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Melanie Cole (Host): SLUCare cardiologists are the forefront of heart treatment in Saint Louis, offering new techniques such as hybrid approach to atrial fibrillation that combines surgery and the use of a catheter to help the heart regain its proper rhythm. Each advance continues a tradition of excellent heart care pioneered by the Saint Louis University cardiologists. Today, we have with us Dr. Richard Lee. He’s a heart surgeon who specializes in mitral valve repair, surgery for atrial fibrillation and the hybrid approaches to adult cardiac disease. Welcome to the show, Dr. Lee. Tell us a little bit about the heart services offered at SLUCare.

Dr. Richard Lee (Guest): Well, thanks for having me. I’d say we really redesigned the delivery of cardiac care about two years ago at Saint Louis University, and we actually changed the entire structure of the departments. Before, it used to be separate organizations between cardiology and cardiac surgeons. Now, we both treat patients with heart disease, but one treats patients with medicines or catheters, and the other treats with open surgery. Now, we’re really all under the same roof, and virtually every patient gets a pin from both a medical and surgical perspective. And once they have intervention—particularly, surgery—our patients are seen by both the cardiologists and the heart surgeons throughout their stay.

Melanie: So this higher level of expertise and this combination that you’re discussing, how does that help you design a treatment plan for patients around their specific needs? Because each person is different and each heart situation is different, so tell us about that.

Dr. Lee: Well, you’ve already that question for me, so that helps a lot. You’re right. Every patient is different. Sometimes, there’s more than one way to approach a problem. There’s an instrument hypothesis: when you have a hammer, the world’s a nail. Actually, with this approach, we’ve got a whole set of tools, and every patient, there might be an approach that might be a little better for our patients in general but might not work for you. For example, say I had heart disease and we could choose between a bypass or an angioplasty and a stent. Well, there might be something going in my life or conditions where maybe the shorter-term approach, an angioplasty and stent would be more important for me because they really needed the shorter recovery time. But every single disease is like that. Every different condition of the heart is like that, and we can provide, really, a balanced approach for patients. And so, as I said, we have a whole toolkit for every patient of ours.

Melanie: Now, tell us about you’ve pioneered a new minimally invasive hybrid treatment for atrial fibrillation. Give just a little bit of a working definition for the listeners of what A-Fib is and what you’ve pioneered with this hybrid treatment.

Dr. Lee: Atrial fibrillation is a disorder of the upper chambers of the heart. Normally, the way your impulse from your heart travels is cell to cell in the upper chamber. It’s like having a rock and throwing in a pond and a wave spreads out. That’s how the electrical impulse spreads out and gets the upper chamber to contract in a coordinated fashion. However, when your atrial fibrillation is kind of like a rain, you have a million different little rocks everywhere, and that causes an arrhythmia. It causes the heart to beat very fast and irregular. And because there’s so many different ways everywhere, you can’t get that coordinate impulse, and blood tends to pool and form a clot. Well, historically, for some of those patients, we still offer catheter ablation alone, where, with a small little puncture in one of your vessels, we are able to put up little wall of scar from the inside of your heart. But that’s only good for certain types of A-Fib, especially when it comes and goes. For A-Fibs there all the time, before, the only way to really treat it was an open surgery. We needed to do it open because we had to examine those little scars on the inside and the outside of the heart. With the hybrid approach that we’ve developed, we can do about half of the full operation with small incisions, but we can’t get inside a heart. Well, that’s where we work together as a collaborative team and our EP, electrophysiologist can use a catheter from the inside of a heart and make the small scars on the inside. So together with the lines of scar on the outside and the inside, we can cure A-Fib about 90 percent of the time.

Melanie: That is so exciting. And how fascinating. Now, you also offer a hybrid approach to adult cardiac disease. There are so many different types of cardiac disease, and people aren’t realizing that lifestyle is so involved. We hear more about it. Tell me about your approach and the approach of your whole team there.

Dr. Lee: I think the best way to do this and discuss is to illustrate one specific example. We have a heart valve clinic. So Dr. Lim, my co-director and I, see patients together who have valvular disease. The reason we do this is there’s new evolving technologies that sometimes are more appropriate for some patients that may be less invasive. So we are now seeing people in offering what we call MitraClip. Traditionally, surgery is a great option, and I do probably about two mitral valve surgeries a week and it’s a great operation and it’s a great option for patients, especially if they’re lower risk. In fact, even if they don’t have symptoms but they have severe mitral regurgitation, they should be considered for an intervention. And that’s one of the things we would do together at the valve clinic. However, oftentimes patients are really very debilitated and very sick and kind of past the point where we’d be able to say if we’d get them through an operation. That’s why we have these new clips that go on the inside of the heart that Dr. Lim and I do together, and we kind of tether and make the valve tighter on the inside and keep it from leaking as much. Now, it’s not for everybody, and actually, if you’re healthy and could undergo a surgery safely, probably the better thing is an operative procedure. But nonetheless, it’s one approach. We’ve got a whole different array of options for patients which may include no operation whatsoever, and we can give a dual perspective at our valve clinic. We do that for atrial fibrillation. We do it for valve disease. We do it for coronary disease and aortic valve disease as well.

Melanie: Dr. Lee, in just the last minute or two, tell us why patients should come to SLUCare for their cardiovascular care and about some of the multi-disciplinary approaches that you have in your cardiology program, the preventive cardiology and cardiac rehab, diet nutrition and counseling. Give them a rundown of all of them.

Dr. Lee: I’d keep it even more simple and more brief. I send my parents here for heart care because I know that all my colleagues treat the like they’re their own family and their own relative. I do the same for my patients. So if there’s one reason you should come to Saint Louis University, it’s because you’ll get treated like you’re a family member. In addition, that’s a great start, but you’ll be treated by someone who is an expert not in the field of heart care but a super specialist. For example, we have specialists in arrhythmias and mitral valve disease. And the reason multi-disciplinary approach comes in is we have surgeons who are experts in the mitral valve disease and cardiologists that are experts in mitral valve disease. And, working together, we treat our family members—or our patients—with the best approach and the most up-to-date technology that medicine has available today.

Melanie: Well, that certainly is a great reason for coming there. You’re listening to For Your Health with the physicians of Saint Louis University, SLUCare Physician Group. SLUCare is the academic medical practice of Saint Louis University School of Medicine. For more information, you can go to slucare.edu. This is Melanie Cole. Thanks so much for listening, and have a great day.