Surgeon closing in on 25,000th operation

BIRMINGHAM, Ala. - A heart surgeon usually performs about 4,000 operations in a career. Dr. Albert Pacifico at the University of Alabama, Birmingham is approaching his 25,000th.

Pacifico, 59, who has been at UAB for more than three decades, said he will reach the plateau within a few months. He is performing heart surgeries at a rate of about 100 a month, or 1,200 a year.

"Can you believe that?" he said. "That's a lot of cases."

Dr. William Wood, a general surgeon at Medical Center East in Birmingham, said Pacifico's achievement was the product of "incredible" intelligence and skill.

"There can be nobody else who could have possibly done that many," said Wood, who trained with Pacifico at UAB in the early 1970s. "We're not talking about someone who is a little faster. It's off the scale."

Speed shows skill

And in surgery, speed is an indication of skill, Wood said. "You've got to do it right; you've got to do it fast."

Pacifico said he has created a system that allows him to perform heart surgery in about a third of the time normally required. The system is based on precise, choreographed movements. A team begins the surgery, and Pacifico steps in to perform critical parts of operations.

"I don't waste motion," Pacifico said. "I don't waste time with personnel. I finish the important parts of the operation very quickly."

Never hurries

Patients suffer less stress when they spend less time under anesthesia and on a heart-lung machine. But Pacifico said his system is based on efficiency, not speed.

"I never hurry. Hurrying is bad."

As he spoke, a nurse told him the status of a 66-year-old woman being prepared for surgery to replace three faulty heart valves with artificial ones.

"Tell them to proceed," Pacifico said.

A short time later, Pacifico enters the operating room. The woman's chest has been opened. Working with a quiet intensity, he makes final connections for a machine to take over her heart's functions. The team of 11 doctors and nurses moves slowly and whispers or uses hand signals.

He snips away at the woman's mitral valve, which guards the opening between two of the heart's chambers. It is made up of two triangular flaps that are attached to a fibrous ring about the size of a half dollar.

Pacifico calls for a prosthetic replacement valve. He begins stitching threads from the woman's heart to the rim of the artificial valve.

The heart-lung machine swishes as Pacifico pushes the prosthetic valve down its threads and into the heart and knots the sutures.

"This is looking great," he says softly. He begins trimming the thread, finishing the first part of the surgery that has taken about 20 minutes.

UAB's division of cardio-thoracic surgery performs about 2,200 operations a year.

Pacifico said there is no way to prevent the disease, but it can be delayed by controlling risk factors such as diet.

"It means you will have trouble at age 75 instead of age 50," he said.