After decades of running bone saws through rib cages, surgeons are finding less invasive ways to do their work
HORACE STONE IS A MINOR CELEBRITY around Roswell, Ga. No one was surprised last fall when the retired AT&T manager had to go in for a bypass operation; he had already been through a heart attack and two angioplasties when his chest started aching again. What impressed people was his recovery. Instead of spending a week in the hospital and three months gaining the strength to dress himself, Stone walked out of the hospital in three days. Two weeks later he was playing golf. Stone's internist was flabbergasted when he showed up for an appointment sporting a three-inch cut in place of the traditional foot-long chest wound. And when the story spread through Stone's church, folks started calling from as far away as Florida to learn his secret. Not that he minded. "1would recommend this treatment to anyone," he says.
Stone owes his notoriety to Dr. William Mayfield, an Atlanta surgeon who is pioneering alternatives to traditional open-heart surgery. In a standard coronarybypass operation, surgeons sever the patient's breastbone with a saw, pry open the rib cage with a steel retractor, then stop the heart cold while they reconfigure its supporting blood vessels. Mayfield and other surgeons are learning to do the same job with instruments they can slip through tiny "keyhole" incisions between the ribs (chart). Their techniques vary--some surgeons stop the patient's heart, while others leave it beating--but all avoid massive damage to the chest. And as Horace Stone discovered, that means less pain, smaller hospital bills and far quicker recovery. "This is the biggest advance in heart surgery in 20 years," says Dr. Greg Fontana of Cedars-Sinai Medical Center in Los Angeles. "It's turning the whole field upside down."
The most versatile of the new techniques, developed by the Heartport company of Redwood City, Calif., is also the least radical. Surgeons using the firm's Port Access system still stop the patient's heart and use a heart-lung machine to maintain circulation while they go about their work. But instead of attaching the machine's hoses directly to the surface of the heart--a …