The cutting edge of heart surgery

By JUAN A. LOZANO

Associated Press

HOUSTON — A 57-year-old woman underwent a surgical gamble Tuesday in which doctors temporarily removed her heart, cut out three rapidly growing tumors and returned the repaired organ.

Doctors were cautiously optimistic afterward. Only one other patient has survived the surgery.

Joanne Minnich was in serious condition in the intensive care unit of Methodist DeBakey Heart Center following the nearly seven-hour operation.

"The prognosis is good but guarded," lead surgeon Michael Reardon said during a news conference. "She’s doing well but it’s very early. I feel very good we got (the tumors) all out."

Her heart rested in a bowl while the team of cardiac surgeons worked on it.

Doctors said the malignant growths, one as large as a lemon, were on the wall of her heart’s left atrium, restricting blood flow, and could have killed Minnich in as little as two weeks if left unchecked.

"They have saved my wife," her husband, William Minnich, said. "I’m grateful. All the aftereffects (of a heart transplant) just didn’t make sense. This procedure made sense."

A heart-lung machine took over the function of Minnich’s diseased heart for the approximately 45 minutes it was out of her body. The team would have had a maximum of six hours, the length of time a heart can survive out of the body.

Reardon said a smaller tumor was behind Minnich’s aorta but did not involve the vital artery, which he called good news as he spoke to reporters observing the operation.

Reardon performed the procedure, called an autotransplant, successfully in 1999. Two other patients died, in 1983 and 1998.

Doctors had repaired the damaged organ with tissue from a cow’s heart and returned it to her body when Reardon discovered a third, even smaller tumor. Surgeons had been aware of only two tumors.

The team again pulled out the heart, removed the last tumor, and reinstalled the organ.

Reardon had sounded a note of caution Monday. "Can I remove the tumor and rebuild the heart? I don’t know," he had said. "I don’t know how much of the heart the tumor has invaded. The possibility exists that when I cut the tumors out the heart will be so badly damaged I will not be able to reconstruct it.

"The patient knows that."

Minnich, of Mahopac, N.Y., said the surgery was the only way she had a chance at life. A business manager with three grown children, she said she learned about Reardon and his procedure on the Internet as she searched desperately for a way to defeat her illness.

"Of course it’s scary, but I have no other choice," Minnich said. "I don’t have time to wait for a heart transplant."

Finding a donor heart would likely take five or six months, Reardon said. In addition, Minnich would have to take drugs to suppress her immune system so her body would not reject a new heart, and that would allow the tumors to grow.

She had an operation to remove a tumor in April, but the malignancy recurred.

"She was short of breath a few weeks ago, and by last week she had trouble climbing a stairway," Reardon said. "Yesterday (Sunday), she had to sit up straight to breathe."

Heart malignancy is extremely rare, Reardon said, because most cancers happen in cells that replace themselves regularly, unlike cardiac cells. He said he developed the procedure with famed cardiac surgeon Dr. Denton Cooley in 1983.

On the Net:

DeBakey Heart Center: www.methodisthealth.com/debakey/hrtcntr.htm