Gypsum man is one of first patients for robotic procedure
March 12, 2014
About a month ago, 66-year-old Jim Bickling of Gypsum became concerned when his heart rate started racing. Little did he know that about 24 hours later, he would be one of Valley View Hospital's first patients to undergo a robotic-assisted heart procedure.
"I was kind of scared, but I was very confident with the doctor who would be doing it," said Bickling.
Valley View Hospital in Glenwood Springs is the only place in the region where patients can undergo robotic angioplasty. It was the eighth hospital in the nation to use the technology, and it now is one of only 14 nationwide.
The Corindus CorPath Vascular Robotic system occupies the same room in Valley View's Heart and Vascular Center where interventional angioplasty used to be performed manually. The fundamentals of the procedure — which entails guiding a tiny balloon, often surrounded by a metal mesh stent, into a patient's clogged artery and inflating it to open the blockage — remain the same.
But the robot adds a level of precision that some hope will make it the new standard of care.
"The utility of the robot … is a safety issue and a cost issue," said Dr. Frank Laws, medical director of the Heart & Vascular Center.
When Bickling first started experiencing heart problems last month, he knew nothing about the new procedure being offered in Glenwood. He just knew that something was wrong.
When his heartbeat started racing, Bickling decided to have it checked out at the Gypsum Urgent Care. He recalled that it was about 1:30 p.m. when he arrived. The urgent care staff advised him to go to the hospital and Bickling opted to travel west to Valley View. By Wednesday night, he had undergone a stress test and physicians had located the blockage that was causing his symptoms.
"By 3 p.m. Thursday, I was in the operating room. They didn't give me much time to worry about it," said Bickling.
Turns out, he didn't need to worry.
"I went home the next day. It's pretty amazing and I felt so much better after the procedure," said Bickling. "I noticed a big change in a big hurry. Really, I felt better later that same night."
Bickling's comments may read like promotional information from Corindus CorPath, but his experience is not unique even if the technology is.
Dr. Laws said there are several benefits to the robotic system. It results in less radiation exposure to patient and physician and can net cost savings of 20-30 percent. Laws noted it reduces the chance of having to repeat the procedure and lessens the risk of complications.
Valley View was selected for the robotic system in part because of its mountain locale. The hospital only offers interventional procedures without surgical backup. Surgical backup often requires open heart procedures, and the closest hospital offering that is in Grand Junction.
Timely intervention is particularly critical during cardiac arrest.
"The longer it takes you to get to a cath lab, the more damage there's going to be," said Laws.
Nationally, it takes an average of about 90 minutes to get patients from the emergency room to the cath lab. At Valley View, the average is about half that.
Corindus Vascular Robotics, the Massachusetts company that manufactures the CorPath robotic system, was looking for a hospital research partner just like Valley View.
"We were like a natural fit for them," Laws said.
The room where the robotic angioplasty takes place features a large, ironing board-shaped table in the middle. The robot comprises a small articulated arm attached toward the wider end of the table with a long, thin wire protruding from it toward the narrower end of the table. The wire is guided from a separate wheeled semi-circular control module with lead shielding, four computer monitors and two joy sticks where the physician sits.
One wall of the room is glass, which provides a view from the adjacent monitor-filled room known as mission control. In all, five people including the doctor are involved in the procedure, during which the patient, though sedated, remains conscious, said cath lab director Sean O'Flinn.
He referred to the patient's conscious state as "audience participation" and said it is important that the team be able to get patient feedback about pain levels and other factors to help guide them during the procedure.
Sitting at the control module, O'Flinn demonstrates the "millimeter by millimeter" control of the balloon and stent afforded by the robot. He can move the silver wire, about the diameter of fly-fishing line, forward and back, up and down, right and left. And he can rotate it, a process that when performed by hand requires considerable dexterity as the physician rolls the wire back and forth between thumb and forefinger.
Laws said there is noticeably less unwanted movement in the wire when using the robot.
Once the balloon and stent are positioned properly, the touch of a button inflates the clear balloon, which spreads the ultra-fine wire mesh to the proper diameter for an artery. Laws said that is about 2.5-3 millimeters.
"The entire procedure was pretty amazing," Bickling said. "It wasn't painful, and it was so quick."
A month after his robotic procedure, Bickling said his life has returned to normal. "It was so much easier than knee surgery," he said, with a laugh.
But as he thinks about the procedure, Bickling is a bit awed. He noted that he and his wife are still amazed that he could undergo a heart procedure and return home the next day.
"I would recommend the procedure to anyone and I would recommend Valley View to anyone," he said.
— Drew Munro of the Glenwood Springs Post Independent contributed to this report