Health Editor Barry Nelson talks to a young North-East consultant who is using an amazing new technique to perform ‘beating heart’ surgery.

HUNDREDS of heart bypass operations have been performed at one of the region’s biggest hospitals in recent years. Nicknamed ‘cabbages’ by surgeons (after the full name of Coronary Artery Bypass Graft, or CABG), the operation to restore blood flow to the heart has become an everyday event at heart units such as The James Cook University Hospital in Middlesbrough.

Normally, in order to perform a bypass, the patient needs to be connected to a bulky and sophisticated machine which effectively takes over the functions of the heart and lungs. This is needed to still the patient’s beating heart, which is pulsing at between 80 and 90 times a minute. Otherwise the surgeon would be trying to hit “a moving target”.

While these machines are miracles of medical technology they inadvertently put the human body under a lot of stress and strain during an operation, which can last several hours.

Until recently, the patient undergoing a CABG also needed to have a large incision made in the centre of the trunk to give surgeons access to the heart. But in the last few years a new way of performing heart bypasses has gradually been introduced into the NHS.

This involves something which would have been unthinkable when the first heart bypass operations were carried out – performing surgery on a beating heart.

This new way of operating on heart patients is gradually spreading around the UK. One of the few exponents of the technique in the North-East – and the only surgeon based at James Cook – is Enoch Akowuah.

Mr Akowuah, a consultant cardiac surgeon, arrived at the Teesside hospital in July 2010.

Before that he was based at the heart unit at Bristol Royal Infirmary, which has been at the forefront of using this new beating heart approach to heart surgery.

“Bristol is probably the UK’s largest centre for beating heart surgery, or ‘off-pump’ surgery,” says Mr Akowuah, who has operated on 17 patients using the new technique since coming to the North-East.

“This new approach started in Bristol in 1995 and has slowly spread across the UK since then. I would say about 20 per cent of coronary artery bypasses are done this way now. In the past you had to stop the heart from beating because you simply couldn’t do the fine suturing you needed to do with the heart still moving.”

Mr Akowuah says the advantages of using a heart and lung machine greatly outweigh the disadvantages of not operating on someone with a restricted blood flow to the heart.

But the downside is that connecting someone to such a machine is an artificial, abnormal way of keeping the heart and lungs going, which can cause other problems, including strokes.

The new alternative to this is to use a small, hand-held suction device called a stabiliser.

Equipped with a number of rubber suckers, the stabiliser is introduced into the chest cavity via a small incision and is placed on the surface of the beating heart.

Suction is applied which causes the surface of the heart to stick to the stabiliser. This allows the heart surgeon to carry out the delicate stitching on a small area of the heart.

“Normally patients need three or four bypass grafts and the stabiliser allows you to move gradually along, repositioning the device as you go,” says Mr Akowuah.

HE describes the stabiliser as “extremely ingenious and brilliant in its simplicity”

but also acknowledges that using it during heart surgery does represent a great technical challenge. “By operating in this way the risk of bleeding is reduced along with the risk of infection,” he says.

While the new procedure can be done by going in through the chest the normal way, with patients who have limited heart disease Mr Akowuah can do it via so-called keyhole surgery.

“If we do it this way, the incision is just under the left nipple. It means there is a much smaller wound, recovery is much quicker and the patient has a much shorter stay in hospital.”

One of the big benefits of not using a conventional heart-lung machine is the reduction in stroke risk compared with conventional bypass surgery.

“The heart-lung bypass machine connects to the main blood vessel and it is known that manipulating the aorta in this way increases the risk of stroke,” says Mr Akowuah. “The risk of stroke if negligible without the heartlung bypass machine.”

The approach also allows some patients who would otherwise be inoperable to have bypass surgery. “It gives us more flexibility how we manage some of our patients,” says the surgeon.

Now Mr Akowuah is planning to use the same technique to perform other heart procedures.

“It is a very exciting time for heart surgery,” he says.