Defeating the silent killer: HCA Healthcare’s groundbreaking heart surgery

This is a first!  

It’s the perfect bookend to American Heart Month. In a medical first, an HCA Healthcare heart surgeon performed four different procedures in a single operation and saved the life of a Mississippi man.

Dr. John Breaux, a cardiothoracic surgeon at affiliate Lakeview Regional Medical Center, a campus of Tulane Medical Center, became the first surgeon in the United States to execute this intricate surgery, involving a series of procedures that each depended on the other.

“In this case, I had to develop a very complicated plan which had never been attempted before,” said Dr. Breaux, “but with our team of experts at Lakeview Regional, I knew we could make it happen.”

Focused on innovative patient care, the HCA Healthcare affiliate in Covington, La., armed Dr. Breaux for success. “They let me bring my whole team with me,” said Dr. Breaux. “And that was key because this surgery was a big team effort.”

Dr. Breaux and his team planned extensively to tackle Edmondson’s complicated heart surgery, involving four different procedures

Hoping for a medical miracle

Sixty-four-year-old Larry Edmondson was suffering from severe end-stage heart failure due to four concurrent heart issues, including:

• aortic valve disease – a condition that restricts blood flow from the heart to the rest of the body.
• coronary artery blockage – typically caused by cholesterol plaque build-up in the wall of the artery.
• chronic atrial fibrillation (aFib) – one of the most common and undertreated heart rhythm disorders.
• large ascending aortic aneurysm – a weakened area of the aorta that can lead to a tear in the artery wall and can cause life-threatening bleeding.

Not to mention, Edmondson’s ejection fraction (EF), a measurement that determines how well the heart is pumping out blood, was only 10 percent. (A normal range is typically between 50 and 70 percent.)

After being turned away by other hospitals and physicians due to the complex nature of his case, Edmondson and his wife April sought out Dr. Breaux hoping for a miracle.

“He was so weak he couldn’t even walk across the room,” remembers April. “He felt like his body was giving up on him. We knew he couldn’t hold on much longer without immediate help.”

The Plan

There are several medical interventions that could have helped treat Edmundson’s individual heart conditions, according to Dr. Breaux.

• A stent procedure could have treated his coronary artery disease.
• A catheter-based ablation could have helped the atrial fibrillation.
• Another stent procedure could have treated the aneurysm.
• A transcatheter aortic valve replacement or TAVR could have treated the aortic stenosis.

“All of those modern, minimally invasive procedures are available to help patients that have one of these problems,” Dr. Breaux explained. “However, he had all four. He had theoretically correctible problems, but when you add them all up into one patient, it became close to impossible to fix. No simple plan would ever work for him.”

In came Dr. Breaux’s revolutionary plan to “fix” all of his patient’s issues in one surgery. It was a strategy that had never been attempted before, but one he felt positive would work and would save his patient’s life.

“When I perform complex open heart surgery, I always go into the operating room with a well-thought-out plan, as well as a backup plan,” he said, noting his team planned for nearly a week to outline all the steps of the surgery. “In this case, we essentially had to go full court press.”

The Procedure

In the past five years, many new technologies have come to market to treat complex heart conditions, including a very tiny heart pump used to improve severe heart disease. The device is intended to pass through the blood vessel of the arm through the patient’s healthy ascending aorta, then through the healthy aortic valve and into the failing left ventricle.

But in Edmondson’s case, the aorta, valves, and vessels were all failing and Dr. Breaux had to repair them before the pump could be placed.

The seven-hour procedure involved:

• a two-vessel coronary artery bypass grafting,
• followed by a Maze atrial fibrillation ablation procedure,
• an aortic valve replacement,
• an ascending aorta replacement, and
• finally the placement of the heart pump.

Chest x-ray imaging, showing Edmondson’s life-saving heart pump

New Lease on Life

The unconventional operation yielded the best outcome – a new lease on life.

Edmondson’s ejection fraction increased to 45 percent just four days post-surgery; the heart pump was removed the following day and Edmondson was discharged after 12 days at Lakeview Regional.

“The blood supply to the muscles is good,” Dr. Breaux said. “His aneurysm has been removed. Now he’s back to regular heart rhythm. And the valve that he has should be good for about 18 years. So if I’m still around in 18 years, I’ll be happy to replace it for him,” he added with a smile.

Edmondson, who now enjoys building chicken coops on his property, says he can’t thank the team at Lakeview Regional enough.

“I don’t think I would have survived this at any other place. I want to thank Dr. Breaux,” he told a local reporter. “I’m just so glad I’m still here.”

“You put your faith in me and I just tried not to let you down,” Dr. Breaux offered humbly in reply.

Dr. John Breaux is a board-certified cardiothoracic surgeon affiliated with HCA Healthcare’s Lakeview Regional Medical Center, a campus of Tulane Medical Center. His areas of clinical focus include complicated heart procedures, open-heart procedures, valve surgery, heart arrhythmia surgery, esophageal surgery, lung surgery, mini-maze surgery and alternative incisions. Dr. Breaux is a member of the Society of Thoracic Surgeons and the American College of Chest Physicians.