A Second Chance with Minimally Invasive Heart Surgery

Posted on March 1, 2023.

Robin Siegfried is a businessman who helped build a worldwide company, a past University of Oklahoma regent and an avid outdoorsman. He grew up riding his bicycle across the field of what is now Utica Square to get to school. His grandfather helped build the original St. John Hospital which remains at the core of the current medical center. The Siegfried name is present on several buildings at Ascension St. John (ASJ) Medical Center representing the family’s deep commitment to Tulsa and the health system, manifested through their generous philanthropy. Something about Mr. Siegfried’s hardiness makes it difficult to imagine him in the state of health he describes when, one year ago, symptoms led to the discovery of a severely leaky mitral valve along with an abnormal heart rhythm. Health effects from Mr. Siegfried’s atrial fibrillation were heightened due to an airplane crash after which he spent over 30 minutes in freezing water, forcing him to seek surgical care in 2019. Following a friend’s recommendation, Mr. Siegfried visited a cardiothoracic surgeon at the Cleveland Clinic. After two visits and testing, he finally met with the surgeon who declined to operate because of his very high mortality risk, attributed to age and anatomic considerations. Disappointed, Mr. Siegfried returned to Oklahoma and called a cardiothoracic surgical leader at another institution in Tulsa, who felt Mr. Siegfried was unlikely to survive open heart surgery. Fortunately, Dr. Zainal Hussain asked Mr. Siegfried if he had sought an opinion from a new ASJ cardiothoracic surgeon, Dr. George Comas. Dr. Comas completed his advanced fellowship training at the Emory University School of Medicine in Atlanta, Georgia, after graduating from medical school with honors at Cornell University and completing a residency in cardiothoracic surgery at Columbia University College of Physicians and Surgeons.

During his tenure at Ascension St. John Heart and Vascular Center, continued in Tulsa, Dr. Comas has also been awarded an advanced robotic cardiac surgery fellowship grant from the Society of Thoracic Surgeons. Dr. Comas came to Ascension St. John to develop a robotic cardiovascular program with a focus on micro valve repair and other intracardiac procedures, bringing eight years of experience completing hundreds of minimally invasive valve procedures. Knowing Mr. Siegfried had been turned down by other surgeons, Dr. Comas and the Heart and Vascular Center team carefully reviewed Mr. Siegfried’s case. He was felt to be a very high risk candidate for mitral valve surgery for several reasons, but particularly due to a marked build up of calcium involving the entire mitral valve apparatus. However, Dr. Comas felt the surgery was technically feasible and that the benefits exceeded the risks. The surgery included extensive removal of calcium surrounding the valve with subsequent mitral valve replacement (MVR) utilizing a minimally invasive approach along with closure of the left atrial appendage, thus lowering his stroke risk. His cardiologist, Dr. Zainal Hussain, found a well functioning mitral valve prosthesis in postoperative echocardiographic images, deeming the surgery a success both anatomically and clinically. Mr. Siegfried recovered fully and has returned to a very active life as an outdoorsman. Mr. Siegfried explains that he received world class care before, during and after surgery. “Dr. Comas and the whole team are exceptional, but even Dr. Comas will tell you one of his greatest strengths is his Advanced Care Nurse Practitioner, Laura Dorwart,” says Siegfried. Dorwart, Associate Clinical Director of Cardiovascular and Thoracic Surgery, is specially trained to provide post-acute cardiothoracic care. Dorwart ensures the entire surgical and postoperative recovery is carefully orchestrated to the surgeon’s standards, by treating, monitoring, and providing patient updates to the surgeons throughout the healing process. Ascension St. John’s Heart and Vascular Center differentiates itself in Tulsa as the only hospital providing minimally invasive cardiac valve surgery. Minimally invasive options allow patients to undergo major cardiac surgery through a small incision, thus minimizing risk, post operative pain and dramatically speeding recovery.

When asked why Dr. Comas chose to build a minimally invasive program in Tulsa, he explained that his training would be put to optimal use and provide the greatest benefit to patients at Ascension St. John in Oklahoma. He was drawn to the supportive leadership and administration, and also understood the benefits of being part of a national health system like Ascension. The Medical Center offers surgeons some of the most advanced surgical equipment available, including the daVinci Xi robot and instrumentation. Dr. Comas explained the Heart and Vascular Center is further differentiated by the expertise and experience of Ascension St. John’s dedicated cardiac anesthesiologists, perfusionists, OR staff as well as ICU providers and associates. “Our team is patient-focused,” says Dr. Comas. “We work in a collaborative environment that provides a good culture for our team and promotes patient safety. Our collaborative teamwork includes weekly interdisciplinary conferences with our cardiology, surgery, and anesthesia teams to discuss advanced care options for our patients. We also have an excellent continuous quality improvement team.” Resources needed to recruit quality surgeons and build the program at Ascension St. John’s Heart and Vascular Center were made possible through the national resources of Ascension, paired with the support of then St. John Medical Center’s President, and now Ascension St. John’s Chief Executive Officer, Jeff Nowlin. Nowlin has previously led other top health systems and has been instrumental in building other high quality heart programs prior to returning to Tulsa to assume his current roles at Ascension St. John. “From excellent cardiologists with superb subspecialty training including interventional, heart rhythm, diagnostic and structural cardiologists, three high quality cardiothoracic surgeons, an array of specialty clinics as well as cardiac and peripheral rehabilitation programs, the Ascension St. John Heart and Vascular Center provides excellent and comprehensive care to patients throughout the region. Patients referred to the Heart and Vascular Center can be seen in general and subspecialty clinics including heart failure and structural heart for ongoing management of chronic heart failure, valvular heart disease, and other structural heart abnormalities,” explains Dr. Robert Haas, Medical Director of the Cardiovascular Service line and an interventional cardiologist. “Ascension St. John Medical Center has earned the American Heart Association’s 2020 Gold NSTEMI Award and the 2020 Gold Performance Achievement Award for the Chest Pain - MI Registry by the NCDR because of the entire Cardiovascular service line’s commitment to quality care,” says Dr. Haas.

The Heart and Vascular Center was also recently chosen as a teaching site for minimally invasive surgery. Additionally, the Heart and Vascular Center has also recently received preliminary certification by the American College of Cardiology for its transcatheter valve (TVT) program. Ascension St. John is the only ACC certified TVT program in Oklahoma. “Ascension St. John’s cardiothoracic surgeons, Dr. Comas, Dr. Nagasawa, and Dr. Neel, along with Dr. Milton and Dr. Katari who provide heart rhythm services, and our excellent team of cardiologists has the bench strength of the best institutions. Each offers a component of expertise within the cardiovascular service line uncommon among programs nationwide,” says Jeff Nowlin, Ascension St. John CEO. “Dr. Comas does it right, and I would tell anyone to give him a shot,” says Siegfried. “The Tulsa community is lucky to have Dr. Comas, Dr. Neel, Dr. Nagasawa, Dr. Katari, Dr. Milton, and Dr. Hussain at our health system. Their expertise, combined with the leading innovative therapies and resources Ascension is bringing to the table under Nowlin’s new leadership, is making Tulsa, and more largely Oklahoma, a stronger community.”

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