Taking another look at open-heart surgery

ISSUE: HMH's open-heart surgery program
OUR VIEW: Re-evaluation an appropriate step

Following a five-month hiatus in performing open-heart surgeries, Hardin Memorial Health officials are re-evaluating the open-heart program.

HMH President and CEO Dennis Johnson and Chief Medical Officer Dr. Stephen Toadvine point to a combination of factors that led to a pause in scheduled surgeries and the re-evaluation. Among these are declining trends in the number of certain procedures performed in the program, advances treatment alternatives and the decision of Dr. Bill Hymes, the program’s sole cardiothoracic surgeon, to exit the program.

Conducting such a careful and purposeful reassessment of the open heart program is an appropriate process for HMH leadership to undertake at this juncture.

HMH began its full-time open-heart surgical program in January 1998. One month later that year, the hospital expanded its comprehensive cardiac services to include angioplasty, atherectomy, cardiac stint and lithotripsy procedures. According to the hospital’s website, the 1,000th open-heart surgery was performed in January 2005.

Since that time, much has changed in cardiac medicine. New and less-invasive treatment technologies, advances in preventative cardiac medicine and care and high-volume specialization within larger regional hospitals statistically have driven down open-heart surgery volumes on a national basis. HMH’s program has mirrored this trend, according to Johnson, with only about one open heart surgery performed per week on average before the program went into hiatus.

Statistics show hospitals that perform the highest volumes of open-heart surgeries annually also have the highest percentage of patient survival rates and with better outcomes. Recommended medical guidelines on annual open-heart procedure volumes run from 200 to as high as 500 or more in noted medical journals for best outcomes.

It’s also understandable that those high-volume facilities will tend to draw not only a larger percentage of patients, but also the best of the best of heart surgeons and cardiologists. It’s natural these high-demand specialists will seek out facilities where they can perform more surgeries than at lower volume hospitals. It appears that is the driver leading to Hymes’ departure from HMH.

Cardiovascular disease continues to be the leading cause of death in the United States. Kentucky’s dismal statistics for serious contributing risk factors such as smoking, diabetes, obesity, high blood pressure and cholesterol continues to place our state well ahead of the national average for heart disease and stroke risk.

According to the Centers for Disease Control among all deaths in Kentucky in 2009, 26 percent were from heart disease and almost 6 percent were from stroke.

Statistics will show we’ve certainly not become healthier as a state, continuing the need for cardiac medicine and treatment across the commonwealth and certainly within our region.

To continue the measured progress HMH is making with improvements to hospital services, facilities and programs, the hospital needs a healthy and competitive open-heart program. But to be viable, the volumes of demand for such surgical services must be present to support the program financially and to be attractive in the recruitment and retention of high-quality surgeons and cardiologists Johnson and Toadvine intend to pursue. 

This editorial represents a consensus of The News-Enterprise's editorial board.