Transcription:
Types of Heart Surgery

Melanie Cole (Host):  Heart surgery is done to correct problems with the heart but how can you understand all the different types and what they do for your health? My guest today is Dr. Utpal Desai. He's board certified in cardiothoracic surgery at Florida Hospital Memorial Medical Center. Welcome to the show. Doctor Desai, tell us about the heart and how it works. Give us a little physiology lesson to begin.

Dr. Utpal Desai (Guest):  Hi, Melanie. The heart is the main pump in the body. When the heart squeezes, it needs blood and when the heart squeezes, it needs the valves to work properly. So, those are the two main things, as surgeons, when patients are identified as having certain problems with the heart, those are the two main areas that need correction.

Melanie:  So, if somebody is in need off some type heart surgery, how do you determine which? There are so many today that we hear about and so many advances happening all the time in cardiothoracic surgery. Tell us about the different types.

Dr. Desai:  Sure. The cardiac surgeon works with a cardiologist. So, a cardiologist is a physician--medically trained physician--who identifies a certain problem with a patient. Then, that cardiologist works hand-in-hand in a partnership with a cardiac surgeon and the cardiac surgeon can, then, fix certain problems. Cardiologists can also fix certain problems. When a cardiologist identifies, for example, problems with the coronary arteries -- those are the arteries which help your heart get blood and oxygen -- then, if that problem is limited to one artery, sometimes the cardiologist can put a stent there. When the problems are in all the arteries or the problems are involved with diabetics with a weak heart, generally, surgery is indicated for those patients. If the cardiologist identifies that a patient might have an aortic valve problem or a mitral valve problem, the determination about what kind of surgery and when to do it is often made in a partnership with the cardiologist and the cardiac surgeon.

Melanie:  So, what can people expect? They hear “heart surgery,” doctor, and they think back to the days when your whole chest had to be opened up for everything but that's not the way you're doing things today, is it?

Dr. Desai:  It is not. There have been tremendous strides. One of the most scrutinized parts of medicine nowadays is cardiac surgery, so we know very clearly what our mortality rates are, infection rates and we strive towards excellence in those. For bypass surgery, there have been a lot of advances in how we put someone on life support, what arteries and what new pipes we use for bypass surgery, essentially, coronary artery bypass grafting is when we put new pipes on the heart. So, it's like a plumbing problem. The pipes on your heart are clogged. Sometimes, if the cardiologist can do a Roto-Rooter and open up that pipe, that works great and it can be done without opening your chest. Sometimes, if you need a lot of new pipes, that can be done with bypass surgery and that's when we take some veins from the legs, we take arteries underneath your breastbone and we essentially re-route the blood with new pipes to make the heart work stronger. For valve surgery, there are a lot of different new technologies which are helping us fix valves without necessarily opening the chest. For low-risk and medium-risk patients, we still think that a regular, surgical, open-heart surgery is the right way. For patients who are at higher risk, we now offer transaortic valve replacement, which is where we can put the valve through the groin into the heart, position it in the right place, and then deploy this new valve and these patients have essentially a new valve without having anything done as far as opening their chest. So, there are some tremendous advances.

Melanie:  That's absolutely fascinating and, for example, with valve repair or bypass grafting, what is it like for the patient recovery-wise? How soon can they get back to activity; because it used to be lie in bed for six weeks but, now, it's different, too, isn't it?

Dr. Desai:  It really is. If the sternum needs to be opened then, generally, we have patients follow sternal precautions. We want patients to walk the next day. We have patients get very active in the hospital. We do want the bone to heal properly. If we're able to fix the valve with the smaller incision on the side or we can fix the valve by putting the valve through the groin into the heart with this new TAVR procedure, the recovery is much, much faster.

Melanie:  Speak about the TAVR procedure because that's a fascinating procedure.

Dr. Desai:  It really is. So, the TAVR is Trans Aortic Valve Replacement. It's been done for many years in Europe and it has been released for patients in the U.S. for the last three to four years. Right now, the main patients that are done with Trans Aortic Valve Replacements are patients who are considered to be at high risk for surgical valve replacement. A lot of times, we're actually able to put the stitches in the artery in the groin without even an incision. So, some of these patients--a lot of these patients--are getting a valve replacement and they can't even find an incision on their body, which is pretty remarkable when you think about it. So, we can put this valve, which makes a reasonable size hole in the groin artery, we can fix that groin artery from the outside without ever seeing the groin artery. Once we put the valve in place, we can temporarily make the heart stop ejecting just for a few seconds. When we get the valve in the correct place, we open the valve and the valve actually stays in place by holding on to the calcium that was there. So, when we do a TAVR, we don't remove the old valve, we push it to the side and now the new valve works. We've had patients who've had severe shortness of breath for years, whose shortness of breath is better the day of the procedure. It's a remarkable thing. These are patients who, years ago, would have been in the hospital for a long time, having their chest cut open, and have a difficult time with recovery. These patients are now recovering and having a very, very good quality of life.

Melanie:   People hear the word “aneurysm” and they think right away that this is something very, very terrible. Talk about aneurysm repair and what's involved in that?

Dr. Desai:  Sure. Similarly to TAVR, about 10-15 years ago, there was a movement away from opening the abdomen to fix the aneurysm that's in the belly. So, the most commonly found location for an aneurysm is in the abdomen, just below the kidney arteries. I just saw a patient this morning who has this aneurysm and when we looked at the aneurysm with the patient in the office, we told the patient that we will be able to re-line that aneurysm with a stent, again, which is introduced through the groin, and which I think will be able to be done percutaneously, meaning we won't have to make an incision in his groin and he should be able to go home the next day. So, what happens now is again, the same analogy, as far as plumbing. When you've got a clogged pipe, you want to unclog it. When you've got a weak pipe, we re-line that pipe and that's what an aneurysm is. We can re-line that pipe with a covered stent so all the blood stays inside the stent and the aneurysm no longer has pressure and won't burst. So, an aneurysm, nowadays, 90% of aneurysms can be fixed with a stent and the patients will go home in a day. And it's a remarkable thing. And then, we continue to follow them to make sure that that aneurysm continues to shrink.

Melanie:  That's amazing, Dr. Desai. Give us your best advice, your best information that you tell patients all the time about heart surgery and why it's not something that's not as scary as it used to be.

Dr. Desai:  It is a big surgery. It is a major operation, no matter how you cut it and when we're dealing with such an important organ, it's completely understandable that patients are concerned. The important things to remember are the risks nowadays are much, much lower than they used to be. The mortality rates at our hospital are extraordinarily low, less than 2%. The patients’ outcomes are very well-scrutinized and the patients are doing very well. The recovery is excellent. The most important thing is that in the hospital, we have a team of people; the nurses are fantastic, the therapists, the social workers, the whole team around the patients to get them better has evolved to a point where the patients, when they come in, have a clear understanding of what's happening. It's not rocket science, it's plumbing, most of the time. Once we can have the patients understand what we're doing and why we're doing it and the risks involved, they're a lot calmer and they understand and they're anxious to get the surgery done and get on to their recovery.

Melanie:  In just the last few minutes, Dr. Desai, tell the listeners why they should come to Florida Hospital Memorial Medical Center for their care. What's exciting? What are you doing there?

Dr. Desai:  Well, the patient comes first here. It's important for us that quality metrics are carefully and consistently looked at. We have excellent numbers as far as our outcomes and our patient satisfaction scores, the team that the Florida Hospital has arranged and recruited around all of us:  the physicians, the nurses, the therapists, everybody in the hospital, the administrators have one singular objective in mind and that's to take excellent care of patients and we see that every day. The commitment is 100%. I'd say that when a patient comes here, they understand that their well-being in the most important thing; their outcome is the most important thing; making sure they understand what's happening is the most important thing. All of these things make me extremely proud to be a part of this organization.

Melanie:  Thank you so much for being with us. It's absolutely fascinating information. You're listening to Health Chat by Florida Hospital. For more information, you can go to FloridaHospital.com. That's FloridaHospital.com. This is Melanie Cole, thanks so much for listening.