Portugal in September, followed by a second European vacation to explore the Czech Republic, Austria, Hungary and Spain. In Barcelona, they will board a transatlantic cruise ship for the voyage back to Fort Lauderdale.
“I thought, ‘You're going be in the middle of the Atlantic Ocean for four days between stops,’” he says. The notion of being so far from medical care gives him pause, but only fleetingly. It’s certainly not enough to dissuade him from the trip of a lifetime. “That’s what it means to have faith in your surgeon.”