Last year Robin Heijmen moved from Nieuwegein to Nijmegen, where he started as head of the Department of Cardio-thoracic Surgery at Radboud university medical center. His expertise lies mainly in surgery to the aorta. He investigates and treats ruptures, dilation and problems of the aortic valves. Heijmen: ‘With our research we are modernizing cardiac surgery, treating less and less invasively. We look at the patient from a multidisciplinary setting. In addition, we think ahead about follow-up steps and take into account the long term, even in an emergency situation.’
Many of his patients enter the hospital in a life-threatening condition, for instance with a rupture in the aorta. ‘We used to perform life-saving surgery, and only then look further. But in such a situation, the aorta is severely damaged and surgical follow-up steps are always needed. We are now preparing the next steps already during emergency surgery. For example, we place a piece of prosthesis in the aorta close to the problem spot. We can then place a stent much more easily later if necessary, using the prosthesis as a kind of landing place to which we attach the stent.’
Through the groin
A major advantage of this approach, which Heijmen set up in Nieuwegein and is now developing further at the Radboudumc, is that the follow-up surgery with the stent can be done through the groin, so the sternum does not have to be opened. ‘We have three options for surgery on the aorta’, Heijmen explains. ‘In an emergency situation, the surgery is often an open procedure through the sternum. The follow-up surgery can usually be done through the blood vessels in the groin, which we call an endovascular procedure. And then we have a hybrid intermediate procedure.’
Heijmen is currently investigating whether emergency surgery can also be done through the groin. 'That poses fewer risks and is more manageable for the patient. We investigate which technique suits an individual patient best and take a personalized decision.' Heijmen also applies that personal approach in planning procedures. ‘We look at whether we can divide a large surgery into several smaller interventions. After all, that adds up to a lower risk.'
Aortas in the freezer
Heijmen is also investigating improvements for surgery on the aortic arch. That is a part of the aorta just above the heart, from which large blood vessels branch to the brain and arms. Surgery on the aortic arch carries a high risk of brain damage, because dislodged pieces of clot and air can get stuck in the blood vessels of the brain. Heijmen: ‘We now map the blood flow in the brain with scans, such as MRA and CT, before the surgery. This allows us to better assess risks and adjust our operation plan accordingly. That lowers the risk of brain damage.’
Finally, the Radboudumc has a tissue bank, where pieces of removed aorta are stored in the freezer. 'We use that material in the laboratory to see how the aortic wall heals at different stages after treatment of a rupture’, says Heijmen. 'If you place a stent in a damaged aorta, one patient recovers and another does not. We would like to know why. With that knowledge, we can better determine the optimal timing to place a stent. Also in this way we make care more personal.'
Heijmen (Zevenaar, 1970) graduated cum laude from Radboud University. In 1998, he received his doctorate in Utrecht for his thesis, titled ‘End-to-side anastomosis in OPCAB’. Heijmen was trained in Surgery and specialized in Cardio-thoracic Surgery at St. Antonius Hospital in Nieuwegein. Last year, Heijmen moved to the Radboudumc, where he was appointed professor. The appointment is effective Oct. 1, 2022, for a period of five years.