Heart Surgeon's Unique Surgery Primed to Go National
e-mail: Mary Muhlbradt
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(MINOT, ND)—A choice procedure to reduce the risk of stroke in patients with a certain type of irregular heartbeat just got better, thanks to the ingenuity of Trinity Health Cardiovascular/Thoracic Surgeon Christopher Phillips, MD, FCCP, FACC, FACS.
Dr. Phillips came to Trinity from the Cleveland Clinic, where a breakthrough treatment for atrial fibrillation was developed.
Atrial fibrillation or A-fib, as it's often called, is a type of irregular heartbeat in which the two upper chambers of the heart beat rapidly and unpredictably. "Atrial fibrillation is the most under treated form of heart disease." Dr. Phillips declares. "A-fib causes 25 percent of all strokes, and studies show that 90 percent of all arrythmias originate from the left atrial appendage."
Basic heart anatomy shows that the heart is divided into four chambers - two lower chambers called the right and left ventricles, and two upper chambers called the left atrium and right atrium. When it comes to strokes, it's the left atrium that is the primary culprit, according to Dr. Phillips.
"The left atrium receives oxygen-rich blood from the lungs through the pulmonary vein. During atrial fibrillation, blood can pool in the heart and form clots which can escape and be carried to the brain, causing a stroke. Seventy percent of these strokes are fatal," he explained.
First line treatments for A-fib are blood thinning medications, like coumadin, or electrical stimulation, performed by a cardiologist in a cath lab. But when these remedies don't succeed or aren't feasible, there are surgical interventions that generally try to isolate or cut off the blood supply to the left atrial appendage so that the blood cannot pool.
One of the most promising of these surgical treatments - and the one developed at the Cleveland Clinic during Dr. Phillips' tenure there - is the AtriClip√”, a device that looks like a woven rectangular collar that fits over the left atrial appendage and contracts, cutting off the supply of blood. Current practice is to insert the clip through an incision on the side or front of the chest. But Dr. Phillips devised a much better approach.
"I was performing a lung resection using a posterior approach (from the back), and it occurred to me that this approach might be feasible for the AtriClip," he said.
His unique method involves making a small incision (2-3 inches) through the back, just under the left shoulder blade. Not only is this a cleaner, more direct method of reaching the left atrial appendage, it enables the surgeon to slip past the lateral muscles of the back without cutting any muscle tissue.
'That's why I think this is a better approach," Dr. Phillips said. "You're not sacrificing muscle and movement. It's a faster recovery - the patient goes home in 24 hours; and there's less pain. Patients return to normal activity more quickly."
Dr. Phillips has successfully performed the procedure using his unique approach a number of times. On one recent occasion, a team from AtriCure, Inc., the maker of the AtriClip, was present to videotape and view the procedure.
"We think it's a very promising approach," said AtriCure's Tom Beckjorden. "It's reproducible, which means that other surgeons around the country could duplicate it. We'll take this information and do a thorough assessment. Potentially it's very much a superior approach."
The AtriClip is just one element of Trinity's A-fib services. Given the under treated, under diagnosed nature of atrial fibrillation, Dr. Phillips says it's his goal to turn these services into a comprehensive A-fib program at Trinity Health.
A Fellow of the American College of Chest Physicians, the American College of Cardiology and the American College of Surgeons, Dr. Phillips is board certified by the American Board of Thoracic Surgery. In addition to performing atrial fibrillation treatments, he does valve repair and replacement, CABG (coronary bypass), off-pump bypass, lung surgery and minimal-access cardiothoracic procedures. The Syracuse, NY, native began his professional career with CardioThoracic Surgery Center, PLC, Jackson, TN, and moved to Great Falls, MT, where he brought innovative heart & lung treatments to the region including CyberKnife for thoracic oncology, SPY for cardiac imaging, and the Epicore MAZE Device for atrial fibrillation. Before coming to Trinity he practiced at the Cleveland Clinic, where he taught board fellows and residents operative techniques, clinical skills and management. He also gained additional expertise there in robotic and mini-mitral and aortic valve repair.
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