Dan Leversen, Robotic-Assisted Cardiac Bypass Surgery

A Minimalist Approach to Major Heart Surgery Repairs Dan’s Heart

Dan Leversen has one word to describe why he chose not to go to the Emergency Department at Borgess-Lee Memorial Hospital in Dowagiac despite shortness of breath and tightness in his chest after an evening walk last March: “Stubborn,” says the 53-year-old auto businessman.

Fortunately, he’s not too stubborn to negotiate a deal with wife, Stacy. Dan agreed to see a doctor the next morning. “I was a little worried about his discomfort and suggested that he go to the ER,” said Stacy Leversen, “but he didn’t seem to have the classic heart attack symptoms.”

The next morning, Dan felt better, but still was short of breath. When he went to Donald Lyons Health Center, the medical staff there immediately sent Dan across the street to Borgess-Lee, where blood tests showed that he had indeed had a heart attack. In short order, Dan was in an ambulance bound for Borgess Medical Center in Kalamazoo. “I told them that Stacy could drive me to Borgess, but they said no way,” he said. “They even made me sit in a wheelchair to get to the ambulance. The doctor said, ‘Sir, you had a heart attack.’”

An angiogram at Borgess showed three narrowed heart arteries, one of which was too severe to be repaired with the use of a small metal device called a stent. Instead, Dan would need open heart surgery.

Dan Receives his Wish for Less Invasive Care

Cardiothoracic surgeon, Jerry W. Pratt, MD, Medical Director, Thoracic Surgery, Borgess Heart Institute, looked at Dan’s condition—fairly young and strong—and offered Dan the chance to undergo a new, minimally invasive heart bypass surgery— the first patient in southwest Michigan to receive this surgical technique.

“Dan only needed one bypass,” Dr. Pratt said, “and it was in the front of the heart and easy to bypass.”

Called single-vessel small thoracotomy (SVST),the procedure allows a cardiothoracic surgeon to perform a bypass graft through a small incision between the ribs.

“We use a robot (da Vinci Surgical System) to harvest an artery to be used as a bypass graft,” said Pratt. “This method eliminates the need to open the chest (sternotomy) or to use a heart-lung machine.”

Unlike traditional open-heart surgery, minimally invasive coronary artery bypass is performed by inserting miniature tools through three tiny holes and a small 3–4 inch incision in the patient’s chest. A tiny camera allows the surgeon to see inside the chest and computer-aided robotic tools, manipulated by the surgeon, are used to complete much of the bypass.

Dr. Pratt has previously performed SVST at the University of California Davis Medical Center. He is a highly decorated Air Force Colonel who served as Chief of Cardiothoracic Surgery and Commander of the Heart, Lung & Vascular Center at David Grant Medical Center, Travis Air Force Base, Fairfield, California. Dr. Pratt served tours of duty in Iraq and Afghanistan. Upon leaving active duty in 2012, he opted to join the Borgess Heart Institute because of what he described as its “outstanding heritage with more than 20,000 open-heart procedures since 1971.”

“Few surgeons perform the entire bypass surgery with the robotic arms,” Dr. Pratt said. “In Dan’s case, the initial part of the surgery was done with the robot and the bypass artery itself is stitched in the traditional way.”

Dr. Pratt and his team moved Dan’s heart up near the small incision for easier access to the mammary artery, which was used for the bypass.

According to Dr. Pratt, only certain patients qualify for the minimally invasive, robot-assisted surgery. Most candidates are those who are healthy and want to get back to work and their lifestyle more quickly or those who are too ill to tolerate traditional open heart surgery.

“I felt comfortable having Dr. Pratt do the minimally invasive surgery even though I was the first one at Borgess,” Dan said. “I was a little scared but it wasn’t for me, it was for my kids”—Adrian, 16, and Mary, 14. “Stacy said that if there was a problem with the minimally invasive procedure, Pratt and the OR (operating room) team could immediately do traditional open-heart surgery.”

Dan was taken to the OR about 7 a.m. on March 14 and Dr. Pratt came out of the OR about 1 p.m. to tell Stacy that the procedure went “really well.”

“He told me that Dan was doing great,” Stacy said. “When I saw him about 4 p.m. in the recovery room he already had the breathing tube removed. The nurses said that was highly unusual.”

“I felt a little queasy when I woke up,” Dan said. “But really pretty good. A lot better than I expected.”

The next day, a second narrowed artery was propped open with a drug-eluting stent by cardiologist, John Gustafson, MD, with Borgess Heart Center for Excellence. A third narrowed artery did not require repair.

The collaboration between Drs. Pratt and Gustafson provides a new hybrid approach to coronary artery disease where cardiac surgeons and cardiologists work together to combine the best forms of heart treatment possible.

“This hybrid approach to revascularization of coronary artery disease can combine advantages of new, less invasive heart surgery techniques with other minimally invasive heart care like balloon angioplasty and stenting,” said Dr. Pratt. “It can mean less pain, less hospitalization and a quicker recovery and return to normal activities for appropriate patients.”

Three days later Dan was home in Dowagiac and soon began cardiac rehabilitation, which ended in late June.

“I was really impressed with everybody at Borgess,” he said, “from the people who do the maintenance, to the people who deliver the food, to the nurses and other medical staff. I was shocked by the amount of concern and compassion by everybody and the care was unbelievable.

“The fact that I was the first to have the minimally invasive surgery meant that I was visited by maybe 15 different nurses who all wanted to see the small incision. I can be a critical guy, but I didn’t find a blemish anywhere.”

He and Stacy were so pleased with the care that they made and delivered cookies to the staff.

Since the surgery, Dan has stopped smoking the occasional cigar and has lost 30 pounds, which he fully intends to keep off. He said that the other patients he has seen at the cardiac rehabilitation center are all amazed at both the small size of his incision and the fact he did so well so quickly and felt so good.

“I think about my kids and if they keep making inroads like this, the future looks good,” he said. “If my son, Adrian, inherited any potential for heart disease, I feel good about what they would be able to do for him.”