Transcription:
Open Heart Surgery: What You Need to Know

Scott Webb: Welcome to Live Greater, the health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This podcast is sponsored by UM Capital Region Health.

I'm Scott Webb, and just hearing the words open-heart surgery may scare many people. But is it as frightening as it sounds? Dr. Jamie Brown, Medical Director of UM Capital Region Health's Heart and Vascular Institute, shares some surprising facts today about the procedure, as well as what every patient needs to know if they will or might need this life-saving surgery.

So, Dr. Brown, thanks so much for your time today. We're going to talk about open-heart surgery. And I think when some of us, most of us, maybe picture open-heart surgery, we, you know, picture open-heart surgery. So it's great to have your expertise today and really take us through this. So let's start here. What is open-heart surgery?

Dr. Jamie Brown: Well, open-heart surgery, as most of the world thinks of it is actually a bit of a misnomer. Let me explain. When a heart surgeon thinks about open-heart surgery, they think about actually opening the heart and working on something, for example, a valve inside the heart. But to most people in the world, when you're going to have open heart surgery, that may also mean, for example, coronary artery bypass surgery. But the coronary arteries usually live on the surface of the heart. So it's not really opening the heart per se, but you're opening the person or the patient up to get to the heart. Hence, the term open-heart surgery.

So open-heart surgery really generally applies to any operation on the heart. But within the specialty, open-heart means you're opening a cavity of some kind and working on something important on the inside of the heart.

Scott Webb: Yeah, I see what you mean. And that's what I was kind of referencing. It's like we picture sort of open-heart surgery, but it's really more open-person surgery and you're working on the important things in the heart, related to the heart, connected to the heart and so on. So why would someone need to undergo any of the procedures that we're referencing here?

Dr. Jamie Brown: Yeah, so we as humans, of course, get diseases and we're fallible. Heart disease or heart and vascular disease are still the number one killer. And, you know, I think some of these diseases have answers, these days especially. For example, coronary artery disease. When we get blockages in our heart vessels that supply our heart with the oxygen it so much needs, there are a couple of things that can be done. Medicines, we know now usually is not the first answer, unless someone really is not a good candidate for a procedure. But the first answer usually is a procedure, either a stent with a catheter or coronary artery bypass surgery. Not really open-heart surgery, as we said before, but as most people know it, open-heart surgery. And of all the things we can do to kind of make coronary artery disease not such a killer, coronary artery bypass surgery is probably the first choice.

Scott Webb: Yeah. You know, whether it's a social media or just regular old media, that does seem to be one that we're probably all familiar with, one that gets discussed fairly often. And if you could just sort of set the scene here and set the record straight, you know, what is open-heart surgery? What are you mostly doing when you're doing open-heart surgery? And I think that just saying that, right, open-heart surgery probably evokes a sense of fear and panic in people. What are some of the other misconceptions? We've addressed one of the elephants in the room here. What are some of the other misconceptions about having open-heart surgery?

Dr. Jamie Brown: To get back to your last question, the heart has other parts, of course. It's muscles and blood vessels and valves and an electrical system, and it's attached to the big arterial systems in your body. For example, they order comes right down and attaches to the heart. So all of those entities can develop a disease. And one in particular, say it's the valve, the aortic valve in particular can become the stenotic in 12% of the population over 80. So aortic valve stenosis is both a deadly disease and a common disease the older we get. And most recently in the news has been the ability to replace an aortic valve over a catheter. So that's minimally invasive. It is not open-heart surgery, but we are still replacing a heart valve.

And the most common misconception I see these days in talking about this with patients is they think because it's a catheter and a needle stick, right, and you don't really have a big visible incision, that it's no risk. And I think the point of what's been in all the trials and everything we know is that it's a matter of balancing which is the best pathway for a patient, what's the best choice for a patient. But even when there's not an incision and it's not per se open-heart surgery, the risk is often the same or sometimes, if it's too aggressive with a catheter, greater. So that means that we have to talk with the patient about the risks. And even though they're pushing hard, because who wants to have open heart surgery and be opened up, sometimes it's actually safer to be opened up

Scott Webb: That's really interesting, you know, because some of the buzzwords in medicine now, so commonly heard or what folks would like, folks want to push for is minimally invasive, smaller scars, faster recovery time. But there may be times, coming from an expert here, where the actual "open-heart surgery" is the better option. Is there anything that we can do to prepare, whether it's mentally or physically for open-heart surgery?

Dr. Jamie Brown: I've been doing this for a long time now, and I think this is what I've learned works with people and patients, is that sometimes if they've just gotten the test and it's brand new news, that we're recommending open-heart surgery and they have that fear or shock that you referred to earlier. And right then and there, it's time to just walk them through the why, what they have in the why and the potential options. And I always say to them, "Take your time." Unless it is a true emergency, take your time. The most important thing is to fully understand this, fully understand your options and understand that we are only recommending this surgery because in balancing all risks and benefits, short and long-term, it's the better pathway to take.

Once they've done that, then I say, "Okay, once you understand that, it's normal to be a little bit nervous about any procedure, especially, you know, the scary word open-heart surgery. But best thing you can do is develop a determined I'm-going-to-do-this mindset, because when you go into surgery with that determined mindset, most of the time the patients come flying out the other side, do well, come out of surgery, get moving, walking down the hall, and they're out of the hospital in very short order.

Scott Webb: That's good to hear and I'm sure there's a range, right? You've just mentioned here there's a variety of things you could be doing, right? So generally speaking, when we think about how much time someone's in the operating room on the table, how long do these procedures take?

Dr. Jamie Brown: That's a good question. It depends on the procedure, of course, and it depends on a lot of things. But let's say on average, a coronary bypass operation, the whole thing is probably four hours. An isolated valve operation may be two hours to three hours. If there's an operation that involves planning with stent grafts and working on the aorta in a big heart and vascular team, then using wires and catheters and x-rays and positioning, a big team in a hybrid OR suite with all sorts of x-ray equipment, then that can take longer, the whole intent being to take care of a really big life-threatening problem, but do it minimally invasively, and the number of hours on that can be four to five.

When someone has had prior surgery, we call it a reoperation, their heart is often encased in scar and those operations take longer because the very first step is that you have to very carefully, safely as possible, extract the heart from the scar tissue and then go ahead and do the heart surgery that's planned. That can be five hours, six hours, seven hours depending

Scott Webb: It's all pretty amazing. You know, you say from just a couple of hours to, you know, something longer than that, but I'm just picturing in my head years ago, however many decades ago, first of all, some of this stuff probably wasn't even possible. And if it was, I'm guessing it wasn't two to three hours for one of these procedures. It may have been all day or even longer, right?

Dr. Jamie Brown: Absolutely. Even now, if there's something, you know, really big that's not done typically. For example, someone has a cancer in the back of the heart, we're going to do something that's, you know, out there, complicated, which is take the whole heart out and try to resect the cancer, restructure the heart, sew in back in, that's an all-day thing. But once upon a time, as you just said, when all this started, back in the beginning with the first coronary bypass or the first heart transplant or the first this or first that, it was all day. Absolutely.

Scott Webb: Yeah. So you mentioned that maybe not in all cases, but in many cases, you know, after folks get over the fear and panic and everything is explained, the why and all of that, and they have the surgery, then they're motoring around and they're on their way, let's talk about recovery, right? Are we talking about days, weeks? How long does it take from the time they leave the OR until they really feel like themselves again?

Dr. Jamie Brown: Well, that's a good one. So, you know, we try to get them up and at 'em and off the breathing machine and up and at 'em in the hospital as soon as we can. And I tell them the best way to have the fewest possible complications is to get up and get going. No pneumonia, no clots, out the door, in four days. But I say you got to commit to being a patient that's recovering. And so, long story short, if they do desk work, usually they're starting to feel pretty good by about four to six weeks and they can start back on desk work. And I always tell the patient, "Don't go back to a big, bad, stressful, full day, right out of the block." That doesn't make sense and it's also not a good way to start out. But they leave the hospital, hopefully going for a walk once or twice a day. And oftentimes, they'll be walking a mile twice a day or a couple miles a day by the time we see them at the one-month mark after surgery.

Scott Webb: Well, this has been really educational. I just love listening to experts and hearing you explain all of this and, you know, some of the misnomers when we think of open heart surgery. As we wrap up here, doctor, what are your takeaways that you want to share with the audience?

Dr. Jamie Brown: I think the field of open-heart surgery from the days of it being just the shot in the dark and let's try this and let's try that has come so far. And even though heart and vascular disease is still the number one killer, we have so many things we can do now within the general field of open-heart surgery, if you will, at very low risk, that I think it's important for people just to not panic when they hear the word open-heart surgery if it's them or a family member and realize that there are options that are good and can lead to long-term quality of life after the operation is done and the patient's recovered.

Scott Webb: Definitely. You know, we as patients of course want options. And as you say, there is some fear and panic, sure. But you experts have a lot of tools in the toolbox or the belt or whatever, however you carry your tools into the operating room. It's really amazing. Thanks so much. You stay well.

Dr. Jamie Brown: You too. Thank you.

Scott Webb: This episode is sponsored by UM Capital Region Health, the largest healthcare provider in Prince George's county. Dedicated to enhancing the health and wellness of the community by providing high quality accessible patient care. UM Capital Region Health, changing up healthcare in prince George's county.

And find more shows like this one at umms.org/podcast. And thank you for listening to Live Greater, a health wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.