By Jon Nalick

In quiet moments, especially after going to bed, Rob Hertel could hear that something was wrong with his heart.

“There was a whooshing sound loud enough that my wife could hear it too,” says Hertel, a 54-year-old South Pasadena resident who works in medical sales.

That sound accompanied every heartbeat and hinted at what his doctors would later confirm—his aortic valve was failing and he required open-heart surgery to repair it.

But after being referred to Vaughn A. Starnes, M.D., chair of the Department of Surgery at the Keck School of Medicine, surgeon-in-chief of USC University Hospital and USC Norris Cancer Hospital, and director of the Cardiovascular Thoracic Institute, Hertel soon received some good news: he qualified for minimally invasive valve replacement surgery. The surgery, developed in the last 10 years, promised a faster recovery time, fewer complications and less pain than standard open-heart surgery.

“To me, that was an answered prayer,” Hertel says.

USC cardiothoracic surgeon Craig Baker, M.D., explains that standard heart surgery typically requires exposure of the heart and its vessels through median sternotomy, in which the sternum is divided to provide access to the heart—considered one of the most invasive and traumatic aspects of open-chest surgery.

However, the minimally invasive approach that was pioneered and refined at USC relies on much smaller incisions and specially adapted surgical instruments to provide access to the heart with much less trauma to the body. Surgeons are able to open a small port into the chest cavity to expose the heart to view and allow just enough space for the surgeons’ hands and instruments to complete the repairs. Dr. Baker notes that because the procedures are done though a single, small incision between the ribs, the patient benefits from significantly less blood loss and faster recuperation times. Patients can often return to their normal activities in two weeks rather than the typical six to eight weeks with conventional surgery.

The cost of minimally invasive cardiac surgery may be approximately 25 percent less than the cost of conventional surgery.

Hertel, a USC alumnus (’78) and a former college baseball and football player who went on to play for the Philadelphia Eagles and take the field in Superbowl XV, says he can vouch for the efficacy of the minimally invasive approach.

Diagnosed with severe aortic regurgitation—a condition in which the leaking valve allows blood to slosh from the aorta back into the heart and can lead to a life-threatening enlargement of the heart muscle—Hertel underwent his surgery at USC University Hospital on Memorial Day 2009 and went home after just five days in the hospital.

“The next day, I was able to do three 20-minute walks a day with no real fatigue and I never needed any pain medication after leaving the hospital,” he says.

He was back to work less than four weeks later with a barely noticeable four-inch scar between his right collarbone and right nipple.

USC cardiothoracic surgeons perform about 150 minimally invasive surgeries each year, which Baker says is a “much higher number than is traditionally done at academic medical centers. The reason is that we have an active minimally invasive surgery program and we serve as a training site for others who come and learn the techniques from us.”

The current technology's high degree of flexibility and precision have allowed USC surgeons to successfully perform difficult cases involving coronary bypass, mitral valve repair and replacement procedures, aortic valve replacements and multi-valve operations, Baker says. The approach is especially applicable in elderly patients and patients at high risk for sternal complications. It is less well suited for patients who have had multiple operations that resulted in the accumulation of scar tissue around the heart.

Starnes, who is also the H. Russell Smith Chair for Cardiovascular Research, says that USC’s Cardiovascular Thoracic Institute employs minimally invasive procedures as a standard procedure, not an extraordinary one, “and we’re constantly striving to improve the technique and continue our record of excellent clinical outcomes.”

For example, he noted that the institute was the first in the Los Angeles area to employ robot-assisted heart valve surgery, which allows slender robotic instruments—controlled by a surgeon seated at a nearby console with a video screen—to enter the body and effect repairs without cracking open the chest.

Starnes emphasizes that for all the advantages of minimally invasive surgery, it is not a one-size-fits-all approach; every patient’s case is different.

“We never compromise the quality of what we do, so we educate the patient about the optimal approach to achieve the best outcome, whether it is through a minimally invasive approach or other technique,” he says.

Baker says that apart from USC’s state-of-the-art surgical approach, what sets USC’s Cardiovascular Thoracic Institute apart from other care providers “is our use of the institute model, which breaks down the barriers [between departments] that many academic organizations have. The institute brings together surgeons, cardiologists, pulmonologists and basic scientists to provide comprehensive patient care. All our physicians, nurses and caregivers collaborate and we always keep the needs of the patients foremost in mind.”

Based on his own experience, Hertel says he agrees. “I have only good things to say. Anyone who goes to USC just needs to know they’re in good hands.”

For more information about the USC Cardiovascular Thoracic Institute, visit http://uschospitals.com/heart.