That means patients for the first time on Maui could receive angioplasty treatment, also known as catheterization for clearing clogged arteries to the heart.

The cardiac unit will also offer open-heart surgery eventually as an elective or in an emergency when an angioplasty procedure encounters complications or severe blockages.

As many as 260 heart attack patients at Maui Memorial last year were transported to Oahu or the Mainland for surgical procedures to treat heart diseases that cannot be handled without the facilities and staff specifically needed for heart surgery.

With approval of the certificate of need, Chief Executive Officer Wesley Lo said Maui Memorial may begin offering angioplasty operations within a year to 18 months. Once the cardiovascular services are available, he said the number of off-island transports will be cut down substantially.

At the State Health Planning Development Agency, acting Administrator Darryl Shutter issued a letter Wednesday to Lo, notifying him that Maui Memorial's certificate of need had been approved as modified.

Former SHPDA Administrator Dr. David Sakamoto, who left his post in May, had granted a conditional certificate last October with conditions requiring the hospital to devise written plans that specifically included medical staff input and that clarified the mission, vision, goals and objectives of the cardiovascular service.

Once the language of the plans was approved, Shutter signed off on the certificate.

"This is huge," Lo said. "If done properly, this could change the face of health care in the state of Hawaii."

Wednesday's certificate approval was also key for the hospital because the cardiac services are projected to generate revenues for the hospital to offset losses from other medical services it must provide to the community. Earlier this year, Lo reported that Maui Memorial, which has generated operating profits in some years, was showing an operating loss for 2007.

The angioplasty and open-heart surgery services will initially be performed in the Heart Brain and Vascular Center currently housed on the second floor of the hospital's Wailuku Tower. The center, which first opened in 2004, also houses equipment for stroke intervention procedures currently not offered anywhere else in the state including wingspan stent and the use of a biplane system that delivers images of blood vessels and other organs in the body in a fast and precise manner.

Maui Memorial hopes to eventually build a heart, brain and vascular tower, possibly in three years, with funding through a $100 million revenue bond the hospital hopes to issue next year.

The revenue bond authorization appeared to be uncertain after Gov. Linda Lingle on Tuesday vetoed House Bill 1764, which specifically authorized the revenue bond float to finance the Maui Memorial Heart Brain and Vascular Center.

Lingle said revenue bond issuing authority was granted to the new regional boards within the Hawaii Health Systems Corp. under Senate Bill 1792, which became law as Act 290 without the governor's signature.

While the Senate did not accept the governor's argument, the House did and the veto was allowed. Still, Maui Rep. Bob Nakasone, a longtime advocate for Maui Memorial, said a new revenue bond authorization can be pushed through the 2008 Legislature if it is needed.

While Lo said he would have liked legislation that specifically authorized the $100 million bond for Maui Memorial, he trusts that Act 290 will provide the means to finance the planned cardiac care center.

"The better way would have been to be specific that it's Maui, but we're the only guys talking about issuing revenue bonds," he said.

Under Act 290, the 13 community medical centers under the Hawaii Health Systems Corp. will be split among five regions, with each of the regional boards given authority to float revenue bonds.

Still confident that Maui Memorial will have the authority to proceed, Lo on Wednesday said he plans to travel to the Mainland in about a week and a half to talk to investment bankers about financing the heart center.

Simultaneously, Lo and his staff are continuing their ongoing efforts to recruit a cardiovascular surgeon and an interventional cardiologist to operate the planned cardiac care center.

After reviewing 48 resumes from cardiovascular surgeons, the staff is considering 10 names, according to Lo. A subcommittee has also formed to work with the hospital's medical staff on establishing cardiac services, and Maui Memorial is consulting with other medical centers on setting up a training program for the professional staff needed for a heart center.

"We're not on the verge of starting, but we're certainly hitting the ground running," Lo said.

Claudine San Nicolas can be reached at claudine@mauinews.com.