Caitlin Whyte (Host): Today we are sitting down with Dr. Jennifer Wan, a Cardiothoracic Surgeon with Community Memorial Health Care. Dr. Wan discusses the role of a cardiothoracic surgeon in today's rapidly advancing surgical environment and the exceptional Cardiothoracic Surgery Program here at Community Memorial Health Care.

Welcome to Wise and Well, presented by Community Memorial Health Care. I'm Caitlin Whyte.

Well, to start off our conversation today, Doctor, can you first describe the role of a Cardiothoracic Surgeon? What types of procedures do you perform and what conditions or diseases do these procedures treat?

Jennifer Wan, MD: Yeah, so thanks for having me. My name is Jennifer Wan. I am a Cardiothoracic Surgeon in Ventura, California. Let me tell you all about cardiothoracic surgery. So, Cardiothoracic Surgeons perform surgery to treat all disorders of the chest. We're trained to fix everything from basically the neck down to the bottom of the chest.  Cardiothoracic surgery in adults is divided into two broad categories. There's cardiac surgery, which refers mostly to the heart, and general thoracic surgery, which refers to the lungs, esophagus, and the other organs in the chest. The main problems I treat on the cardiac side are coronary artery disease, aortic disease, and heart valve disease.

The most common operations I perform on the cardiac side are coronary artery bypass surgery, valve repairs and replacements, and surgical operations for the aorta, as well as rhythm surgeries. On the general thoracic side, the most common problems I treat are lung cancer and lung nodules, esophageal problems, and other infections and disorders in the chest.

Host: Wonderful. Well, I'd love to hear more about your background as well. How does your education and experience impact the care you provide to your patients?

Jennifer Wan, MD: So let me share a little bit about the path I took to get here. I grew up in the Midwest. I moved to Southern California in high school, and went to Berkeley for undergrad and USC for med school, and then I trained in general surgery at UCSF East Bay. I also did some research at San Francisco General Hospital.

So, during my general surgery training, I decided that I wanted to specialize in cancer surgery in the chest. Especially lung and esophageal cancer because I loved that relationship that I would build with my patients. I went to the University of Michigan for a cardiac and thoracic surgery fellowship. I unexpectedly fell in love with cardiac surgery during my training, but I still followed my originally planned path and   began my career specializing in thoracic surgery, especially thoracic cancer surgery.

In my first practice, I was at a high volume referral center. And people drove hundreds of miles to my location to have their lung and esophageal cancers removed. So I did learn quite a bit about what it means for people to travel so far for their operations. There are a lot of things I loved about that practice, but eventually I decided to leave.

And when I look in retrospect, I now understand that I left that job so I could continue to grow as a surgeon. I made a rather unusual move to broaden my practice from a specialized cancer  practice to include adult cardiac surgery again, so I could move here to Ventura and practice at a community hospital.

I returned to training to actually relearn heart surgery at the Mayo Clinic,   and I felt like this was the best way to bring cutting edge cardiac surgery skills with me to my new community. And I've been in Ventura now for five years.

Host: Great, well, let's look at some recent surgical advancements. What have you seen that applies specifically to cardiothoracic surgery lately?

Jennifer Wan, MD: So medicine is constantly moving forward. If we're not evolving, then we're falling behind. And some people think that this isn't important in a community setting, but I think it's actually more important at medium sized hospitals like ours, because we're really in the front line of medicine and caring for our neighbors.

 We are constantly striving to stay up to date so we can offer our neighbors the best care.  These are the areas we have been making strides here. We're doing more minimally invasive surgery. We have all kinds of new mechanical support options for heart and lung failure. Things like Impella and ECMO or extracorporeal membrane oxygenation.

We've improved our ICU care and critical care tools. We have much better ways to monitor and support our patients.  Some of the tools that we've added are things like a continuous renal replacement therapy, CRRT, or nitric oxide.  And we often only find these tools in more tertiary settings.  But we have them here in our community hospital.

  Also, in coronary artery bypass grafting, we have made a lot of changes.  This is a really old operation, but it's still evolving and getting better and better, and still serves people very well.  We have now converted to methods that help grafts stay open longer, and that means that patients live longer, and the bypass grafts last longer, and most of this is by using arteries rather than veins.

Host: And how would you say that these advancements have enhanced the care that you are able to provide to your patients?

Jennifer Wan, MD: All these advances mean that our patients are recovering faster, they're surviving much more complex operations than we were previously able to do, and people are able to recover from more severe illnesses. Our patients are living longer, and they're living with better quality of life,   and that's what it's all about.

Host: Well, we love to hear that. And what would you say is the role of minimally invasive cardiac and thoracic procedures?

Jennifer Wan, MD: We perform a great deal of minimally invasive surgery. Nearly all the thoracic surgery done at our hospital is performed minimally invasively with a camera and often a robot. We harvest arteries and veins for bypass surgery through tiny incisions by using a camera. We perform valve replacements over catheters through the groin, and we can perform cardiac surgery through smaller and smaller incisions with less division of the sternum.

However, when I talk about minimally invasive surgery, even though I do a lot of minimally invasive surgery, I like to put in this caveat. I don't believe in doing minimally invasive surgery only for the sake of a smaller incision. Honestly, cardiac surgery, even when you perform it through tiny incisions, is still invasive.

So, I offer minimally invasive surgery when it serves you well and provides you with a better outcome. I will always tell you about what we can do and what can be done in the world, but I will also give you my honest opinion on what serves you best for your survival and recovery.

Host: Of course. Well, let's talk about the specific procedures that are available at Community Memorial. What is available and what is the benefit of having these procedures done so close to home?

Jennifer Wan, MD: At Community Memorial Hospital, we perform a full scope of cardiac and thoracic procedures for adults. Everything from minimally invasive lung and esophageal surgery, to all arterial coronary artery bypass grafting, aortic surgery, heart rhythm surgery and Heart valve replacement and repair through a lot of different approaches.

So, since arriving in Ventura five years ago, I have thought a lot about the purpose of heart and lung surgery in our hospital and why people should have surgery here. I had previously only worked at academic centers and referral centers. Academic centers really focus on research and teaching and spend much of their effort performing the craziest operations that only a few people need, and that's why they're great places to train.

Community hospitals serve a different purpose. We specialize in the types of heart and lung surgery that most people need, and we make it the focus of our life's work. We spend almost all of our waking hours, making sure your operation goes well, you have a good outcome and a good experience, and you're cared for by a happy and high functioning team that's close to your home.

Together, our team has performed these operations thousands of times. And we don't have a lot of other distractions. Our stated goal in our practice is to provide the most modern, high quality cardiothoracic surgery that's available in a community setting. So, your heart surgery, lung surgery, or esophageal surgery is actually our focus and we are kind of obsessed with making sure it goes well.  When you come to our hospital, you get a personal and direct relationship with your surgeon and with our small and tight knit surgical team.

Host: Well, we'd love to hear more about that team. Tell us about the benefit of having a team dedicated to these types of procedures.

Jennifer Wan, MD: I cannot say enough about how much I love our cardiothoracic surgery team. They are great. These people are the real deal and   if you visit our OR, ICU, cath lab, hospital floor, our office, and everywhere in between, you will meet fantastic people that like working with each other, are good at what they do, and genuinely want to help you. We have nurses, techs, perfusionists, physician's assistants, office medical assistants, and surgeons that work well together and really consider each other family;   which is only something you get in this more medium sized hospital setting.  In the operating room and the ICU, our nurses and techs are selected specifically for the cardiac surgery team and they are specially trained in cardiothoracic surgery.

Many of them have been together for years and in some cases decades and there are actually no traveling nurses or techs on the team. Everyone lives locally and is devoted to the team.  We also have fellowship trained cardiac anesthesiologists in every heart operation.   These really great relationships, they translate to great care.

I have a philosophy that every member of our team should be the best at what they do, and I really think they live up to it.

Host: Well, Doctor, we are the only program in the Tri County area to offer Extracorporeal Membrane Oxygenation, or ECMO, to support patients with life threatening lung and heart failure. Can you discuss the importance of this?

Jennifer Wan, MD: Yes, this is so exciting. ECMO, Extracorporeal Membrane Oxygenation, is a device that temporarily replaces the heart and lungs when more traditional treatments are not enough. We have used it for patients with cardiac arrest from heart attacks, heart failure from bad valves, or patients with flu or COVID.

The purpose of ECMO is to support the body until the heart and lungs recover or to act as a bridge to more long term treatments like heart or lung transplant or permanently implanted heart assist devices. Now, we don't perform heart or lung transplants and we don't implant permanent assist devices.

These are the procedures where academic centers really excel. However, when you have heart or lung failure, you go to your nearest hospital, and if things are very critical when you get there, you're often too sick to transfer, and many people go on to die from their illness. So now, for certain patients, if we're able to put them on ECMO, we can stabilize the heart and lungs so people can either recover or be transported to where they can be considered for things like transplants and  permanently implanted devices.

I don't think that our community's access to those types of modern health care should be limited by our distance from a tertiary center. And that's why I think it's really important that we have this type of technology here in our community. We started using ECMO in 2020,   just a little bit before COVID.

  Almost all people who go on ECMO  would otherwise die. But if you are a candidate and you go on ECMO, you actually have a 50 percent chance of leaving the hospital alive and often with a meaningful recovery, which is so amazing.  We have now saved enough people that we even have this group of ECMO survivors that work out together in our outpatient cardiac rehabilitation class. And when I see these guys working out together on their treadmills, it makes me so proud of our team and really happy for their families.

Host: Oh, that is so cool to hear. Thank you for sharing, Doctor. And as we wrap up, is there anything else we didn't touch on that you would like to highlight?

Jennifer Wan, MD: So there are always new technologies and new ideas coming down the pipe, so stay tuned.   We're really committed to offering the best modern heart and lung surgery you can get here in a community setting.

Host: Wonderful, Doctor. Thank you so much for your time and for all the work you are doing. We really appreciate it. You can always find more podcasts and resources online at MyCMH.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.

I'm Caitlin Whyte. This is Wise and Well presented by Community Memorial Health Care.