The Novant Health Heart & Vascular Institute provides leading-edge treatment of heart and vascular conditions, including minimally invasive approaches and non-sternotomy approaches.
Novant Health’s structural heart program interventional cardiologists, heart surgeons, imaging specialists and electrophysiologists provide holistic, multidisciplinary care. The team diagnoses and treats conditions including aortic stenosis, atrial fibrillation (AFib), atrial septal defects, paravalvular leaks and more, with state-of-the-art, minimally invasive options.
But when nonoperative minimally invasive approaches aren’t an option, that’s where Novant Health’s skilled cardiothoracic surgeons come in.
“Some patients are not candidates for nonoperative minimally invasive approaches,” said Tom Theruvath, MD, cardiothoracic surgeon, Novant Health Heart & Vascular Institute - Elizabeth. “Some candidates still need surgery with the heart-lung machine, and the heart actually opened and operated on. We are one of the centers that does a fair amount of non-sternotomy approaches for open-heart surgery such as the replacement and repair of mitral valves, aortic valves and tricuspid valves. This can also sometimes apply to coronary artery bypasses.”
While open-heart surgery is still considered maximally invasive because it requires stopping the heart, after placing the patient on a heart-lung machine and opening the heart, non-sternotomy approaches are an innovative option that improves recovery.
Dr. Theruvath provides key insights about the benefits of non-sternotomy approaches, as well as Novant Health’s cardiothoracic surgery program.
Non-sternotomy approaches to open-heart surgery utilize smaller incisions
“We don’t have to ‘crack’ the chest open, but instead work through smaller incisions through the side,” Dr. Theruvath said. “We use high-resolution camera technology and long instruments.
We create a 2-to-3-inch incision along the right chest wall in between the ribs and then we utilize percutaneous placement of the heart-lung machine tubing into the leg artery and leg vein. So the patient is still on the heart-lung machine, we stop the heart, we open the heart.”
There’s no age limits for candidates for non-sternotomy approaches.
“If someone for example has an isolated mitral valve pathology, and is otherwise in good shape — younger, doesn’t have heart failure or previous strokes — those are candidates for non-sternotomy approaches,” Dr. Theruvath said. “Patients who are obese can also be candidates and, in fact, they can probably benefit from it even more because we don’t have to separate their breastbone, which helps with healing.”
Recovery is faster for non-sternotomy approaches.
“Results are equivalent to the ones where we go through the front by cutting through the breastbone,” Dr. Theruvath said. “Recovery is such that patients are able to return to normal life faster. Instead of waiting six to eight weeks, they can return to work or whatever they want to do essentially, as soon as two weeks after the surgery. They can use their arms immediately after surgery. With sternotomy approaches, they cannot use their arms or drive for a whole month. It takes six to eight weeks to recover from open-heart surgery via sternotomy (cutting through the breastbone), but that recovery is not because of the heart healing, it’s because of the bone healing and chest wall healing. So, if you don’t have to cut through the sternum, you can decrease that amount of recovery.”
“The goal is to offer therapies that are more modern and more advanced from an approach standpoint.”
— Tom Theruvath, MD
Cardiothoracic surgeon, Novant Health Heart & Vascular Institute
Novant Health’s cardiothoracic surgery program attracts top talent.
“Charlotte has opportunities and possibilities,” Dr. Theruvath said. “We’re well-situated from a healthcare standpoint to attract a lot of people. A lot of people travel through Charlotte, it’s a magnet for growth. And I chose Novant Health because of the people I work with. This is not a one-man show. I cannot do it without a specialized OR team, the nurses, scrub techs, the perfusionists, the anesthesiologists, who are all specially trained to do this and the minimally invasive approaches. And of course, the cardiologists, who see all of these patients and refer them for these types of procedures.”
Novant Health’s cardiothoracic surgeons strive to provide the most advanced options for heart patients.
“The goal is to offer therapies that are more modern and more advanced from an approach standpoint,” Dr. Theruvath said. “Heart surgery is still heart surgery. What we can change is how we approach it. That’s a big deal.