from the Belleville News Democrat, May 13, 2003, by Roger Schlueter

Ever hear of an auto mechanic who routinely fixes engines while they''re running?

In a sense, that''s what Dr. Jennifer Lawton does at Barnes-Jewish Hospital in St. Louis. Of all surgeons in the United States, fewer than 20 percent perform coronary bypass operations while the heart continues to beat - and Lawton is one of them.

It''s a "little bit more technically challenging," she says, but it apparently pays big dividends. A study released (in May 2003) found that the death rate from bypass surgery was cut by almost half in high-risk patients when the heart was kept beating.

Strokes and other complications were reduced as well - along with recovery time. The data, compiled by researchers from New York University Medical Center, were presented at the annual meeting of the American Association for Thoracic Surgery.

But you don''t need fancy-schmancy research to convince James Reynolds of Madison, Illinois. He says he''s living proof. When the retired heavy equipment operator found himself needing surgery last winter, he began asking Barnes-Jewish nurses to recommend a doctor. Lawton''s name kept popping up.

When Lawton tried to explain that he''d be a good candidate for beating-heart surgery, he said, "Just do it."

"She tried to explain some of that to me, but like I said to her, ''I wouldn''t ask you to drive my piece of equipment, so don''t ask me about what you do,''" Reynolds said. "I''m not going to be awake to answer any questions, so why not just put yourself 100 percent in her hands?"

His trust apparently was well placed. After surgery on Monday, April 28, he and his wife Rhonda, were already having breakfast the following Sunday at Lisa''s Diner in nearby Granite City. Already, he''s counting the days until he can resume rehabbing the handyman''s special he bought last year.

"Really, really great," said Reynolds when asked about his condition. "I take walks and do whatever I can. And every day I''m improving. I understand people who go on a heart-lung machine have a longer recovery time. She didn''t have to use that on me. She worked on me while my motor was running. Show me a mechanic that can fix a car with the motor running. But she can, you know."

His engine needed an overhaul just a month after he and his wife, a Granite City native, moved here from Pennsylvania last November. That''s when Reynolds suffered a heart attack.

"Not that I know of," he said when he asked whether he had any previous warning signs. "It''s that wild living I did - eating all them hamburgers and french fries."

He figures his move back to the metro-east may have been auspicious because it led him to Lawton. An examination of Reynolds'' history showed him to be a good candidate for beating -heart surgery that would bypass blood around his clogged arteries and aid his oxygen-starved heart.

In more than 80 percent of bypass surgeries, the heart is stopped and blood is circulated through a mechanical heart-lung machine until the new vessels can be sewn onto the heart. Obviously, Lawton said, it''s easier to sew on a target that''s not moving.

But using the heart-lung machine also may create problems. To divert the blood, doctors have to insert tubes into the arteries, which may dislodge some of the hard plaque that has formed along the artery wall. This gunk may float downstream and clog another vessel, causing a stroke or heart attack.

"It also may be because of the heart-lung machine itself can often have small microbubbles that get into the tubing or debris that can go to the brain," Lawton said. "So without stopping the heart, without using that machine, without putting the blood through this machine could all be reasons why people are less likely to have a stroke or die when the surgery is done this way."

The New York study of 913 patients showed a death rate of 6.5 percent among those who underwent the beating-heart technique as opposed to 11.4 percent of those undergoing traditional surgery. Stroke occurred in 1.6 percent of beating-heart patients compared to 5.7 percent of other patients.

In addition, about 92 percent of beating-heart subjects were free of all surgical complications compared to 80 percent of those who went on the heart-lung machine. Hospital stays were cut by two days as well, and many surgeries can be cut by an hour or two in ideal situations, Lawton said.

Although she was not part of the trial, Lawton and Dr. Ralph Damiano, who also performs beating heart operations at Barnes-Jewish Hospital, have seen similar results. The operation takes a different set of instruments that help keep the heart stable during the surgery.

"I guess I was not that surprised (by the study) because we looked at women who typically have twice the death rate of men for bypass surgery," Lawton said. "When we look at our numbers, the death rate was half of what it was, so it''s sort of a similar finding."

Lawton, however, says she chooses candidates for the beating-heart surgery carefully, using it in only about 30 percent of cases in her year and a half at Barnes-Jewish Hospital. Her colleague, Damiano, has been doing it for years and uses it in roughly 90 percent of his cases, she said.

She said if the patient''s vessels are particularly small or highly diseased or if the patient needs more than three bypasses, she will opt for the heart-lung machine.

"Also, the anatomy - where the vessels are on the heart," she said. "If you have to bypass several blood vessels that are on the back side of the heart, you can imagine it''s not as easy to lift the heart up and over while it''s beating and have the patient tolerate it."

Reynolds'' surgery turned out to be a bit more complicated than first thought. Expecting to do a triple bypass, Lawton found a fourth vessel needing an assist as well. But the operation went smoothly and Reynolds'' prognosis is "very good," she said.

She won''t get any arguments from Reynolds.

"I''m 100 percent better already and it''s only going to improve," he said. "In fact, I kiddingly joked to her, ''While you''re in there, why don''t you take 100 pounds of fat out for me, too?''"

Liposuction is not her field, but Lawton hopes the new findings spur more surgeons to be trained in the beating-heart method.

"It may," she said. "It may influence cardiologists to request that someone have the operation done that way or patients may request it. That may change things. But we''re very excited about this data."

Return to Top