Dr. Estioko Champions ‘Bloodless’ Heart Surgery
Even without meeting him in person, one gets the sense that Filipino American Cardiovascular and Thoracic Surgeon Manuel Estioko is precise and exacting. When asked a question, he explains in detail. He rarely uses medical terms and he speaks slowly, making sure his listener follows.
He wastes no time because he is a busy man. For the past 30 years, Dr. Estioko, currently medical director at St. John’s Transfusion-Free Medicine and Surgery Center in Santa Monica, California, has performed surgeries on high-risk heart patients from all over the world, specializing in repeat operations and multiple valve surgeries.
He is also a well-known advocate and practitioner of “bloodless” heart surgery, a technique of open-heart surgery without blood transfusions. In fact, Estioko is recognized as one of the pioneers of the technique, earning wide notice and acclaim while a young surgeon at Mt. Sinai Hospital in New York.
“Estioko’s employment of a ‘no-blood’ approach in the management of Jehovah’s Witnesses (whose religion absolutely forbids use of donor blood or blood products) referred for CABG or other cardiac surgery quickly led to Mount Sinai being designated as a regional referral cardiac surgical center for this religious group,” wrote Robert
Litwak, M.D., in a 2003 paper on cardiothoracic surgery, published in the Mt. Sinai Journal of Medicine.
Estioko’s interest in the technique started in the 1970s during his early days as a surgeon at Mt. Sinai. At the time, he says, transfused blood was used in most open-heart surgeries. Blood transfusions provided the surgeon with a margin of safety during operations and was also used as prime in large heart/lung machines necessary in keeping patients alive during the procedure.
Using blood was problematic because commercial blood bank donors were unreliable. They included drug addicts, alcoholics and those with hepatitis, for which no tests were available at the time. In fact, studies conducted by Estioko and his colleagues revealed that18 out of 100 open-heart patients contracted hepatitis from the blood.
“We considered it unacceptable and that’s how I got started in trying to find ways and means on how you can do open-heart surgery without blood transfusion,” Estioko explains.
Over time, improvements in the heart/lung machine, as well as technological advances that lessened the use of blood as prime made bloodless heart surgery possible. However, due to the higher level of skill and precision needed for the technique, few surgeons practice it. Estioko was an early proponent and practitioner.
“This is a higher level of surgical technique,” Dr. Estioko stresses. “Not everybody can do this type of operation. In fact, many surgeons who are not so good, they don’t even attempt it because it is more exacting, more demanding. It really attracts those who have more expertise in the field.”
Aside from doing away with blood transfusions, the technique aims to minimize blood loss by relying on efficiency of cuts to prevent bleeding problems. Originally an option for religious groups like the Jehovah’s Witnesses, bloodless heart surgery has emerged to be an alternative procedure to combat blood-borne disease. Recent studies also reveal faster recovery time for patients who choose bloodless heart surgery.
Estioko spent 11 years in New York, where he was also professor at the Mt. Sinai School of Medicine. In 1990, he moved to California to be part of the Kay Medical Group in Los Angeles in 1990, a cardiac surgery group where he stayed for 14 years before moving on to St. John’s Health Center.
Apart from his surgical work, he has also collaborated on papers published in prestigious medical journals related to heart surgery like Chest (the official publication of the American College of Chest Physicians) and Circulation (journal of the American Heart Association), among others, firmly establishing his reputation as an expert in his chosen field.