When former U.S. Attorney General John Ashcroft needed heart surgery, he considered only one place: the University of Chicago Medicine.

He also knew the surgeon he wanted: robotic cardiac surgery pioneer Husam H. Balkhy, MD.

“My aspiration was to go to the very best place possible,” said Ashcroft, who served under former President George W. Bush from 2001 to 2005.

Ashcroft recently came to UChicago Medicine for removal of a papillary fibroelastoma, a growth on his aortic valve that put him at risk of a heart attack or stroke.

While reviewing images before surgery, Balkhy and his team found another problem. The patient’s aortic valve didn’t close tightly, causing blood to leak backward with each heartbeat instead of moving out of the heart to oxygenate the body.

Balkhy, the director of robotic and minimally invasive cardiac surgery at UChicago Medicine, recommended replacing the entire aortic valve. Ashcroft was on board.

Ashcroft, who turned 82 in May, knew he wanted minimally invasive surgery that would spare him the long and sometimes difficult recovery from an open-heart procedure.

Those surgeries include a long incision and a sternotomy, where the breastbone is split and the halves spread apart to access the heart. Ashcroft worried he might never recover enough to wield a chainsaw and drive tractors on his 230-acre farm in Missouri.

Two days after Balkhy performed robotic heart surgery on March 25, Ashcroft was discharged to a Chicago hotel. The patient was back home three days after that, and he was able to give a speech the next month.

“We drove 500 miles at a time when, if I’d had a normal open-heart procedure, I don’t think I’d have been in any condition to do that,” Ashcroft said.

Expertise in robotic aortic valve replacement

UChicago Medicine is unique in its 11 years of experience using surgical robots to perform all kinds of heart surgeries, rather than focusing on just one type of operation such as mitral valve repair.

Balkhy adds that it is one of the only places in the country to perform fully endoscopic aortic valve replacement — the operation that Ashcroft had.

Endoscopic means the surgeon uses tools to look inside the body, rather than cutting it open. The patient’s breastbone remains intact, and five small incisions between the ribs allow placement of ports for the robot’s three thin “arms,” a camera and a spot to insert the replacement valve. Ashcroft's new valve is made of tissue from a cow's heart.

At the console with a high-definition, magnified view of the heart, Balkhy uses a set of controllers to precisely move the robotic arms to perform the surgery.

“Using a totally endoscopic approach leads to quick recoveries and return to activity and work,” said Balkhy, who uses robots for all of his surgeries.

Balkhy has performed more than 2,400 minimally invasive, robot-assisted cardiac procedures — including coronary artery bypass; aortic, mitral and tricuspid valve repair and replacement; ablation to correct arrhythmia; and repair of congenital defects.

Life after robotic heart surgery

The complexity of Ashcroft’s diagnosis would have ruled him out for treatment at most robotic heart surgery programs that use the technology only on the most straightforward cases, Balkhy said.

The papillary fibroelastoma erased the possibility of performing transcatheter aortic valve replacement (TAVR), a minimally invasive procedure in which a new valve is placed, but the old one is not removed.

A quick recovery from robotic aortic valve replacement left Ashcroft in good shape to receive hip replacement surgery in July. Six weeks later, he drove 12 hours to Colorado. He also began teaching this month in Virginia.

“He’s just loving life,” said Brooke Patel, MSN, APN, CNP, a robotic nurse practitioner coordinator at UChicago Medicine. “That man, you can't keep him still. He's traveling all over the place, and he’s thankful for everything that he's been given.”

Ashcroft, who served as a U.S. senator for Missouri (1995 to 2001) and governor of Missouri (1985 to 1993), was first referred to UChicago Medicine in 2020 by John Garner, MD, Ashcroft’s cardiac electrophysiologist in Springfield, Missouri.

At UChicago Medicine, doctors performed cardiac ablation to correct an arrhythmia, and Balkhy waited in the next operating room in case further intervention was needed.

Having access to deep and specialized expertise compelled Ashcroft to stick with UChicago Medicine for his future needs.

“I just felt a real sense of confidence that this was a place that was at the very front end of the technology and was very experienced in deploying it,” Ashcroft said.

‘Great appreciation’ and new outlook

The recent surgery marked a homecoming for Ashcroft, who was born in Chicago. He attended law school at the University of Chicago, where he met his wife, Janet. Both graduated in 1967, and they were married the same year.

“Good things happen to me in Chicago,” Ashcroft said.

In a handwritten letter to University of Chicago Health System President Tom Jackiewicz, Ashcroft expressed his appreciation for Balkhy and members of the robotic cardiac surgery team “who were flawlessly helpful and patient and kind.”

“I have great appreciation for U of C,” Ashcroft wrote. “Thank you for sustaining a commitment to quality.”