Avoiding open heart surgery

Heart disease sufferers susceptible to blood clots may breathe easier knowing that an option to open heart surgery now is available.

A new advancement that incorporates extracorporeal bypass, in which blood flow to and heart is bypassed outside the body, and advanced catheter-based techniques, enables doctors to essentially reroute the circulatory system and vacuum potentially deadly blood clots from arteries, the heart and veins.

This minimally invasive therapy, which works best in acute cases, involves a medical device called the AngioVac Cannula and benefits patients through reduced risk of infection, hospital stay and recovery time.

AngioVac was developed by two cardiovascular surgeons as an alternative to open heart surgery primarily for pulmonary emboli (blood clot in the lung). AngioVac was approved by the FDA in 2011.

The technology is new enough, however, that the majority of hospitals using the system are teaching hospitals such as Baylor University and UCLA. In addition to Susquehanna Health, AngioVac is being offered at other Pennsylvania hospitals including Allegheny General, Lancaster Regional Medical Center, Lankenau Medical Center, Penn State Hershey Medical Center, University of Pennsylvania, University of Pittsburgh Medical Center and York Memorial Hospital.

The therapy system is catheter-based and is inserted through a small incision into a vein in the neck or leg. The surgeon uses a live X-ray to guide insertion and placement of the catheter.

When placed near the blood clot, the catheter’s funnel-like tip expands to collect the blockage. Once the system’s centrifugal pump is engaged, the obstruction is vacuumed into a filter and blood flow is restored.

During this procedure, blood is filtered and recirculated through another catheter back into the patient’s body.

The procedure allows surgeons to remove clots of all sizes, some as long as 24 inches, with minimal trauma being inflicted on the patient’s body, allowing the patient to be up and walking the next day and possible discharge within three days.

There are two main conditions that contribute to blood clots in the circulatory system, Atherosclerosis and Deep Vein Thrombosis (DVT).

Atherosclerosis occurs when plaque (deposits of substances including cholesterol and fat) builds up in the wall of an artery and creates a blockage.

When plaque ruptures, a blood clot forms (thrombosis). DVT is a condition that results when a blood clot forms in the deep veins of the limbs (most often the legs).

A few of the factors that contribute to DVT range from recent surgery to bed rest or sitting for long periods of time to medications or other health conditions such as cancer.

Blood clots that travel through the circulatory system increase the risk of more serious health conditions such as pulmonary embolism (PE), heart attack and even death. In many cases patients will not experience the symptoms of PE, but they can include:

Sudden shortness of breath

Chest pain

A feeling of anxiety

A feeling of dizziness, lightheadedness or fainting


Coughing up blood


Low blood pressure

Symptoms of DVT, such as:

Pain in the affected leg (may occur only when standing or walking)

Swelling in the legs

Soreness, tenderness, redness or warmth in the legs

Redness or discolored skin

Individuals who are most at risk for blood clots can help prevent them by staying active, choosing not to smoke and maintaining normal body weight.

When the need for heart or vascular surgery becomes unavoidable, it is important to choose a healthcare provider that offers several treatment options.

Lazar is a cardiothoracic surgeon who serves as medical director of Susquehanna Health’s Heart and Vascular Institute.