Minimally Invasive Cardiac Bypass Surgery Gives Patient with Type 1 Diabetes Another Chance at Life

September 16, 2011

Healthgrades Number 1 in Cardiac Surgery

Larry Crecelius, 51, of Hardinsburg, Indiana, has lived with type 1 diabetes since the age of two. Of those 49 years, the past 10 have been spent under the expert guidance of Sri Mokshagundam, MD, a board certified endocrinologist with the Floyd Memorial Joslin Diabetes Center Affiliate. So in April of this year, when Larry’s unexplained fainting spells led to a diagnosis of blockage in one of the main vessels of his heart, he knew he could put his trust in the team of experts at the Floyd Memorial Heart and Vascular Center.

Larry Crecelius, pictured with his wife, Terri

Larry Crecelius, pictured with his wife, Terri

Sebastian Pagni, MD, a board certified cardiothoracic surgeon at the center, was Larry’s surgeon. “The severity of Larry’s blockage meant that an artery bypass would be needed,” he explained. “Until recently, the standard surgical treatment for severely blocked arteries was traditional coronary artery bypass grafting surgery (CABG-also known as “open-heart surgery”). It requires a long incision in the chest and the need to separate the breastbone, so that the surgeon can reach the heart. It is extremely invasive and involves a lengthy recovery period.”

A Less Invasive Option

Dr. Pagni continued, “The procedure that we chose for Larry, however, is relatively new and is called MICS CABG, which stands for minimally invasive cardiac surgery/coronary artery bypass grafting. It is part of our growing effort to approach cardiac surgery in a less invasive fashion. It can be performed through a small incision on the left side of the chest instead of requiring a complete dissection of the breastbone. MICS allows us to avoid the risk of infection from splitting the sternum, and results in much less patient discomfort during recovery.”

Sebastian Pagni
“Anyone who has ever undergone cardiac bypass surgery knows that the recovery process is lengthy and involves significant discomfort. However, for the right patient, such as Larry, the minimally invasive approach can offer a comparable result, with significantly less pain and shorter recovery time. It truly is the best of both worlds.”

Sebastian Pagni, MD

Board Certified Cardiothoracic Surgeon
University Cardiothoracic Surgical Associates, PSC
Sri Mokshagundam
“Larry has had type 1 diabetes for over 49 years. So, while he is still relatively young in terms of age, when we consider the number of years his blood vessels have been exposed to the rigors of high blood sugar, his need for open-heart surgery at the age of 51 is not surprising. However, what’s astonishing is that he bounced back so quickly from such a major procedure, particularly for a diabetes patient, who don’t historically heal well.”

Sri Mokshagundam, MD

Board Certified Endocrinologist
Floyd Memorial Joslin Diabetes Center Affiliate
“When people ask me what the surgery was like, I compare it to a trip to the dentist. I still can’t believe how easy it’s been, in over four months I haven’t had a single issue.”
Larry Crecelius

“I was terrified when they told me I needed open-heart surgery,” said Larry. “We scheduled the surgery for April 28, so I hurried up and married my wife, Terri, on April 23. If anything happened to me, I wanted to know that at least I’d gotten the chance to call her my wife before I died. But it turns out there was nothing to be worried about. When people ask me what the surgery was like, I compare it to a trip to the dentist. I had more trouble with the arthritis in my shoulder from the position I had to be in than I did with recovering from the actual surgery. In my book, that’s not too bad!”

When is MICS the Best Choice?

“Because the procedure is less traumatic to the body, it can offer an option for patients who are elderly, frail or have other conditions such as diabetes that can lead to a higher risk of infection which might prohibit them from having traditional CABG surgery,” said Dr. Pagni. “MICS, however, is not an option for everyone. The right patient is someone who is not significantly overweight, has blockage in one or two blood vessels, and whose blockage is in the right location to be reached from the angle we can approach minimally invasively. Since Larry’s blockage was in only one vessel in the anterior wall of the heart and his anatomy is such that we could access it with the minimally invasive approach, we knew that MICS was his best option.”

Minimally Invasive Cardiac Surgery/Coronary Artery Bypass Grafting

MICS CABG Offers Significant Benefits

  • Significantly smaller incisions with lower risk of infection
  • Does not require stopping the heart; putting less stress on the lungs and kidneys, and reducing the need for blood transfusion
  • Less discomfort because the breastbone is not separated
  • Shorter hospital stay
  • Shorter recovery time with fewer physical restrictions
  • Faster return to normal activities like driving
  • Less scarring

How MICS Works

Open Heart Surgery

In MICS CABG, the incision is gently opened without breaking the ribs, creating a "window" incision which allows the surgeon to directly visualize the heart.

Minimal Scarring

Scarring is minimal, infection risk is lower and recovery is typically shorter and less uncomfortable.

All CABG surgeries involve bypassing a blocked artery with a vessel taken from another part of the body. This allows blood to be channeled around the blockage, restoring blood flow to the heart. In the MICS CABG procedure, the surgeon uses state-of-the-art technology to perform multi-vessel bypass procedures through a window incision of approximately four centimeters in the side of the chest, allowing the surgeon to directly visualize the heart. Two additional incisions are occasionally made, through which instruments are inserted that position and stabilize the heart, enabling the surgeon to safely put the bypass grafts into place.

The Heart Does Not Have to Be Stopped

Minimally invasive cardiac surgery is commonly done on a beating heart, which means the use of a heart-lung bypass machine can be avoided. The surgeon uses a stabilization system to isolate and quiet only the area of the heart being worked on. The rest of the heart keeps on pumping, eliminating the need for the heart-lung machine.

Heart Disease & Type 1 Diabetes

“The risk of heart disease in patients with type 1 diabetes is often gravely underestimated,” explained Dr. Mokshagundam. “Larry is relatively young, has controlled his diabetes well, and is not significantly overweight, so one would assume that his cardiovascular health is good. However, what you have to keep in mind is that most patients with type 1 diabetes are diagnosed early in life, so by the time they reach middle age, their bodies have been exposed to high blood sugar for several decades. Because of this, it’s very important for type 1 diabetes patients to receive regular cardiovascular health checkups, regardless of their physical condition.”