Advanced Coronary Revascularization for Severe Coronary Disease
Feb 24, 2021 Cedars-Sinai Staff
When it comes to cardiac surgery, it matters where you seek treatment.
"It makes such a difference to your ability to walk out of the hospital and live a long and healthy life. Those are big stakes," said Joanna Chikwe, MD, FRCS, the founding chair of the Cedars-Sinai Smidt Heart Institute's Department of Cardiac Surgery and the Irina and George Schaeffer Distinguished Chair in honor of Alfredo Trento, MD.
"This program is really unique in the depth, quality and sheer innovation of what we're doing," she said.
An international expert in cardiovascular surgery with specific expertise in coronary vascularization, Chikwe is a leader in advancing the surgical technique to improve the lives of patients with severe coronary artery disease.
"There's been a real bias toward doing procedures that make your very short-term results as good as they can possibly be, and a tendency to ignore more challenging procedures that actually matter for the patient over 5, 10, 15 years."
Broadly, coronary revascularization is a surgical intervention used to treat blocked arteries. The method allows a wide range of patients to avoid the trauma of open-heart surgery and restore healthy blood flow to the heart.
The hybrid coronary revascularization approach combines the “gold standard of cardiac surgery”—the single arterial bypass—with stenting for the rest of the vessels, Chikwe said.
Older patients may be especially well-suited for the procedure, which is performed with the assistance of a robot through a very small incision. Cedars-Sinai is one of very few institutions in the country that routinely perform the procedure.
The alternate route is the multiarterial coronary revascularization method, which is ideal for severe coronary artery disease patients who are younger than 65 and have otherwise healthy hearts. The multiarterial procedure involves an arterial bypass of multiple arteries, not just one.
Chikwe says the multiarterial method is vastly underutilized in the U.S.—currently received by less than 10% of eligible patients. Cedars-Sinai is currently one of the country’s only medical centers that regularly performs the procedure, and with outstanding results. One of Chikwe’s goals is to expand access to the exciting and innovative procedure.
"That’s a really important contribution to helping patients with coronary disease get treatment that will last them longer than anything else we know in medicine," Chikwe said.
Part of the reason that many medical centers have been slow to adopt the multiarterial coronary revascularization method is it requires an intense technical demand on the surgeon, and additional expertise on the rest of the surgery team—especially to perform it as safely as conventional bypass operations.
Also, traditionally, many surgeons have focused on short-term results, such as 30-day outcomes, because those are the results that must be reported publicly.
"There’s been a real bias toward doing procedures that make your very short-term results as good as they can possibly be, and a tendency to ignore more challenging procedures that actually matter for the patient over 5, 10, 15 years," Chikwe said.
"It’s taken the last few years for those of us who feel strongly that a patient’s long-term outcomes are at least as important as their outcomes in 30 days to effectively advocate to our specialty, and to cardiologists, that this is a really important technique and it’s worth investing the extra time and effort to do it well, and do it safely," she continued.
As the leader of the Smidt Heart Institute’s Cardiac Surgery program, expanding the possibilities for coronary revascularization is only a part of her vision to innovate and discover new ways to improve heart patients’ lives through academic and clinical research in ways that are minimally invasive.
"Repairing valves using less invasive incisions is incredibly rewarding," Chikwe said. "It’s life changing for many patients. And Cedars-Sinai does much more of that than almost any other center in the U.S."