MORGANTOWN — WVU’s Heart & Vascular Institute has gone beyond cutting edge – to not just perform but to become one of the few places in the country to teach robotic heart surgery.
“Having access to this technology is not just having access but having nation-leading access,” said Dr. Vinay Badhwar, executive chair of the institute. “We are humbled that other places around the country and around the world are coming to Morgantown to learn this.”
Those other places include cardiac surgery teams from Saudi Arabia and Switzerland, he said.
Before coming to WVU in June 2016, Badhwar was chief of cardiac surgery at UPMC Presbyterian and started the robotics cardiac surgery program there. He came to WVU with his whole surgical team and started the program here.
Several other medical disciplines perform robotics surgeries. “I’m pleased to be part of a multidisciplinary robotics team here at WVU,” he said. “We’re doing a whole host of robotics care.”
In the heart field, not every surgery is right for robotics. For instance, a multiple bypass still requires opening the breastbone and going in from the front.
But they can do single bypasses, mitral valve repair and replacement, and atrial fibrillation surgery (AFib, irregular heartbeat).
AFib is sometimes treated with catheter ablation – where catheters are inserted and transmit radio waves that produce a small scar which blocks the electrical impulses that cause irregular heartbeat. With the robot, instead of multiple catheters through the groin, they just do a side incision, Badhwar said.
In fact, he’s written national guidelines for that, he said.
It’s the same for bypass and mitral valve, repair. Instead of opening the breastbone, they do small incisions in the side and insert the robotic arms.
The robot in the operating room isn’t a humanoid like C3PO or Data. It’s a da Vinci Xi. The surgeon sits at a station off to the side of the room, looks at a screen and works a set of handles that remotely work the five robotic arms hovering above the operating table.
The arms are spidery looking things wrapped in sterile plastic bags with various tools on their ends – cameras, scalpels and such.
“It’s a bit of a symphony,” he said of his team. They all know what their colleagues are doing, they all know what to do next, and they often can work without asking or telling anything because they know the job. “Because of the team effort, our success is multiplied.”
What moved WVU into the forefront of the field, Badwhar said, was pushing the boundaries of what the robot can do. In the past, the robot was reserved for straightforward cases, he said. It was thought that advancing cardiac surgery with robotics took more time and more cost.
But they learned they can use it on more complex cases too, for the same cost as a traditional open heart procedure.
For example, an otherwise healthy 45-year-old with mitral valve prolapse – the mitral valve sits between the upper and lower left heart chambers; when it prolapses it allows blood to leak back from the lower chamber into the upper during contraction – would be a routine candidate for the procedure.
But WVU can offer it to others – the elderly who may be too weak to tolerate a sternotomy (cutting the breastbone), an IV drug user who’s wasted away, someone with infections or multiple serious diseases.
They’re one of just four or five programs in the nation equipped to teach this, he said.
“We are unique in that experience in the United States in that most people don’t do cases like that,” he said. “It’s because we’ve got a great team and we’ve been using the robot as a tool of quality advancement, as opposed to using the tool to do a cool procedure but not to advance and progress the field.”
Visitors from various hospitals have come to observe his team work, he said, including form Italy and Switzerland. They went to Switzerland to perform a surgery and help the University of Zurich start its own robotics program.
Teams came from Saudi Arabia and Switzerland to learn how to perform and get certified in the procedure with hands-on practice (via simulator and medical cadavers, not actual patients). In October, a team came from Yale. In December, another Saudi team will come.
Badhwar emphasizes that its teams that learn and train, because each operation is a team effort – the head surgeon who works the robot along with one or two more who are at the table, the profusionist who works the heart-lung machine, the nurses, and so on.
There’s a bit of lineup of people who want to come, Badhwar said. However, “Our primary focus is to our patients. Training is time consuming. We are so busy with the many patients that need robotic surgery that sometimes it’s just not physically possible to take a break for a few hours and teach them.”
Badhwar wrapped up his explanation with this thought: “The entire mission of the WVU Heart & Vascular Institute is to bring the most advanced care and the most advanced technology, and access to both, to every citizen of the state so that currently no one ever has to leave the state for the most advanced care that’s available in the country. That’s what makes this so enjoyable and gives us so much pride in what we do and hope for every patient in the state.”
A success story
Austin Gisriel is a Winchester, Va., author and blogger with a passion for World War II and baseball, and ballroom dancing.
He’s also a walking success story for WVU Heart & Vascular Institute’s robotic cardiac surgery team.
“If you have a heart procedure, you don’t hear most people say, ‘It was one of the great experiences of my life.’ But it really was. I still can’t believe that they did what they did and it happened to me. … I look back on the care, and how it fixed my heart, and it’s just amazing.”
Some years ago, he said, his cardiologist detected a bad mitral valves in his heart. (The mitral valve sits between the upper and lower left heart chambers; when it prolapses it allows blood to leak back from the lower chamber into the upper during contraction.)
But he was displaying no symptoms – until November 2017. He suddenly developed severe fatigue that worsened over the course of a week.
The time for surgery arrived. Winchester sits southwest of Martinsburg along Interstate 81, near the Virginia-West Virginia Panhandle border. And his wife, Martha, works at Berkeley Medical Center in Martinsburg, part of WVU Medicine’s University Healthcare.
So her insurance covered surgery in Morgantown. “I feel extremely lucky that it worked out that way.”
Gisriel turned 61 on March 1. He met with Dr. Vinay Badhwar, executive chair of the institute, early that month and they determined he was a candidate for robotic surgery.
The operation took place the morning of March 13 – a Tuesday – and he was home by Friday afternoon.
The evidence of his procedure, he said, is seven little incisions on his right side. That’s where tubes, lights and camera went in. The biggest were 2-3 inches for the robotic arms. “They’ve all healed up so you’d probably have to look twice to even notice something was there.”
Now, “I‘m doing great.” Two Fridays after going home, he was back on the dance floor. “I wasn’t throwing my partner around over my head or anything like that.” He built up gradually. “Within a month I was full strength.”
And he’d recommend the team to anyone who needed it.
“The care was fantastic,” he said. “The most impressive thing was that they clearly have a philosophy: ‘We’re going to treat these people as people, not numbers, not even as patients.’ And that attitude carries from Dr. Badhwar down through the nurses, the therapists. Everybody I came in contact with, they were concerned about me as a person first.”
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