elana 1.jpgLarry Robbins is a lucky man. A few months ago, the 58 year old was slumped over his bathroom sink coughing up blood. Today, he is at home recovering well from brain bypass surgery.

His story has the makings of a miracle—with a healthy dose of good timing.

Robbins was born with a heart defect and had previously undergone three open-heart surgeries to correct the problem. Doctors at Toronto General Hospital, where he was taken by ambulance the day he was coughing up blood, believed that the sutures or materials implanted during previous surgeries had perforated Robbins' aorta over time, causing blood to leak from his heart and into his lungs.

But as physicians began to treat the bleeding in Robbins' aorta, they discovered that he was also suffering from a completely unrelated and, in fact, more life-threatening condition. Robbins was in the process of having a stroke due to a blocked artery in his neck, which was restricting blood flow to his brain. He needed brain bypass surgery—and fast.

Too ill to survive a radical operation like traditional brain bypass, Robbins was taken to Toronto Western Hospital where Dr. Michael Tymianski, a neurosurgeon in the hospital's Krembil Neuroscience Centre, performed a new, laser-based, brain bypass procedure called the ELANA technique.

"Mr. Robbins was one of a handful of extremely ill patients who we selected to undergo the new laser bypass procedure," Dr. Tymianski says. "No alternative treatment was possible for these patients."

Bypass surgery involves replacing a diseased vein in a patient's body with a healthy vein taken from another part of his or her body, such as a leg. With a traditional brain bypass, doctors must temporarily clamp off blood flow in the blocked artery before creating a hole in it and attaching the donor vein. The clamping facilitates the surgery by preventing blood from gushing out everywhere. The danger, however, is that cutting off blood flow, even for a short while, puts the patient at risk of stroke.

The technique known as ELANA, which stands for excimer laser-assisted non-occlusive anastomosis, is considered safer because it eliminates the need to temporarily stop blood flow. With this new procedure, doctors suture the donor vein onto the blocked artery and insert a laser catheter through the new vein. The laser beam then penetrates the surface of the blocked artery, creating a perfectly tidy hole.

In Mr. Robbins' case, Dr. Tymianski grafted a donor vein onto an artery in his neck (carotid artery) as well as an artery in his brain, allowing blood to bypass the blockage and flow into his brain.

Toronto Western is the only hospital in Canada—and one of a handful worldwide—currently offering the ELANA procedure. The hospital purchased the $300,000 laser in 2008, thanks to a generous donation to the Toronto General & Western Hospital Foundation.

Robbins is one of only five patients in Canada to be treated by the ELANA method. He was also among the most fortunate. Despite the success of all five surgeries, three patients still succumbed to their illnesses.

Invented by a neurosurgeon in the Netherlands, the ELANA procedure offers seriously ill patients hope when traditional bypass is not an option.

"It saved my life," Robbins says. "I have a long recovery ahead of me, but I'm grateful to be alive."​​​

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