When Dr. Francis Sutter operates these days, about half the time you'll find him at the controls of a surgical robot, moving the arms that put in healthy arteries to do the work diseased ones can't handle any more.
When he started using the robot in 2006, it wasn't because it was new technology.
He realized the traditional open-heart method often failed to help people who needed it most - the very sick.
"You do perfect surgery, but it was so much trauma to the patient, they didn't do well," Dr. Sutter told us.
So he's doing more less-invasive cases - using a combination of robotic surgery and stents.
"Robotic surgery does the one thing that makes patients live longer - putting an artery inside the chest wall to the most important artery in the heart," says Dr. Sutter.
Dr. Sutter says there's no scientific evidence using it for other heart arteries increases long-term survival.
For them, he says stents do just as well.
Morrie Richfield, an author and businesman from Gulph Mills, who was the 1000-th patient, appreciates the more cautious approach.
He was willing to put up with chest pain to avoid open-heart surgery.
"The thought of being cut open and ripped to pieces, I'd never had any surgery before - so it scared the..... It scared me," Richfield says.
Although Dr. Sutter is proud of his milestone patient, he's just as proud of that first patient in 2006.
"He's still with us, and going strong," he says.
Dr. Sutter says the big gain for patients is getting back on their feet in about half the time as open-heart surgery.
For some that means going back to work, for others it means getting back into the gym faster.
He's now part of a government study to see how much difference the hybrid approach makes.