Transcription:
Dissecting Cardiac Surgery

Liz Healy: Hello, listeners and thank you for tuning into the Well Within Reach podcast brought to you by Riverside Healthcare. I'm your host, Liz Healy. And joining me today is Jennifer Dole, who is an advanced practice nurse with our Riverside Heart and Vascular Institute's Cardiac Surgery Team. Thanks for joining us today, Jen.

Jennifer Dole: Thanks for having me here today, Liz.

Liz Healy: Yeah. Would you be able to give us a little bit of background about yourself? You know, some of your education and why you chose cardiac surgery?

Jennifer Dole: Sure. So, as Liz said, my name is Jennifer Dole, and I am an advanced practice nurse in cardiothoracic surgery here at Riverside. I've been part of the team here for about eight years now. And actually, I was born and raised in the Kankakee area. So locally, I attended and graduated from Bishop McNamara. Then I went to college at Loyola University, Chicago. And after graduating, I started working in a surgical heart ICU where I actually took care of patients after having heart surgery, which really kind of drew me to the field. And then over time, I kind of went back to school, got my masters, and then an opportunity arose for me to kind of come back to the area and work at Riverside, which I was thrilled about, considering I still live here with my husband and my children.

So, you know, when I explain to patients about what my role is on the team, I basically say that I'm everywhere, but the operating room. So essentially, I help guide and care for patients throughout the entire surgical process from before surgery to the postoperative hospital stay and beyond in their outpatient recovery. So I'm pretty much everything short of doing the operation itself. So we'll leave that to Dr. Simsir.

Liz Healy: Yes. And hey, your role is just as important. It's the handholding before and after. So as you said, we have a great team of surgeons, Dr. Simsir as well as other support members. So we're going to talk a little bit about the background of cardiac surgery. So is it obvious when someone needs cardiac surgery? So are these like planned surgeries or are they things that are performed in an emergent situation?

Jennifer Dole: So you can't tell from looking at someone that they do or they don't need open-heart surgery. You can only tell this after they have a series of testing done, usually what's called a cardiac catheterization or some people call it an angiogram or an echocardiogram, which is essentially an ultrasound of the heart where they kind of look at the inside of the heart and how the walls are moving and the valves are opening and closing.

So usually, after these testing, it can be determined if a heart surgery is necessary or not. And these tests, you know, unfortunately, doctors just don't order and do these on everyone. You can't just, you know, go to your primary care and order up a cardiac catheterization. So, you know, you have to be doing them for a reason. So a lot of times they're done in response to something that's happening with the person. So either they're having some chest pain or shortness of breath, or maybe they're retaining some fluids or having some racing heartbeats, I mean, really like there is a wide spectrum of different symptoms that can be caused from heart problems, which usually, you know, will cause a cardiologist, you know, a different kind of heart doctor, a little bit different than us in surgery, to sort of order these tests.

And, you know, most of the heart surgeries that we do here at Riverside and actually in general are done on a planned basis. So sometimes we can do the planning for surgeries weeks to months in advance when patients are still at home. Other times, we have to plan for surgeries done more urgently, you know, within a few days when the patients are in the hospital. Very rarely I would say do heart surgeries have to be done emergently or right away. And that usually would be if someone is, you know, really in a desperate situation and has to get in there quickly to have something done.

Liz Healy: Yeah. So, movies and shows are kind of misleading because it's like you go into the emergency room, "I need open-heart surgery." So that's not often the case.

Jennifer Dole: It is not often the case. And, also open-heart surgery is not necessarily something that we can kind of recruit people off the street, that are ready and willing to have that done. One of my favorite shows that I used to always watch was Grey's Anatomy and, you know, my husband would be like, "Wow." and it's like, no, people don't go from, you know, having a breathing tube in to then being awake and talking the next minute. So yeah, you kind of keep things in perspective about what's reality and what's not.

Liz Healy: Yeah, for sure. So you kind of touched on it a little bit. Let's talk about the process. So you find out you need open-heart surgery because you've had these tests done. Then what happens?

Jennifer Dole: So after it's been determined that a patient needs heart surgery, we initiate a series of tests to basically more completely evaluate a patient, determine if he or she has any additional risks or concerns with undergoing surgery. Routine testing done before having heart surgery usually consists of blood work, urine studies, a chest x-ray and an ultrasound of the carotid arteries, which are the big arteries that bring blood to the brain to make sure they don't have any blockages in there. Sometimes we might have to perform some additional testing, like CAT scans or lung function testing, but that's not always the case. We also meet with patients and families to provide further education on the disease itself, what to expect before, during and after surgery so that, you know, patients and their families alike are as well prepared, you know, to undergo surgery as what they can be. So we don't like to have surprises and stuff after the fact. So we really make sure that everybody's kind of on board and we're all on the same plan and everybody has all their questions answered before surgery, which I think helps to kind of ease and relax patients because there's not very many more major surgeries that someone could have in their lifetime beyond cardiac surgery.

And then once we kind of come up with a date of when we're going to do things, the surgery itself is somewhere around four to six hours in length, and that's pretty standard from the time they start to finish. And a usual stay in the hospital after patients having heart surgery is about five to seven days. Sometimes we can get patients home in as soon as like four days after surgery, but that kind of depends. But what's nice is that, you know, after surgery, every single day, you know, the patients will be visited by, you know, us and surgery. So they'll see their surgeon, they see their cardiologist and they also see a hospitalist physician and we all kind of work together to sort of guide patients and, you know, determine when they're doing well enough to go home.

Liz Healy: So that's one thing that kind of comes to my mind hearing that you could possibly be in the hospital for seven days, that you want to be somewhere that your family can visit you. So what are some things that a patient should consider when they're thinking about like where they're going to have their cardiac surgery performed?

Jennifer Dole: Yeah. When patients are considering where to have their cardiac surgery, there's obviously a lot of things to consider. So, you know, first, you want to go to a facility that places a strong emphasis on quality outcomes. So here at Riverside, we participate in the nationally known Society of Thoracic Surgery Database. Thousands of other open-heart surgery programs across the country participate in this too. And we are very proud of our quality outcomes and commitment to maintain the highest standards of care here at Riverside.

Next, you know, you want to go with obviously a care team that you trust. So here at Riverside, we aren't the largest of health system as some of these tertiary centers up north. But in some ways, that allows us to form more personal relationships with patients. So when you come to Riverside, you're not a number. You know, you see your surgeons every day. You know the members of your care team. And you're not only going to see them in the hospital after your surgery, but you're going to see them also in your outpatient followup, which will go on forever.

And then, you know, last, obviously you want to choose a facility that is experienced in performing the kinds of procedures that you need. So here at Riverside, we pretty much cover the entire spectrum of all open-heart surgeries that there are out there. We do everything from the most common CABG surgeries, which we call coronary bypass graft to valve surgeries to even more complex aortic and minimally invasive procedures like the TAVR that we started doing here at Riverside within the last few years. We also have advanced technology equipment such as Impellas, ECMOs and ventricular assist device to even help with those very high risk patients that otherwise probably a few years ago only had the option of traveling outside the community.

And the best news of all this is that, you know, we're right here in the community. So we are close to home. We are close to family, close to all your doctors for followup and anything that patients would need after surgery. They don't have to deal with the stress of traveling a distance during what is inevitably a very stressful situation to begin with.

Liz Healy: Yes, and location is definitely key and would be in my mind if I were in the situation where I was going to have open-heart surgery. I'd want my support team around me and to fully trust the team that is doing the surgery. So you kind of touched on one surgery in particular I know it's a pretty common one as I've recently heard about it through family situations, and just out looking at heart information. Can you talk a little bit just briefly about what the CABG procedure is?

Jennifer Dole: Sure. So CABG on the contrary to being a round green vegetable is what we call -- it's short for coronary artery bypass graft surgery. So this is the type of surgery when patients have very tight blockages in the major arteries that bring blood to the heart muscle.

This surgery is performed if patients are deemed to not be a good candidate for stenting procedures, because obviously patients should have whatever procedure needs to be done that's going to be the least invasive. So, open-heart surgery is not necessarily what anybody wants to have done, but, you know, there are certain situations where patients may not be candidates for having their more minimally invasive procedures with the cardiologist.

So in this surgery, we actually don't remove the blockage from the artery, but rather we bypass, like the name says, or reroute the blood flow around the blockage. And we use a combination of an artery that runs under the chest wall called the mammary artery. And then we take a piece of vein from the leg to essentially lay new pipes for the blood to go through. So in doing this, we protect patients that have very tightly blocked arteries from having a major heart attack before it's too late. And nationwide, CABG is still the most common open-heart surgery performed. So, it's a pretty bread and butter procedure. Whether you go here or you go to, you know, a place in California, the same process and that they've been doing out there, we do it here, so...

Liz Healy: Okay. And that's really good to know, that we can do those common procedures as well as some of those more complicated ones that you've mentioned previously. So we've kind of touched on it. When you have a cardiac team, who makes up that team that would be helping you through this process?

Jennifer Dole: So that's one thing at Riverside that we do a very good job of, I think, kind of having, you know, a smaller community atmosphere is that it is really a team that works together with patients. So, that team usually consists of, you know, a surgeon. So we have Dr. Simsir, we also have Dr. Curran who newly joined Riverside and is assisting us in our surgeries. We have a cardiologist on board. There's a variety of cardiologists in the area and we know them all well, and we communicate back and forth about patients on a constant basis. You might have some staff members like me or some of the other advanced practice nurses that work in cardiac surgery. We have a physician assistant named Drew who assists. You know, when I say I'm everywhere, but in surgery, that person in surgery that's helping Dr. Simsir is Drew, and he's our physician assistant and he helps him firsthand. And then, you know, you have all the nursing staff from the operating room to the intensive care unit or step-down unit. They all are very specialty trained nurses that have gone through a lot of education and teaching to be able to care for patients after this, you know, very specialized area of practice.

And then, I think the list could honestly go on forever because there's therapists, we've got great cardiac rehab department at Riverside. They come, they help rehabilitate our patients in the hospital and then afterwards. And we have all of our office staff. So we do a very good job here at Riverside of kind of having a well-oiled machine and that everybody kind of has their job and knows their roles. And we all work very good together and communicate together. And, you know, obviously, that's all done in the best interest of the patient because we know that communication is key, especially when dealing with something like undergoing this huge, you know, milestone surgery in your life that you want to have everybody kind of in your corner and working together to make sure that you have the best outcome possible.

Liz Healy: Yes, for sure. Especially your heart, you need that to live and be alive. You want to make sure that you're going to have the best outcome. Are there certain things that make Riverside's approach to cardiac surgery so unique?

Jennifer Dole: I would say that that teamwork atmosphere definitely makes it unique. Just having been someone who's kind of been to some of these larger programs, I think that here, what we can do is we can kind of capture and capitalize on that kind of personalized patient approach. So, you know, patients, they see the doctors every day. They can call our office anytime and, you know, actually get us directly on the phone right away. I think that really kind of sets our program apart from a lot of the other ones.

Liz Healy: Yeah, for sure. And I know something that you just mentioned was our cardiac rehab. And understand that's literally just upstairs. If someone can't go home, you know, that day, like we do have the cardiac program right here at the hospital. They don't have to go a hundred miles to some specialized program up north. So I think that's definitely also a great benefit.

Jennifer Dole: And actually, I mean, rehab, we have a couple really good options for patients. So if patients after surgery, you know, because most of the patients we're dealing with, we're talking about people who are mostly in their 70s, 80s and sometimes they need a little bit help to get stronger before going home. So here at Riverside up on the fourth floor, they have the acute rehabilitation unit where patients can kind of go as a stepping stone to get intensive therapy, to get stronger so that when they go home, they're a lot more better prepared and equipped to take care of themselves and end up coming back to the hospitalist.

And then, we have our outpatient cardiac rehab department, which really anybody who has any sort of heart procedure, be it heart surgery or stents or heart failure. It is a program where patients will, once they kind of get back home, can come back to the hospital three times a week and they put patients on a heart monitor and they have special staff that essentially do therapy and kind of monitor the response of the heart to that exercise. And we're excited because we hear that cardiac rehab may be coming to Bourbonnais. So we're going to be expanding our services and hopefully being able to bring it to more patients closer to home.

Liz Healy: Yes. I also heard that great news. So can we talk a little bit about the experience a patient might have who's considering having cardiac surgery at Riverside? So obviously, their cardiologist is going to have to have run these tests and we're going to have to be to the point where it's like, "Okay, we need to start exploring this option," but is there like a referral process into you guys if someone gets a referral, and they're like, "Oh no, you have to go up north"? Can people call you, call your office directly?

Jennifer Dole: Yeah, absolutely. Obviously, like, you got to have a little bit of testing done to know whether you need heart surgery or not. But I would say almost all the patients that come to us, they're filtered through a cardiologist. So someone has to have an angiogram, they need to have testing. But you know, if they hear from one doctor that, "I've been told I need open-heart surgery and they want me to go here. What about Riverside?" You know, they're welcome to call up our office and we will kind of look into things and see what testing they've had done and get the films and the images. And we'll kind of do all that legwork to sort of take the stress off patients who have kind of an already stressful situation that they may not understand what's going on. So, you know, we will kind of help kind of walk them through that process and get the tests that they need done and the films and have a doctor look at them and bring them into the office and meet with them and their family to sort of go over things and give our opinion and input as to whether or not we think that they would benefit from surgery or maybe we can just kind of keep an eye on things for right now and have them follow up with us or with their cardiologist down the line. So yeah, we are willing and able to do what we can to sort of take the burden off this stressful process for patients and families alike.

Liz Healy: Yeah. And that's really great. And it's a great team here at Riverside that we have for our heart surgery team. Is there anything else that you'd like to add?

Jennifer Dole: I mean, I think I've covered everything. I can probably talk about this subject for days on end, but, you know, I don't want to like bore you all with that. So we'll keep it kind of simple, but just know that we have all the resources here at Riverside that we can get patients through these ton of tough health situations and hopefully coming out on the other side, feeling better and living better and kind of moving on and moving up and forward in their life.

Liz Healy: Perfect. Thank you for joining us today, Jen.

Jennifer Dole: You're welcome. Thank you for having me, Liz.

Liz Healy: Yeah. And thank you for tuning into the Well Within Reach podcast with Jennifer Dole, an advanced practice nurse with Riverside Heart and Vascular Institute and your host, Liz Healy. To learn more about the Riverside Heart and Vascular Institute, visit riversidehealthcare.org/heart.