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Scott Webb: Though none of us wants to face open heart surgery, if that can't be avoided, there have been numerous innovations that can help patients before, during, and after open heart surgery. And my guest today is here to tell us about at least some of those innovations. And I'm joined today by Dr. Michael Tuchek. He's a Doctor of Osteopathy and fellow of the American Board of Thoracic Surgery.

This is the Franciscan Health Doc Pod. I'm Scott Webb. So, doctor, thanks so much for your time today. I know a lot has changed, right, when we think about open heart surgery, whether it's before, during, or after. So, let's start here. What are you doing to help diagnose patients before they have a heart attack, which we all appreciate, or before they have or develop something like advanced lung cancer?

Dr. Michael Tuchek: We have lots of tricks in our bag these days. Obviously, you want to find it before it finds you, right? Screening, low dose CAT scans detect lung cancer earlier so you can cure it sooner with better outcomes. Abdominal ultrasounds detect that ticking time bomb, that aneurysm before disaster strikes and it ruptures. In other words, you've heard it before, an ounce of prevention is worth a pound of cure. So, prevent the deadly complication of a heart attack or a ruptured aneurysm or advanced lung cancer by just getting a simple, cheap screening test. You've probably had one, but the colon prep you did for your colonoscopy is miserable. I've been there, I've done that. Drinking all that stuff. Here, we're talking about a three-minute scan with no prep, no needles, nothing. It's easy peasy. It's easier than taking your blood pressure. Then, you can detect a health problem and prevent it from getting worse, or at least now that you know about it, you can follow it closely now that you've found it or treat it at an earlier stage. If you find it earlier, like a heart blockage, the next procedure tends to be smaller, less risky. Catching it earlier usually translates to better outcomes like a lung nodule, for example. If you find it early, it's a small biopsy, not a big one, earlier treatment, better outcomes, less risk because it's a smaller procedure, better cure rates, less additional procedures, which you really don't want to have, right? So, finding lung cancer early means something like an Ion robotic bronchoscope. We were the first ones in Indiana to have it here at Franciscan. And then if you need real surgery, we use the da Vinci robotic resection. So, it's cured all robotically without big incisions, which is far preferable to finding advanced lung cancer with limited options and obviously poorer outcomes.

So if you get a simple heart scan, it can easily detect calcium blockages long before they cause chest pain or a heart attack. And usually, that's a good thing, right? It's literally lifesaving. So, you find it and you fix it before it finds you. If you get a quick scan, you see a blockage, you start treatment earlier because you got to scan early before you had symptoms and that means they'd be on medications only. You never need the additional procedures or big open heart surgery. And even if you do, that's a far better option than having a heart attack or something. So, find it before it finds you, getting the cheap and easy screening test. I did it myself, I myself, because I know the advantage and I'll set you up for one if you need one, Scott.

Scott Webb: Sure. Yeah, I appreciate that. And it's music to my ears and I'm sure listeners as well. I also know that there's been a lot of recent innovations when we think about heart surgery that probably would be surprising to me and to listeners, not to you an expert, but to the rest of us. So whether it's the sternal closure device or ERAS or anything else, tell us about the stuff that's got you excited and is really surprising to patients.

Dr. Michael Tuchek: I think the biggest complaint patients have about any operations, the big incisions, which they equate to more pain, longer recovery, that just isn't the case anymore. In major open heart surgery, we used to close with wires. And now, we start with nerve blocks, which stop the pain before the actual incision is even made. We use better anesthetics during surgery and we close, not with sternal wires, but with sternal plates. Very simple, very effective, decreases pain. Recovery time across the board is down, right? Patients wake up and they're wondering, "Why doesn't it hurt? It happened just yesterday," a patient asked me that.

The orthopedic surgeons figured this out a long time ago, and they repaired broken bones with plates and screws, and people were back walking in no time, no cast needed. When I was young here in the area, I broke my leg three times and I was in a cast, the last time for six months. Now, we learn from them. We do it the same way for the breast bone. So, it's so effective that many open heart patients go home two or three days after a triple bypass, not two or three weeks, two or three days. They're also able to drive not four to six weeks later, but one week later. In fact, they drive to their own first appointment. Most of them don't need anything but Tylenol when they go home. Not all the narcotics like they needed in the past. And part of that's because of the ERAS program, the Enhanced Recovery After Surgery program. It's a program designed to prehabilitate patients, that is to get them tuned up before surgery, better nutrition, more activity if they can do it, if their disease process allows it. A bit like training for that 5K. You don't just put on gym shoes and run it and expect to do well. You train for it, you eat better, you sleep better, you exercise, you run often every day to build up your endurance. We do essentially the same thing now preparing for any kind of surgery, but preparing that patient for their sort of personal health race.

In the hospital, we changed almost every aspect of their care to minimize pain and maximize outcomes. So, quick operations, getting off the ventilator in a few hours, not overnight like we used to do it, getting them moving as soon as possible because we use a small scope, for example, to take the vein for bypass surgery for heart blockages. We don't have these big long leg incisions, so patients can walk immediately after surgery and that translates to less blood clots, better outcomes, less pneumonia, less complications, they get discharged in two or three days.

Thirty years ago, the patient stayed in the hospital, when I was training, seven to 14 days for a routine double bypass. Those days are gone. And here at Franciscan, we got a five-star Healthgrades rating and the highest rating for CABG, coronary bypass grafting by the STS. It's only 180 hospitals out of 7,200 hospitals that got it. And in part, that's because of these innovative technologies combined with improved programs like that Enhanced Recovery After Surgery.

So, thanks to all those changes we've made here over the past few years, people are sitting up in a chair, eating breakfast the next morning after a major open heart procedure. Dr. Gerdisch, my partner down in Indianapolis, was instrumental in doing the research and promoting the advantages of ERAS nationwide. And here at the Franciscan system specifically, it's now being adopted, kind of like the orthopedic surgeons, we stole from them. It's being adopted by all the surgical subspecialties, so they're now doing ERAS also. So when patients drive in for their one week post-op visit, they have the biggest smile on their face and that's very gratifying to me. And that's in part because of these changes.

Scott Webb: Yeah, it really is amazing. And you mentioned the use of nerve blocks, you know, during the surgery. And I love anytime I can talk about robots, whether it's da Vinci or TAVR, you know, and anything where the technology-- of course, the doctors are still doing the surgery, but when we think about minimally invasive surgery and techniques and nerve blocks, maybe you can just kind of go into that a little bit. I get excited just talking about it, and you do this on a daily basis, but it's pretty amazing.

Dr. Michael Tuchek: Open heart surgery is very different than it used to be. It's nothing like what it was. From a purely technical point of view, it's like the difference between a Ford Pinto and a Ferrari, right? The technology and techniques we have that we used to use were good, but they're unimaginable. Now, when I was in training, it was antiquated, almost cavemen-like compared to what we do now, like the changes in the original telephone versus the fancy iPhone. We all use the kind of neuromonitoring we use in anesthesia and some of the anesthesia techniques makes it a lot safer. The procedure is safer, it's a better experience for the patient. We have instantaneous lab readouts thanks to new technologies, so you get instant changes and they can be changed right in the operating room, so that it's now safer from beginning to end.

The techniques we use in the OR, like the leg vein harvest I mentioned, didn't exist back in those days. Taking it with a scope was unheard of. Now, we have advanced devices even for the heart, the way we go on the heart-lung machine and whatnot, which protects it, meaning the heart's stronger, we're done with the procedures faster, it minimizes risks like congestive heart failure or arrhythmias after surgery. Afterwards in the intensive care unit, we've got technology that allows me to see all the patient's vitals at home all securely right on my iPhone, so I know what's going on 24/7. So, I can chime in anytime necessary when it's appropriate. Obviously, we can use some of those game-changing technologies you mentioned like replacing a heart valve without opening the chest or going on a heart-lung machine, right? Sometimes even when you're awake, right? When you're in twilight, we can do that. Aneurysms can be fixed the same way. We avoid the big operations in the abdomen. You go home the next day.

So, it truly becomes a team sport with all these technologies. It usually does, as it's popular to say, it takes a village, right? We've got anesthesiologists and cardiologists and surgeons and nurses and perfusionists. You can't play baseball with just a pitcher, you need that full team. And part of that is the team, and part of it's the technology. So within this village of specialists here at Franciscan, we can diagnose and treat complicated patients with advanced diseases, truly sick people, and cure them as well as sometimes even more effectively and certainly more efficiently than the academic centers because we're focused and because we're local.

I'm a Professor of Heart Surgery at one of the academic centers in Chicago, and we can provide academic care right here in our own backyard. And this is my backyard, as you know, because I grew up here just down the road on a farm. So, I take this community and the patients very personally. I've operated on high school classmates, which is kind of scary operating on my people. But you have to take care of my peeps like I would my mom or my dad, and you just can't get that kind of care anywhere but here, local, rather than traveling, you know, across the state line or five hours to the Mayo Clinic, like my parents would do 30 or 40 years ago. It's different. So, you get university level care here in a very personalized fashion, and that makes open heart surgery here truly different, above and beyond the technical improvements, right?

We have robots, you mentioned robots. We have robots for everything these days for certain kinds of procedures. It improves the accuracy in finding a tumor. For example, you remove it with no big incisions. It's all done robotically. That's a great thing. We have a big program here anchored by Dr. Fitzgerald, my partner, and Dr. Infusino, the pulmonologist. Ironically, we even have robots that deliver food trays to the patients here. So, robots are taking over, but they're only an adjunct procedure, right? They only help, they don't hand the patients the food. They don't feed the patients with something, but they're there to help us. So, academic centers used to be the only place to get this kind of high-tech treatment. Not anymore. This state-of-the-art care is available right here, second to none, in all of the Franciscan institutions.

Scott Webb: Yeah, it's really amazing. And of course, I was thinking about your Pinto reference. You have to be a certain age to get that reference, but I definitely grew up in that era. Pintos and Gremlins in those early '70s, time bombs, if you will. Really educational today and interesting to know, you know, that because probably many of us would think, well, for these really complex procedures, you probably need to go to an academic center. And as you're saying, you really don't. You can come to Franciscan Health. And I also was reading about and was sort of surprised, you mentioned earlier about things that patients are surprised about, that you can do more than one procedure at a time. You can do multiple things at one time. Juggle a few things. You just mentioned the team and all that. Maybe you can take us through that. How does that work? How do you do multiple heart procedures at the same time?

Dr. Michael Tuchek: Well, you know, over the years, thanks to all changes in medicine and all the upgrades in technology, heart surgery has become a lot more complex, in part because the patients have gotten sicker and sicker. We're able to take care of them with less invasive diagnostic and treatments like stents and medications and whatnot. So if they need heart surgery, they tend to be pretty complex and pretty sick. So when your car breaks, for example, speaking of old cars, right? The Pinto. How about a Vega? Remember that?

Scott Webb: Oh sure. Yeah.

Dr. Michael Tuchek: But when that breaks down, it's usually the battery and a rusty cable and a bad starter and a bad alternator and a broken belt, and a cracked radiator, right? It's all those things. Just read the next repair bill. It's never just one bad spark plug. Heart disease usually is no different. If you feel palpitations at home, a little flutter in your heart, and you're a little bit fatigued and a little bit winded, some people, "Eh, I'm just getting old." Well, you may find out that you've got atrial fibrillation, an irregular heart rhythm, and maybe some heart blockages once we look that might need some addressing. And maybe you've got a bad valve. So now, you need a maze procedure, fancy procedure to fix the irregular heart rhythm and some bypasses or stents to fix the blockages, and a valve replacement. So, you've got these complex procedures, three surgeries all at the same time, and we do this kind of complicated surgery all the time here at Franciscan. It's now the new norm for us because the patient population has gotten so much sicker. We've got a multidisciplinary team of specialists, as you mentioned here, just like in the academic center because these are the kind of patients we are taking care of every day.

You know, patients are too frail, talking about technology, if they're too frail for this magnitude of an operation, multiple procedures at once, we do have the technology and expertise to do a series of staged lesser invasive procedures if they qualify. So taking that example, if you have that atrial fibrillation, that irregular heart rhythm, you can do an ablation in the cath lab through the groin or the Watchman procedure, again all through the groin, to decrease their risk for stroke because of that irregular rhythm. If you've got blockages, do stents for certain kinds of heart blockages. If you have a bad valve, you can do a transcatheter valve, put the valve in through the groin, sometimes, as I said, while you're awake.

So, there's lots of different procedures and certainly they are less invasive for frail patients with multiple heart problems. Either way, you have that, as you mentioned, the one-stop shop for those complex heart problems, whether it's the big surgery with multiple procedures or multiple smaller procedures for patients that just don't qualify. Best yet, you don't have to drive to an academic center in a different state for that appointment a month and a half from now, you can just come right here locally and we'll be happy to see you. And because of our connections to the academic centers, like I said, I'm from one of the academic centers, if you really need a heart transplant, something that really needs to be done at an academic center, I can make that happen with one phone call. So, it really is that one-stop shop no matter how complex the heart problem is.

Scott Webb: Yeah, it's really amazing. I wish we could talk all afternoon, but we are going to wrap up here. And as we do that, doctor, what's the common thread that runs through all of this? What ties it all together?

Dr. Michael Tuchek: I think at the end of the day, Scott, when patients are thinking about cardiac or vascular lung disease, they have to forget what they thought they knew back in the day when they saw their mom and dad being treated with big surgeries, long length of stay, long recovery, so many changes have taken place. That old treatments are hardly recognizable even by me and I went through that because the current state of treatments, the state-of-the-art treatments are so different, right? Robots even delivering food as we said, and stent grafts and minimally invasive options. And they're more effective, easier recovery for patients, shorter length of stay, less narcotics as we talked about. So, even complex open surgeries done the way we do here at Franciscan benefit from new technologies and advanced recovery protocols, making it better, stronger, and faster. Remember Six Million Dollar Man, right? Better, stronger, and faster for patients. And at the same time, doing it locally, not having that hour and a half drive, which keeps the family close for emotional support that every patient needs during their recovery. It's a powerful one-two punch that never really existed here in the region before.

So for example, many patients have my cell phone. I had to get an iWatch recently because I was feeling so many questions. It's a little bit tough for me, but I'm an analog guy sometimes. But we are accessible and we're local and that makes us different. We have a full complement of the kind of staff you need to take care of complex patients, get the diagnosis, get the treatment, kind of like a concierge that helps guide you through the process so you can focus on the care you get not on how to get there and what's the rush hour traffic downtown and where's the lab and radiology. We have it simple, it's guided and focused, so that you can get through that process with minimal hassles, maximum efficiencies, no matter how complex the heart surgery is. So, that complex threat ultimately is the personal touch, combined with the technical expertise and the state-of-the-art technologies that you and I have been talking about to make sure that every patient gets the kind of treatment and care that I would want for my mom and dad. That's our goal here at Franciscan.

Scott Webb: Doctor, this has been great. Really educational. You have such a great way of explaining all this stuff in layman's terms that even I could understand. So hopefully, that's good for listeners and they take your advice. Early diagnosis, that ounce of prevention, all good stuff. Thanks so much and you stay well.

Dr. Michael Tuchek: Thank you. You too, Scott. Take care.

Scott Webb: And for more information, please visit franciscanhealth.org/heartcare. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.