HOUSTON (AP) - Myron Whatley’s cardiologist told him there was no other option: A year after a heart attack, Whatley needed to have a valve in his heart repaired, and that meant a cardiac surgeon would need to crack open his rib cage to operate.
The Houston Chronicle reports (https://bit.ly/2o3JzE6 ) it would take up to two months to recover, the doctor said, and he’d probably need a strong narcotic to cope with the pain.
For days, the prognosis haunted Whatley, a 53-year-old manager at a Houston shipping company. He lay awake at night, dreading what awaited him.
Then, in late February, he met the surgeon he’d been referred to at Baylor St. Luke’s Medical Center, and everything changed: “We’re not going to do that,” Dr. Joseph Lamelas told him.
Instead, Lamelas said he would cut only a 2-inch hole between two of Whatley’s ribs. He’d use special tools to repair his leaking mitral valve and strengthen his heart. Then he’d stitch him up and send him on his way. Whatley would be on his feet in a day or two and back to work in two or three weeks, Lamelas said.
“I felt like a kid at Christmas,” Whatley said hours after the meeting. “I’ve been worried to death about this surgery until today.”
Lamelas, a pioneer of minimally invasive heart surgery, is new in Houston. So new, it seems, even some of the area’s cardiologists aren’t aware of what he can do.
The morning after meeting Lamelas, Whatley lay unconscious on a surgical table at St. Luke’s.
“Let’s get started,” Lamelas said.
He made a small cut to the right side of Whatley’s chest. “That’s it,” Lamelas said, as a resident physician peered over his shoulder. “The incision is about the length of your index finger, maybe a little shorter.”
Lamelas came to Baylor College of Medicine in January, leaving behind his practice of more than 20 years in Miami, where he’d established himself as one of the busiest - if not the busiest - cardiac surgeons in the world. He was performing more than 700 operations a year, the vast majority of them through small incisions using surgical tools that he helped design.
“This is one I developed,” Lamelas said, holding up a small metal device before placing it into the opening in Whatley’s chest. He uses the “soft-tissue retractor” to pry open incisions, creating a circular opening to operate through.
“That’s better than a sternotomy,” Lamelas said, referring to the traditional open-chest approach. “Much better for the patient.”
Research increasingly shows minimally invasive techniques result in shorter recovery times and fewer complications, but heart surgeons have been slow to adapt. In Houston, where Drs. Michael DeBakey and Denton Cooley helped usher in the modern age of heart surgery 60 years ago, only a few cardiac surgeons routinely use minimally invasive techniques. The operations, although easier on patients, are often more challenging for surgeons.
Dr. Mahesh Ramchandani, a heart surgeon at Houston Methodist Hospital, has specialized in small-incision operations for the past several years. He said he welcomes Lamelas’ arrival at a rival Texas Medical Center institution.
“The problem is cardiac surgery is so mired in tradition, it’s difficult to move the needle,” said Ramchandani, who next month is hosting an international seminar on the advantages of minimally invasive heart surgery. “Joe (Lamelas) is a friend, and Joe coming to Houston is a good thing. I think it’s going to make other surgeons sit up and realize they’d better learn how to do this if we want to do the best for our patients.”
Lamelas has completed more than 5,000 minimally invasive surgeries over the past 15 years, he said, pushing himself to take on ever more complex operations. He does minimally invasive valve replacements. Minimally invasive double-valve replacements. Minimally invasive triple-valve replacements. Minimally invasive bypass surgeries.
“Some of the operations he does - for example, replacing the aorta through those tiny incisions - I think you can probably count on one hand the number of surgeons in the world who can do that,” said Dr. Todd Rosengart, chairman of surgery at Baylor College of Medicine. “That’s why we brought him here.”
Lamelas was born in Cuba in 1960. Three years later, his family fled the communist regime, landing in South Florida aboard a Red Cross boat. They lived in poverty, sharing a home with two other families in exile. His baby brother slept in a dresser drawer; for Christmas gifts one year, his parents bought a single bag of tiny green soldiers and divided them up among the three children.
His father emphasized the importance of education, something he said no government could take away. Lamelas, determined to become a heart surgeon, went to medical school in the Dominican Republic because he couldn’t afford to attend a U.S. program. He returned to Miami after his residency in Brooklyn and, over the next decade, established a thriving surgical practice.
He wasn’t satisfied. Around 2004, Lamelas said it struck him that he needed to do something to differentiate himself. Something to help move the field forward.
“At the time, some cardiac surgeons were dabbling in minimally invasive approaches, but it was somewhat controversial because the results were not good,” Lamelas said. “But I saw the potential.”
He traveled the country to learn from surgeons who’d developed the first minimally invasive techniques and then worked to improve them. He began offering minimally invasive valve surgery to high-risk patients - those who were too frail for a traditional open-chest operation.
“I applied the technique to those patients and saw they were doing quite well,” Lamelas said. “So I started offering it to lower-risk patients. Then I expanded it to double-valve operations. Then triple-valve. And it’s just grown from there.”
Soon surgeons from across the world were coming to Miami to learn from Lamelas, he said. About 700 of them have spent time observing in his operating room, he said, but because most only stay for a day or two, only a small number of surgeons have incorporated the techniques.
One of those who made a pilgrimage a decade ago to learn from him: Rosengart, who later became the head of surgery at Baylor College of Medicine. He called Lamelas last year “on a lark,” he said, and asked if he was interested in making a move.
“I sit in the seat that Dr. Michael DeBakey used to sit in, and I think about all the greats who have been here,” Rosengart said. “Whenever we’re hiring, we’re looking for people to make sure we’re continuing to move the field forward, and Dr. Lamelas very much fits the bill.”
Lamelas was ready for a change. By going to work at a prestigious medical school, he said, he hopes to develop even better surgical techniques, test them in the lab at Texas Heart Institute and then pass them on to a new generation of surgeons studying at Baylor.
He brought part of his team from Miami with him: Marcos Garcia Salas is his lead surgical assistant, and his wife, Shay Lamelas, is a nurse practitioner in his office.
“We’re going to turn Houston into a world center for minimally invasive cardiac surgery,” Lamelas said.
An hour after making the small incision in Whatley’s chest, Lamelas had cleared a path through the opening, giving him access to the patient’s damaged mitral valve.
“Long DeBakey,” Lamelas said, calling for a modified pair of forceps named for the famous Houston surgeon who developed them. Only, this pair is 12-inches long, giving Lamelas the reach needed to operate through the narrow opening.
“You can’t do these operations with conventional instruments,” Lamelas said, looking back at the surgical resident. “The longer tools require extra precision. If you have any little tremor in your hand, any little move that’s not accurate, it’s going to be translated disproportionately on the other end.”
He was performing what became a signature operation in Miami: The Ring and Sling. After separating the ribs, he removes excess valve tissue and inserts a synthetic ring to support the repair, preventing blood from backflowing into the left atrium and lungs. Then he inserts a plastic tube that serves as a sling, strengthening the weakened left ventricle.
Whatley’s case was more challenging than expected. Scar tissue from his heart attack was obstructing Lamelas’ view of the valve.
“I don’t have a great visual,” he said. “But I’ve done this before.”
Within a few hours, Lamelas was done. The medical team removed Whatley from the heart-lung machine, which had pumped oxygenated blood through his body while Lamelas operated, and nurses wheeled Whatley into the intensive care unit for recovery.
He wouldn’t stay there long. Three days later, he was discharged from the hospital. He took a painkiller that day, he said, but realized later he didn’t need it.
Three weeks later, Whatley was walking 4 miles a day and preparing to go back to work. At a follow-up appointment with his cardiologist, he raved about Lamelas.
“I’m telling everyone about this one,” Whatley said. “I felt like I hit the lottery by walking into that man’s office.”
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Information from: Houston Chronicle, https://www.houstonchronicle.com
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