BY LUCY SCHULTZE

Dr. David Talton performs heart surgery at North Mississippi Medical Center.

It was largely his patients' desire to avoid the tell-tale scar down the center of the chest that prompted Dr. David Talton to introduce a new option.

Beginning in October, patients at North Mississippi Medical Center (NMMC) requiring mitral valve repair surgery have had the option of a minimally invasive procedure.

"We're actually making smaller holes than we would for robotic surgery," said Talton, who with his partners weighed that option — the $2 million investment it would mean — before choosing to rely on his own hands.

The procedure uses instruments similar to what the cardiothoracic surgeon would employ for traditional open-heart operations. The difference is their shape and size, Talton said.

"They're 10 inches long and you operate with just your fingertips," he said. "It's about an 8-cm hole that you're operating through."

The short length of the incision — and of the scar that follows — is particularly beneficial for women, he said. In a recent case, Talton was able to make an incision right under his patient's breast and operate by going between the ribs.

"If she stood up, with the natural lay of the breast, you wouldn't be able to tell she had an operation," he said.

The incision for a minimally invasive procedure is about one-third as long as for traditional open heart surgery. A television monitor makes up for the decreased field of vision.

Although the procedure has not been available to north Mississippi patients until recently, it has been performed in other parts of the country for several years.

According to a study published by The Journal of Thoracic and Cardiovascular Surgery, surgeons at Brigham and Women's Hospital in Boston introduced the procedure in August 1996 with the goals of reducing hospital costs, improving patient recovery and cosmetic appearance, and decreasing trauma, all while maintaining the same quality of surgery.

Reviewing the experience after nearly six years in 2002, the surgeons concluded that the safety of minimally invasive mitral valve repairs had been established among the 358 patients they evaluated. The study also showed a low incidence of homologous blood use, requirement for post-hospital rehabilitation and general morbidity.

Prior to introducing the new procedure in Tupelo, Talton had performed several minimally invasive aortic valve repairs there. He received training for that procedure at Massachusetts General Hospital, which is affiliated with Harvard Medical School.

Since then, he attended nearly a half-dozen classes in training for the mitral valve procedure, going to New York University in the early fall to observe procedures there. Back home, Talton had performed three of the procedures by the end of 2006, with a couple more lined up for the new year.

So far, his patients' swift recovery time has been a bonus. His first patient, a 66-year-old retired plumbing contractor, went home on about the fourth day after his surgery.

"The blood loss is less, the length of stay is less, and the recovery time is much, much less," Talton said. "It's eight weeks before you're doing any heavy lifting versus three or four weeks going back to work."

Currently, Talton is the only surgeon in his five-member group practice who performs the minimally invasive mitral valve repair procedure.

But two of his partners at Cardiothoracic Surgery Clinic of North Mississippi are pursuing the training, too. Talton's partners include doctors Robert Derveloy, H. Pat Ewing, C. Max Hutchinson and Vishal Sachdev.

"When we start something new, we just find it easier to let one person get it started and get it going," Talton said.

The downside so far has been the limited number of patients in need of merely an isolated valve procedure. For example, one of Talton's recent patients required both a mitral valve repair and the ablation maze procedure for atrial fibrillation.

"You don't have room to get all that done" through a minimally invasive incision, Talton said.

In recent years, Talton's practice has also introduced left ventricular remodeling surgery to strengthen hearts enlarged through congestive heart failure.

In addition to the surgeons, the NMMC Heart Institute is staffed by 17 cardiologists and a network of internal medicine and family physicians. Now in its 26th year, the institute is home to four state-of-the-art cardiac catherization labs, as well as labs for echocardiography, electrophysiology and nuclear studies.

Among its recent advances are the introduction of the maze procedure; implantation of the biventricular assist device for patients awaiting heart transplant; and endoscopic vein harvest in the leg for coronary artery bypass. NMMC was also among the first hospitals nationwide to offer cardiac MRI.

The surgery group performed some 950 open-heart procedures last year. Among its plans for 2007 is the introduction of a new advanced lung center, Talton said.


February 2007