The Heart & Lung Center's Cardiac Surgery Program has been recognized both regionally and nationally for outstanding patient outcomes. Our three cardiac surgeons perform hundreds of cardiac surgeries each year in our state of the art facilities.

Our Chief of Cardiothoracic Surgery, Dr. Donato A. Sisto, was named Cardiac Surgeon of the Year in 2005 by HCA Healthcare, in recognition of his exceptional track record and expertise. Under Dr. Sisto’s leadership, the Heart & Lung Center at Portsmouth Regional Hospital has become one of the finest cardiac surgery programs in the country, achieving results comparable to the world’s leading cardiac surgery centers.

Topics

• Cardiac surgery staff
• Facilities
• Patient-centered care
• Cardiac Surgery procedures

Procedures

• Coronary Artery By-Pass
• Valve Repair and Replacement
• Advanced Surgical Techniques
• Minimally-Invasive Vein Harvesting
• Additional Procedures - Glossary of terms

Cardiac Surgery Staff

The three surgeons in our Cardiac Surgery program provide a broad range of complex services, including coronary artery bypass surgery, heart valve repair and replacement, surgery for aortic and ventricular aneurysms, and lung and chest wall resection.

Our cardiac surgery team enjoys a world-class reputation for leading edge clinical techniques and outcomes. For example, Donato Sisto, M.D., FACS., our Chief of Cardiothoracic Surgery, recently published the results of pioneering work he has done in radiofrequency ablation to eliminate atrial fibrillation, or irregular heartbeat. In 70 treatments over two years (performed in conjunction with bypass and valve procedures), he saw a 98 percent success rate in correcting atrial fibrillation in coronary artery bypass patients and an 82 percent success rate in mitral valve patients.

Achieving successful outcomes in cardiac surgery, day after day, is a team effort of dozens of highly trained professionals. The caliber of our surgeons is matched by our teams of perfusionists, anesthesiologists, nurses and therapists, who repeatedly earn outstanding scores for patient satisfaction. Cardiac surgery patients receive round-the-clock, highly personalized and focused attention to their every need.

Facilities

The Heart & Lung Center has one of the most technologically advanced cardiac surgery facilities in the northeast. Our 4,000 square foot, cardiac surgery unit includes two identical 29 ft. x 29 ft. operating suites equipped with the latest technology. The availability of dual operating suites allows for two surgeries to be conducted simultaneously in order to respond optimally to emergency situations.

Planning for the Cardiac Surgery Program, which opened in 1999, involved visits to a dozen highly respected heart surgery centers throughout the country. Our goal was to set the standard in facility design and patient care -- to become a model for future cardiac surgery programs.

Focus on Patient and Family Support & Comfort

Every detail that could enhance quality of care and patient recovery was incorporated in the design of the Cardiac Surgery facilities:

• Surgical waiting room with privacy for three family groups of different sizes
• ICU rooms and nurses'
• Glass fronted ICU rooms
• Private conference rooms for pastoral counseling and physician consultations
• Meditation chapel adjacent to the waiting area with beautiful stained glass chapel window commissioned by the Guild at Portsmouth Regional Hospital
• Art gallery wall featuring changing displays of Seacoast artists

Cardiac Surgery Procedures

The following is a brief description of the most common cardiac surgery procedures.

Coronary Artery By-Pass

Sometimes referred to as CABG or "cabbage," this surgery is done to reroute blood around clogged arteries and improve the supply of blood and oxygen to the heart. During bypass surgery, the surgeon may take blood vessels from the leg, arm, or chest area and graft them to the coronary arteries. The blood can then use this new path to once again flow freely to the heart muscle. Most bypass surgery is performed on a still heart, while the patient's blood flow is maintained by a heart-lung machine.

Coronary Artery Bypass Surgery has become increasingly commonplace and safe in recent years. Recovery time from bypass surgery depends on the severity of the patient's heart disease and his or her overall health. The average hospital stay for bypass surgery has decreased from 12 days in 1988 to approximately five days today.

Valve Replacement & Repair

Four valves in the heart open and close to let the blood flow in only one direction. When working properly, the heart valves open and close fully. But some people are born with abnormal heart valves, while in others a valve can be damaged by infections, rheumatic fever and other causes. Some valves can be repaired by surgery -- and severely damaged valves can be replaced by an artificial valve.

Dr. Sisto’s procedures emphasize surgical techniques that allow the sparing of the patient’s own valves. If a prosthesis is necessary, careful consideration is given to the choice of the artificial valve that is used. Dr Sisto’s experience encompasses multiple techniques of valve repair. He has participated in the development of widely used procedures designed to maintain the architecture and function of the patient's own mitral valve. Delicate operations to spare diseased aortic valves as well as repair them with the patient's own tissues are also part of his surgical expertise. Valve replacement and repair are very often performed through small incisions to lessen pain and post-operative discomfort.

Advanced Surgical Techniques

"Beating Heart" Surgery

Recent technical advances in the field of coronary artery revascularization (bypass) have resulted in exciting modifications of the standard CABG, or "cabbage" procedure. Some patients benefit by avoiding the side effects associated with using a heart-lung machine. Coronary revascularization can often be safely performed on a fully functioning, beating heart without using cardiopulmonary bypass (heart-lung machine) surgical techniques. Advantages of beating heart surgery include reduced risks, faster recovery time, and smaller incisions (depending on the number and the location of the vessels to be bypassed). Dr. Sisto has extensive experience with beating heart coronary revascularization.

Minimally Invasive Techniques

Even for patients for whom the use of a heart-lung machine is optimal, new, minimally invasive surgical techniques use smaller incisions – resulting in faster recovery, quicker return to work, and less post-operative discomfort. In addition, Port-Access cardiopulmonary bypass techniques allow surgeons to perform CABG on a still heart through a 3-4 inch incision.

Endoscopic Vein Harvesting

The Heart and Lung Center Cardiac Surgery Program at Portsmouth Regional Hospital uses a cutting-edge vein harvesting technique for bypass surgery. Many patients are surprised to learn that a bypass operation includes two surgical procedures; the actual bypass surgery, where a healthy blood vessel is used to "bypass" the blocked arteries of the heart, and the removal (or "harvesting") of a healthy blood vessel, usually from the leg, which is used to construct the bypass grafts.

Recent advances in medical technology have made it possible for vein harvesting to be done endoscopically, requiring a small, one-inch incision in the leg. Before this technique was introduced, vein harvesting was done through an incision that could extend from the ankle to the groin. This large incision lead to many complications including: infection, post-operative pain, and delayed rehabilitation and recovery. The minimally invasive endoscopic vessel harvesting (EVH) benefits the patient by reducing wound complications and offering a much better cosmetic result.

Guidant Corporation’s VASOVIEW Endoscopic Vessel Harvesting System has been used in the vessel harvesting procedures at Portsmouth Regional Hospital since 1998. Portsmouth Regional Hospital’s experienced Cardiac Physician Assistants Steve Jones, Mark Sullivan, and Mike Wassell have received recognition for performing over 2,000 EVHs each.

Additional Procedures – Glossary of Terms

In addition to the procedures described above, the following surgical procedures are routinely performed at the Heart & Lung Center. For a description of diagnostic tests and non-surgical cardiac procedures, please visit the cardiac diagnostic testing page of this Web site.

Abdominal/peripheral vascular surgery

Atrial arrhythmia/dysrhythmia surgery (Ablation) – Radiofrequency ablation is now widely used as a treatment for many types of rapid, irregular heartbeats (atrial fibrillation). The Heart & Lung Center is one of a handful of cardiac surgery programs in the United States that use this technique during cardiac surgery. The procedure involves the transmission of a mild radiofrequency energy through a catheter to the heart muscle.

Carotid surgery – A surgical technique for removing obstructions (plaque) in the carotid artery (a large artery in the neck). Blockages in the carotid artery increase the risk of stroke.

Complex congenital and acquired heart defect repair:

ASD (Atrial Septal Defect) repair – the surgical repair of a hole located between the two upper chambers of the heart.

VSD (Ventricular Septal Defect) repair – surgical repair of a hole located between the two lower chambers of the heart.

Endoscopic vein harvesting – Coronary Artery Bypass Surgery requires the harvesting of the saphenous vein from the leg to be used as a graft. The Heart & Lung Center uses a minimally invasive endoscopic technique that dramatically reduces post-surgical discomfort and recovery time.

Thoracic aortic aneurysm –An aneurysm is an area of bulging in a blood vessel, much like a bulge on an over-inflated inner tube. The standard treatment of an aortic aneursym is the surgical replacement of the diseased aorta with a prosthetic graft.

The definitions on this page are based on discussions with the Heart & Lung Center medical staff and material published by the American Heart Association. For more information about heart health and the treatment of heart disease, we encourage you visit the American Heart Association's excellent Web site: www.americanheart.org