When the last light snow of the season fell in March, Clarence Sexton was shoveling when he began feeling extremely weak. "Both sides of my neck hurt, up to my ears," he recalls. "My left arm went numb, and then my chest started hurting."

The Eastgate resident, then 52, is the kind of man who avoids seeing a doctor unless it's an emergency, and he passed off these symptoms as reaction to cold air. But when he awoke at early the next morning, he knew better"”and he told his wife to call an ambulance. In the emergency room at Mercy Anderson Hospital, a dose of nitroglycerin made the pain diminish.

"I thought I was going home. It didn't work out that way."

Dr. Donald C. Buckley, a cardiothoracic surgeon, delivered the news. Sexton had two major obstructions in his coronary arteries. Surgery was essential. And Clarence Sexton would undergo the first open-heart operation performed at Mercy Anderson's new heart center.

Sexton's family balked at first, until they understood that Dr. Buckley had performed hundreds of open-heart surgeries.

"I was a little scared at first, but he (Dr. Buckley) seemed like a real nice guy"”easy to talk to," Sexton says. Something about him I trusted. So I said whatever you got to do, get it done." And he has no regrets about not transferring to another hospital. "The staff there treated me like a king." Five days later, Sexton was back home, recovering from bypass surgery"”a little sore but otherwise "feeling great."

HEART CARE OPTIONS EXPAND
Heart disease remains the leading cause of death among American men and women. To avoid joining that statistical tally, the basic prescription remains the same: don't smoke, eat better, exercise more, get regular physician checkups, take extra precautions if you have diabetes or a family history of heart problems, and take the medicines prescribed for high blood pressure (hypertension) or elevated levels of bad cholesterol. Those so-called "statin" drugs have helped lower risks for so many people "they could end up putting us out of business," Dr. Buckley notes with a wry smile.

For Clarence Sexton, family history was a warning sign he missed. His mother had high cholesterol and heart problems. After his life-saving surgery, Sexton discovered he had cholesterol problems"”and found out his siblings do, too. "My brother and sister are on Lipitor (a statin drug) and I didn't even know it."

So what can you expect if you discover you have a cardiac or coronary problem that requires intervention? Cardiologists and interventional radiologists can perform angioplasties, where a catheter is used to expand a type of balloon, opening narrowed arteries. In most cases today, doctors will place a stent"”a kind of cylindrical scaffold"”to keep the narrowed passage open. The newest stents, coated with special substances, are supposed to help prevent new blockages from forming.

For arrthymia, or irregular heartbeats, a variety of approaches are available. Ablation involves applying microwave or other energy sources to alter electrical fields in the heart. Cardioversion can use electricity or medication to shock a heart back into a more normal rhythm. The biggest advance in recent years is the development of miniaturized, implantable devices, such as combination pacemakers and defibrillators that can stabilize life-threatening ventricular fibrillation.

Other circumstances, however, dictate open-heart surgery, and the Tristate now has nine hospitals equipped for it: Bethesda North Hospital, Deaconess Hospital, The Christ Hospital, Good Samaritan Hospital, Jewish Hospital Kenwood, Mercy Hospital Anderson, Mercy Hospital Fairfield.

Christ Hospital has been long recognized as a leader in cardiac care. Christ's $77 million Heart Center of Greater Cincinnati opened there in 2003. Dr. Dean Kereiakes, a noted Cincinnati cardiologist, was later named the center's director, and Christ continues to be a leader in cardiac research with The Lindner Clinical Trial Center.

Another leader in research is University Hospital, the only area hospital offering heart transplantation. Dr. Walter H. Merrill, chief of Cardiothoracic Surgery at University Hospital and a member of University of Cincinnati Surgeons, says he and other cardiac surgeons are increasingly focused on improved patient outcomes, with minimal discomfort and rapid recoveries.

Years ago, for example, patients were kept unconscious until the day following open heart surgery. Now they can be regain consciousness in the operating recovery room, and be totally awake and off all machines in as little as two hours after surgery.

With all the talk about technology, simple adjustments can make a big difference. Dr. Merrill says that in the past, surgeons were not too concerned about patients' blood sugar levels. "Now we've found there are some real advantages to keeping it within normal ranges through the operation and recovery. The associated outcomes include lower risk of wound infection and better healing," he notes.

Also, University Hospital implemented a "collaborative care model" so that everyone involved in a patient's care"”doctors, nurses, nutritionists, therapists, even chaplains"”all meet together daily in the patient's room to facilitate better communication with the patient, the family and each other. "We associated this with a marked improvement in patient outcomes," Dr. Merrill comments.

SURGICAL ADVANCES
Dr. James M. Wilson is one of the most experienced cardiothoracic surgeons in the nation, having performed more than 7,000 open-heart surgeries. He pushed for the creation of the Heart Hospital at Mercy Fairfield Hospital, where more than 1,300 operations have been performed since it opened in December 2001.

Except for high-risk patients, the danger of having open-heart surgery is almost negligible, Dr. Wilson says. "You no longer have to fear whether you're going to come out alive."

One of the biggest changes in open heart surgery is the option to go "off pump." In years past, operating on the heart required putting the patient on a heart-lung bypass machine, letting the patient's heart take a time-out during the surgery. But some patients experience problems, including neurological and respiratory complications, after being on a bypass machine. In the 1990s, surgeons explored successful techniques for "beating heart" operations, without the artificial pump.

Dr. Wilson notes more detailed research is helping surgeons better evaluate patients and their risk factors to decide which option is better"”on or off the pump"”in each individual case.

"Three or four years ago, about 80 percent (of bypass operations) were off-pump," Dr. Buckley adds. "But now the pump technology is getting better, and we know more about what it does to the blood and organs."

Coronary artery bypass graft (CABG)"”sometimes called "cabbage" by doctors, and simply "a bypass" by patients"”is the most common heart surgery performed in the United States, more than 300,000 operations annually. It basically involves taking an artery from another part of the body, creating a bypass around a clogged, damaged or severely diseased coronary artery so the heart isn't deprived of the oxygen-rich blood it needs.

One of the biggest complaints among bypass patients is the post-operation pain from the location where the bypass vein is harvested. Now surgeons can use minimally invasive techniques, or "keyhole" incisions, to get the vein. "It's a marked change," Dr. Wilson observes. "Before, we had these horrid incisions running up the leg that would take weeks or months to heal. Now there's usually one little incision at the knee."

ROBOTICS TO THE RESCUE?
Surgeons continue to explore ways to employ minimally invasive techniques for heart procedures, because opening up the sternum in the chest is a traumatic step no matter how well it's done.

In 1999, Dr. Randall Wolf of Cincinnati became the first U.S. surgeon to perform a coronary bypass using the da Vinci robotic surgical system. But he left Cincinnati so he could use the system at the Ohio State University Medical Center.

In 2003, Good Samaritan Hospital took the leap and purchased a $1.2 million da Vinci, and Dr. J. Michael Smith built a reputation there as the local leader in robotic surgery. University Hospital soon followed by acquiring its first da Vinci, and lured Dr. Wolf back to become director of UC's new Center for Surgical Innovation, which was made possible with gifts from the Lindner family.

With robotic systems, surgery is minimally invasive, using small "porthole" incisions. The surgeon directs every detailed movement of a procedure using video displays of illuminated interior anatomy and robotic arms that can employ precise instruments. Advocates claim the robotic approach results in fewer complications and faster recovery for patients, lowering hospital stays and saving money in the long run.
Other hospitals may soon join the robotics club. Bethesda North's foundation is raising money for a da Vinci system, and Mercy Fairfield "plans to get one in the next year or so," Dr. Wilson says.

Meanwhile, other new technology is being tested at UC's Surgical Innovation center. New research suggests, for instance, that doctors trained on virtual reality simulators such as the ones being tested at UC are more adept at minimally invasive procedures than those who train on animal cadavers.

LOCATION, LOCATION
The controversy continues about whether Greater Cincinnati is over-saturated with heart surgery centers. Doctors practicing at the newer suburban locations say patients want this care nearer their homes, and if there's too much capacity it's because too many units are concentrated in the "Pill Hill" area of central Cincinnati. But some doctors who practice at those hospitals say they have the patient volume, specialized experience and advanced facilities to deliver the best care, and an extra 10 to 20 minutes drive from a suburb is not a critical factor for patient care in most instances.

Dr. Buckley started at Good Samaritan and Bethesda North, and he's impressed by the facilities and staff at Mercy Anderson. "We have everything we need here," he remarks. The hospital has the latest technology, including a 64-slice CT system for cardiovascular assessments, and an experienced cardiac care staff. When someone has a heart attack and shows up at Mercy Anderson's renovated emergency department, why should the patient risk 20 to 60 minutes being transferred elsewhere, he asks.

All the cardiac surgeons and all the hospitals know that heart surgery is a money-maker, helping offset other financial losses. Dr. Merrill at UC, which is opening a "Heart Failure Treatment Center" in West Chester, sees the reality"”and chuckles.

"Ideally, from a health organization perspective, you'd have a concentration of care. But from the hospital's perspective, heart care is one of the few things that make a profit," he observes. "I want University to be seen as a resource to Greater Cincinnati community, especially for very specialized things like transplantation and high-risk surgery. But it's a fact of life that patients and their families prefer care close to home, and I don't blame them. It's based on convenience, and that's why shopping malls are located where they are."


James M. Wilson, MD, FACS, FACC, FACP
SPECIALTIES: Cardiothoracic Surgery
EDUCATION-TRAINING: Duke University School of Medicine. Internship and junior assistant surgery resident, The New York Hospital, Cornell Medical Center. Resident Surgery and Resident Thoracic Surgery, University of California, San Francisco. U.S. Navy.
PHYSICIAN GROUP AFFILIATION: Cardiac, Vascular & Thoracic Surgeons, Inc.
LOCAL HOSPITAL AFFILIATIONS: Christ Hospital, Jewish Hospital, Mercy Hospital Fairfield (Director, Cardiovascular Surgery), Bethesda Hospital, Good Samaritan, St. Elizabeth, University Hospital, Children's Hospital, Deaconess Hospital, Mercy Hospital Anderson. (Current Director of Cardiovascular Services, Mercy Health Partners.)
PROFESSIONAL/BOARD CERTIFICATIONS: Certified by the American Board of Surgery and the American Board of Thoracic Surgery.
MEMBERSHIPS: American Medical Association; Ohio State Medical Association; Academy of Medicine of Cincinnati; Fellow, American College of Surgeons; Fellow, American College of Cardiology; Fellow, American College of Chest Physicians; Society of Thoracic Surgeons; American Heart Association.

Cardiac, Vascular & thoracic Surgeons, Inc.
4030 Smith Road, Suite 300
Cincinnati, OH 45209
Telephone: (513) 421-3494
Web site: www.cvts.com






Donald C. Buckley, MD, FACS, FACC, FACP

SPECIALTIES: Cardiothoracic Surgery
EDUCATION-TRAINING: B.S., University of Arizona. M.D., University of Arizona. Internship and department of surgery residency, Ohio State University Hospital. Fellowship in thoracic and cardiovascular surgery, Ohio State University Hospital.
PHYSICIAN GROUP AFFILIATION: Cardiac, Vascular & Thoracic Surgeons, Inc.
LOCAL HOSPITAL AFFILIATIONS: Mercy Hospitals: Clermont, Fairfield, Mt. Airy, Western Hills. Bethesda North, Good Samaritan, The Christ Hospital, Jewish Hospital Kenwood, Deaconess Hospital, St. Elizabeth Hospital. Medical Director, Cardiac Surgery Program, Mercy Hospital Anderson.
PROFESSIONAL/BOARD CERTIFICATIONS: Certified by the American Board of Surgery and the American Board of Thoracic Surgery.
MEMBERSHIPS: American Medical Association; Ohio State Medical Association; Academy of Medicine of Cincinnati; Fellow, American College of Surgeons; Fellow, American College of Cardiology; Fellow, American College of Chest Physicians; Society of Thoracic Surgeons; American Heart Association.

Sambhu Choudhury, M.D.
SPECIALTIES: Pediatric orthopaedics, total joint replacements, shoulder/elbow surgery.
EDUCATION: M.D., Thomas Jefferson University Medical College. Internship and orthopaedic residency, Mayo Clinic. Undergraduate degree, Penn State University.
PHYSICIAN GROUP AFFILIATION: Freiberg Orthopaedics & Sports Medicine.
LOCAL HOSPITAL AFFILIATIONS: Mercy Franciscan Mt Airy & Western Hills, Good Samaritan and Bethesda North, Children's Hospital and Kenwood Jewish Hospital.
PROFESSIONAL/BOARD CERTIFICATIONS: American Board of Orthopaedic Surgery
MEMBERSHIPS: Mayo Alumni Association, Cincinnati Academy of Medicine, Ohio State Medical Society, American Medical Association, Cincinnati Orthopaedic Club

Freiberg Orthopaedics & Sports Medicine
9825 Kenwood Rd.
Cincinnati, OH 45242
Telephone: (513) 221-5500
Web site: www.freibergortho.com





John Jacquemin, M.D.
SPECIALTIES:
Spine surgery
EDUCATION: M.D., University of Cincinnati. Internship and orthopaedic surgery residency, State University of New York. Undergraduate engineering degree, University of Dayton.
PHYSICIAN GROUP AFFILIATION: Freiberg Orthopaedics & Sports Medicine. Freiberg Spine Institute.
LOCAL HOSPITAL AFFILIATIONS: Mercy Franciscan Mt Airy & Western Hills, Good Samaritan and Bethesda North, and Kenwood Jewish Hospital.
PROFESSIONAL/BOARD CERTIFICATIONS: American Board of Orthopaedic Surgery
MEMBERSHIPS: American Board of Orthopaedic Surgery, American Association of Orthopaedic Surgeons.