Scott Webb (Host): It may come as no surprise, but men and women are different. That's especially true of our anatomy. And my guest today is going to tell us about the differences between men and women when it comes to cardiac and thoracic surgery.

I'm joined today by Dr. Manesh Parikshak. He's a board-certified cardiovascular and thoracic surgeon practicing at Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb.

Doctor, it's a pleasure to have you here today. We're going to talk about cardiac and thoracic surgery, especially related to women. So let's just start there. What are some of the differences in surgical outcomes for women?

Manesh Parikshak, MD: So you have to really look at the physiology of men versus women. Men are, you know, typically larger build. They have more muscle mass, they have a better bone density typically. So that all plays into both thoracic and cardiac surgery. When you look at women, the anatomy in women tends to be a lot smaller.

So when we talk about doing specifically say, heart bypass surgery, where we're operating on the arteries of the heart. If you look at the films, catheterization films of both men and women, you're going to notice that men tend to have bigger arteries and women tend to have smaller ones because their heart structure is smaller.

And so typically their vessels, or targets, that we use, in terms of doing bypass tend to be smaller. That somewhat portends a poorer prognosis for women compared to men. Because if their arteries are smaller, then sometimes it limits us in the operating room to being able to completely revascularize them.

And sometimes it also, portends a poor prognosis because even if we do bypass them, if their arteries don't have enough runoff or ability to provide good blood flow, then the bypasses may not last as long. So that is one thing that's been shown in the literature that unfortunately women tend to do poorer than men when you look at them from an overall surgical standpoint, from heart surgery.

The two other issues that we run into is bone density. The sternum or the breastbone in men tends to be a lot thicker. So when you put that bone together, it tends to heal a lot better and a lot quicker. In women, a lot of the women that we see are in their, you know, sixties, seventies, they've gone through menopause and they're having some of the osteoporotic issues with their bone.

So when you start to put that bone together, it tends to be a lot more fragile. And that bone to become dense and thick again can take quite some time. And so their healing tends to be a lot slower than it does in men. And then, the other issue that we run into with women is the distribution of their fat or adipose.

You look at men, we tend to hide more of our adipose internally around our visceral organs. Women tend to have a lot more you know, adipose tissue on the outside, and especially when you look at the chest surgery, we're dealing with the breast tissue and, chest wall mass, and it tends to be a lot more complicated in women.

So when you're making an incision through that tissue and having to then get through that adipose to get to the sternum, it makes it a little bit more challenging in terms of getting wound healing for women compared to men. So those are kind of the big things that we face when we separate men from women in terms of heart surgery.

Host: Right. Yeah. It's so good we have experts, doctor, because you know, I just, a lay person, I'm thinking, well, we're all pretty much the same. We all have the same organs and stuff, you know, but you give us a good sense there of the differences, not only in the size, generally between men and women, but some of the other complications.

So yeah. Great to have you here. Great to have your expertise. Let's talk then about some of the advances in minimally invasive and robotic procedures. I love conversations about robots. I get excited about that. That's the 15-year-old, kid in me, you know? But let's talk about that. Like what are some of the advances and how are they helping patient's or, and helping you during surgeries, post-surgery, all that good stuff.

Manesh Parikshak, MD: Sure. The benefits of you know, minimally invasive surgery is, you know, kind of threefold. First, you try to minimize the incision so that there's less tissue trauma and that you're trying to give them the same outcome from an open surgery as you would with minimal access or port access type surgery.

Second is hopefully by minimizing the tissue trauma, you also have less bleeding, so potentially they'll have less need for blood products. And then three, it's better cosmesis. So when we look at, you know, heart surgery, in specific for minimally invasive techniques, robotic surgery is one of those things that's more up and coming with heart surgery.

Host: Okay.

Manesh Parikshak, MD: Robotics kind of started to take off about 15 years ago with heart surgery and it's still, I would say in its childhood state. It's not really matured well to the adult form yet because it is not as precise, if you will, than when you're looking at things from an open standpoint when you're doing the surgery. It takes a little bit more to be able to look at something through a camera and then try to access it with instruments from outside the chest to do as effective of a repair sometimes or surgery as you would do with an open area where you're actually able to physically get in there and touch the organs and or, the valves or whatever that you're working on.

But, it is advancing. We do use some minimal invasive techniques where, you know, sometimes when we're doing valve surgery, instead of having to go through the middle of your breastbone, we are now able to make incisions that, especially for women, sometimes we can go underneath the mammary or their breast and go in the inframammary fold so that it hides the incision for them and we can go through the ribs on that side and get to the structures to be able to do the surgery.

Sometimes we're able to make an incision, a smaller incision, rather than going through the entire breastbone. We're able to go through just the top, maybe, you know, two-thirds of the breastbone and then basically just have a smaller incision. The biggest things I think for us, not necessarily from a minimally invasive standpoint, but it's more in the recovery standpoint, which is kind of the, you know, exciting part for us from a surgical standpoint.

What we've seen over the last decade is how we have changed, how we take on putting the breastbone back together if we have to do a full open incision. In the past we used to use wires and people used to call them like chicken wires to put their breastbone back together. And it's kind of just simple wires that go around the bone.

We twist them together and it holds the bone together. But if you can imagine every time you cough and sneeze, the wires can kind of push a little bit. The breastbone can move a little bit. And so, it tends to lead to more discomfort and a longer time healing. About 10 years ago, we started switching to a more orthopedic closure.

So orthopedic surgeons, they know that when you break a bone, in order to fix it, it has to be immobilized and put together. So we started using plates and screws to put bone back together, and that's really, in my opinion, the biggest advance that I've seen in the last decade in heart surgery. By putting that bone together with plates and screws, the bone doesn't move.

It basically allows the bone to heal quicker and it allows patient's to get up, move and basically get back to their life quicker. I have patients that, you know, are younger patients in their fifties that come to me. We do a heart surgery on them, and they're ready to get back to work within about four weeks of surgery.

In the past, it used to take anywhere from six to 12 weeks to recover from a sternotomy. Now they're ready to get back to work and they're playing golf and doing all the things that they need to to get back to their life, and that's the end goal. We have a lot of techniques now to improve cosmesis of tissues.

We're actually looking at a product right now that we've been using for the past year, which has, you know, zinc and silver inside the matrix of the dressing that we put on the incisions. And basically there's an electro current, which is kind of cool, that transmits through the dressing into the wound and helps with the healing.

And we've seen remarkable cosmesis with the wounds that we're closing. So a lot of new things that are popping up and, you know, making things a lot more appealing for people that need to have chest surgery. It's not just you're going to get your breastbone cracked. Now we really think about the outcomes, the cosmesis, and how they're really going do in getting them back on their life curve.

Host: Yeah, absolutely. As you say, it's so cool. And it's just like, my dad had open heart surgery and so he had the old chicken wires, you know, and, and it was sort of explained to me and I was like, well, how do you, how can you move? How can you sneeze? And, he's got a pretty, you know, nasty scar on his chest, so you're kind of addressing all those things, right?

So making the surgeries a little easier, a little faster recovery, better, faster, smaller scars, all that good stuff. Like that's just music to a potential patients ears, of course. And, and I figure if an expert like yourself is saying, it's cool, then it must be cool, right?

Manesh Parikshak, MD: It is. It's amazing. I mean, just like you, my father had heart surgery.

You know, he walked around with a heart pillow for about six, eight weeks. We don't do that anymore. Our patient's don't need to wear a heart pillow. They're showering when they go home. They're able to lift their arms above their head.

They're able to get up out of a chair, do all those things. So it's just a remarkable thing to, to see people get back to their life. Because that is the end goal here. You know, you have a problem, we can fix it, but our goal is to get you back to your life.

Host: As you say, when my dad walked out of the hospital, well, they got wheeled out of the hospital after his surgery. He was holding his heart pillow up against chest. So a little trip down memory lane. But, great to hear the advances for men, women, everybody. Let's finish up today, doctor, and talk about the importance of early detection for better surgical success.

Manesh Parikshak, MD: Yeah, absolutely. I mean that is kind of the biggest thing for knowing your risk factors, but also we have testing that is now available to everybody who has potential risk factors for heart disease. We know that, you know, the big things that lead to heart disease are high blood pressure, cholesterol, smoking, diabetes, and family history.

So, you know, for me, I know that I have family history. I have a little bit of borderline cholesterol and I have a little bit of a borderline high blood pressure. I don't need to be on medications for all that, but it's something that we monitor. But I just actually set myself up for a heart scan and I had to basically get a small questionnaire, a few questions, and they basically said, yes, you qualify.

And it was a test that may be paid by, by my insurance, but if not, it's a $49 test. It's a CAT scan, it's non-invasive, and they're going to look for calcium in the coronary arteries. They're also going to do a lung scan where they're going to look at my lungs and make sure there are not any lung nodules that we need to be concerned about.

And you know, it's a simple test that can actually help save lives. If you see somebody that has a high amount of calcium in their arteries, then that is a concern that they may have significant blockages. And so that can lead you from that non-invasive test to then go on to get evaluated. And we are seeing so many patients that are now coming in after these tests that then go on to have their heart catheterization and they find pretty significant disease.

And the patients themselves may have noticed that, you know, I'm a little tired, a little short of breath with activity, and they all chalk it up to getting older, but it's not the stat. It's actually that they have heart disease that they didn't know about. And then we can intervene while their heart function is still good, they haven't had a heart attack, and then their outcomes are so much better.

Host: Right. Yeah. And we think about the realm of remarkable is, was a thread running through today. You know, for $49, as you say, whether insurance pays it or not, that $49 investment is probably saving a lot of lives, as you say, as we talk about the importance of early detection, right? To just know and, and so many of us, doctor, we all chalk it up.

I'm 57. I chalk things up like, well, I'm old, I'm old now. Things are supposed to hurt. I'm supposed to be a little out of breath when I do this or that or whatever. So I really appreciate your time, your expertise today. Thank you so much.

Manesh Parikshak, MD: You're very welcome. My pleasure.

Host: And to learn more, 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.