Joey Wahler (Host): Heart failure is the leading cause of death in the United States. So, we're discussing heart surgery. Our guest is Dr. Peter Kane. He's a cardiothoracic surgeon. This is Meaningful Medicine, a Novant Health podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future.

Thanks so much for joining us. I'm Joey Wahler. Hi there, Dr. Kane. Welcome.

Peter Kane, MD: Thank you. Nice to be with you today.

Host: Great to have you aboard. We appreciate the time. So first, give us an idea of what drew you to healthcare initially, and specifically cardiothoracic surgery. Why this for you?

Peter Kane, MD: When I was younger, I wanted to be a doctor. I thought it was exciting. When I was a teenager, I worked on an ambulance crew, and I thought that was great, and that sort of steered me into medicine. And initially, I was very drawn to surgery because of the hands on nature of the field. As I progressed at each step, I found myself gravitating towards cardiac surgery, just because I really enjoyed the technical aspect and hands on approach, and also because I really enjoyed the outcomes that patients got. It's one of the really rewarding specialties in medicine where you see the direct relationship to the work that you do and the patient outcomes, and patients really feel better and can enjoy their lives.

Host: Yeah. It seems like, so often, those that go into healthcare do so largely because of an early experience, like you as a teenager on an ambulance, so not unusual at all. How common is coronary artery disease, and what are some of the risk factors involved?

Peter Kane, MD: Coronary artery disease is one of the most common conditions in the United States. The risk factors are really age, and then there's other important factors like diabetes, and then environmental things like tobacco use, which is still relatively prevalent in our society. High blood pressure, high cholesterol, the things we eat, inactivity, the list really goes on.

And then, of course, the underlying unanswered question is the genetic component that's very strong. And we certainly see people who are doing their best in every aspect of their life to have a healthy lifestyle, but yet still have a genetic component. Of course, coronary artery disease is very strong.

Host: Now, speaking of which, naturally, family history is out of our control, but so many of those other factors you just listed are controllable. So, how important is lifestyle and prevention here?

Peter Kane, MD: Well, they're critical, Joey. We only get one body, and we only get one shot at this. So, you know, we really have to take care of ourselves. And so, eating well, exercising, sleeping, avoidance of stress, avoidance of the triggers of high blood pressure, and all of those things are things that we can do, despite what our underlying genetics may tell us,  will lead to a better outcome.

You know, sometimes I see this small percentage of patients that are really upset because they're having heart surgery, and they say, "You know, Doc, I did everything I could. How did I get here? Why did I get this?" I always tell those folks, "You know, imagine if you didn't take care of yourself. You would have been here ten years ago, and you'd be in much worse condition." And so, you know, truthfully, we're able to make an impact on people with an underlying genetic predisposition that actually take care of themselves as well. So, you know, it's not one of those things where you say, "Well, I got a strong family history, so let me just bury my head in the sand, and I'll deal with it when it comes to me." It's really important to take care of ourselves. It adds an advantage at every step in the process.

Host: No question about that. So, a stent placement versus coronary artery bypass surgery. What are the differences here that those joining us should be aware of?

Peter Kane, MD: Sure. So, they're really different approaches to treating the same problem. And what I try to go over with every patient is, in general, when you have coronary artery disease or blockage in the arteries that lead to the heart muscle, there's really three approaches. One is a pure medical approach that involves all the things we were just talking about, in addition to, you know, certain medications that we know are helpful for your heart. But, you know, lifestyle changes and all of those important things.

And then, the technical things that we can do to fix the coronary arteries involve using a stent to open the arteries up from the inside. So, the cardiologist will come into the artery from either a large vessel in your arm or your leg, typically the radial artery or the femoral artery. And they'll put a small catheter inside your coronary artery and then expand that blockage with a balloon and then put a stent there to prop up the work that they just did and then, surgery, the alternative to that is to reconstruct that pathway. So, rather than trying to go within the congested artery, we're building a bridge around it using extra conduit that we have in the body. We kind of use plumbing terms because, in the most simplistic way, that's what we're doing. We're taking redundant plumbing in our body, whether it's the arteries that live on the inside of our chest, right next to our sternum, or the artery from our radial artery, or often veins that we take from our lower extremities. We use that extra plumbing, or conduit, to build bridges around the blockage.

How we decide what's the right path for each patient is actually a pretty straightforward set of guidelines that have been constructed over time with evidence-based medicine by the American College of Cardiology and they're very easy to review. They're guidelines in regards to the blockages, depending on how many arteries are blocked and the degree to which they're blocked. And then, there's some characteristics that get a little more technical about the types of blockages and where they're located. But we can come up with a score for patients, and we can simply look at, like, do you have one blockage in one artery? That's the simplest form. That's clearly going to get a stent. Or do you have all three arteries blocked or the left main coronary artery blocked in a more complex way? And that's sort of the easiest case for surgery and then, everything else in the middle, the guidelines are actually pretty good at helping us arrive at the right procedure for the right patient and sometimes you get to that with the patient, and there's some wiggle room for folks to make the decision on their own. But we try to lead people in the right direction. So, this is what the guidelines would most support for you and your condition.

Host: Right. So, sounds like a very tried and true scientific process to get there. Now, bypass surgery is being used more commonly today for patients older than in years past. Why is that?

Peter Kane, MD: First of all, people are living longer. There's no question about that and people are living longer, and they're living better, and they're in better condition and techniques and modern medicine allow us to operate safely on patients. That's the key there, is safety and what we've shown over time is that by collecting huge amounts of data, you know, every place in the United States submits all of their data to a large national database, which helps us develop risk models and what it's really shown is that older people do almost as well as younger people with a very small variation in risk. So, at each increment of age over five years, 70 to 75 to 80 to 85, there's a small incremental increase in risk. But, in truth, when we look at all the data, older folks have done really well, and that's why we're able to offer them surgeries that, in the past, were reserved for younger people.

There's a couple of other techniques that have developed over time that also seem to be safer for older patients. Sometimes we use off-pump surgery without the heart-lung machine in some of our older people to preserve their brain and kidneys and to be a little gentler on them, and that's had a marginal increase in safety.

And there's some minimally invasive techniques that we're able to use for some of our older people that may have trouble with larger operations. So, it's really a combination of lots of factors. But what we've really shown with evidence is that those folks do really almost as well as younger people, with very, very small variation in increased risk.

Host: Wow. Very interesting stuff there indeed. So, I want to go back for a moment to something you touched on earlier regarding prevention. What screenings should patients who may have higher risk factors consider here? What should they consider having?

Peter Kane, MD: Well, the first thing is your relationship with a doctor. That's a good place to start. I wish I could say that to everybody I meet has had a long-standing relationship with their doctor, and they've sort of built their way up to this critical time in their lives. But unfortunately, I still meet a lot of people whose introduction to medicine has all taken place over the course of either maybe just a couple of days or hours, but maybe just a couple of weeks because they're just getting involved with their doctor and finding out they have a problem.

So, general healthcare screening is critical, and making sure that we have our weight under control, that our diabetes, which is obviously a huge problem in the United States, that people are really caring for their diabetes and avoiding other risk factors, particularly tobacco use, which is really still prevalent again and still very directly related to coronary artery disease.

But then, there's some other things that your primary doctor may do for you, which is, over 50, is a calcium score. And particularly, there's a whole set of settings in which that may be appropriate as early as age 50 or a little bit later if you have no family history. There's some other symptomatic things. Like if you're having some mild symptoms of angina, you might be referred for a stress test, which is a good screening tool. And then, in conjunction with your primary doctor or your cardiologist, they may suggest a more invasive test like a cardiac catheterization. And interestingly, in the last few years, the cardiac CT has also become a very important tool that the cardiologists use as a non-invasive way of getting some good images of your heart that may ultimately suggest whether you need a more invasive test or whether you need surgery.

Host: Now, of course, whether or not someone has risk factors, it's important to understand concerning heart symptoms. Which are the main ones you see that people should not ignore if they pop up?

Peter Kane, MD: Well, sure. Chest pain is obviously the one that jumps out at everybody first, although it's not quite as common as maybe we initially believed it to be. But certainly, any chest pain with exertion, pain that radiates into your back or down your arm, or into your jaw or teeth or ears.

Angina can be really strange, you know, that sort of funny feeling that comes with some exertion and usually goes away with rest. If you're having those symptoms when you're not exerting yourself, that's even more concerning. Some people may notice weight gain, but particularly if that feels like fluid retention. And that might also be a bit more serious sign of maybe some chronic heart disease that's leading to some heart failure, as you alluded to at the beginning of this talk. But swelling in the ankles and fluid retention, and certainly fatigue. You know, a lot of people say, "Well, hey, I'm older. I expect to be more tired." But that's not really the truth. We don't really suddenly say, "Hey, six months ago, I was fine and now, I'm really, like, having a lot of trouble getting through my day because I'm just exhausted." So, fatigue can really be certainly a symptom that you want to explore with your primary doctor and then maybe, ultimately, your cardiologist.

And then, finally, keeping an eye on your blood pressure. You know, folks will have normal blood pressure for years, and then suddenly you see your blood pressure creeping up and you say, "Well, maybe I'm just getting older." But no, that's something that certainly needs attention.

Host: A couple more questions for you. First, you were named in 2025 to Newsweek's list of America's leading doctors for cardiothoracic surgery based on areas like performance data, peer recommendations, and quality scores. First, congratulations on that and what does that recognition mean to you?

Peter Kane, MD: Well, thank you. That means a lot. It means a lot. It's just a culmination of a lot of years of work. You know, I have great partners and a great team, and I've been in Wilmington for 20 years. So, to be recognized nationally feels great. But it's really a shared thing with our team. It's meant a lot to the team, it's meant a lot to me personally. I think it's really just a reflection of the collective work and effort by all the folks at our hospital to take care of our local community.

Host: And always so important to recognize the rest of the team. Then, in summary here, Doc, you touched earlier on the fact that, naturally, the work you do is so rewarding. What's most rewarding about it? It's amazing to me that someone like yourself, a heart surgeon, gets up in the morning, has breakfast, goes to work, perhaps saves someone's life or at least extends or improves someone's quality of life and then, you go home to your family, I presume. You have dinner, you go about your business. It's amazing to me that within the things that the rest of us lay folks do on a regular basis, that you're doing something pretty extraordinary, to say the least, in between, right?

Peter Kane, MD: Well, that's very nice of you to say it that way, Joey. But, you know, I think what's really rewarding is taking care of patients, honestly. Like, it's funny, I often say to patients, when I meet them, when I'm fortunate to meet them in the office, I usually say, "Hey, you know, nobody actually wants to be here." Like, there's nobody that walks into my office who's, like happy, glad to meet you. But when you see the results and you see people get better and they feel better, that's truly rewarding.

And on the hospital side, I meet about half of my patients in the hospital and half of them in the office, about roughly 50-50 and people in the hospital are terrified. You know, they've just been given a diagnosis that scares them, and rightfully so and then, you know, within a short period of time, they're just not feeling great, and then suddenly someone's telling them, "Hey, you have to have a big operation." and to see them when they leave the hospital feeling better, moving better, understanding that they're on the other side of this huge event is really the most rewarding thing. So, well, seeing patients get better is absolutely the most satisfying part of the job.

Host: Well, what may seem routine to you is certainly still pretty remarkable to the rest of us. Folks, we trust you are now more familiar with heart surgery. Dr. Kane, keep up all your great, amazing work and thanks so much again.

Peter Kane, MD: Thanks very much. I really enjoyed being here today. Thank you.

Host: Appreciate it. Same here. To find a physician, please visit novanthealth.org. For more health and wellness information from our experts, please visit healthyheadlines.org. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks so much again for being part of Meaningful Medicine, a Novant Health podcast.