Advances in Heart Surgery at Cleveland Clinic - Part II

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy and information about diseases and treatment options. Enjoy.

Lars Svensson, MD, PhD:

With me today is our Chairman of Cardiothoracic Surgery, Dr. Marc Gillinov. Thanks for joining us, Marc. And I am Lars Svensson, I’m Chief of the Heart, Vascular and Thoracic Institute, and we look forward to chatting with you today about various aspects of cardiac care.

We do a lot of research, Marc. We spend a lot of money on research. And, you have done a ton of research on the mitral valve and various other operations like atrial fibrillation. Do you want to comment a bit about our research and innovation?

Marc Gillinov, MD:

I think it gets to our fundamental goal, which is to be better every day. We want to be better tomorrow than we were today, and we want to be substantially better, meaning get better results for patients in the coming years. How are we going to do that? Through research and innovation. We recognize when there is a procedure that's being done or a condition that exists that is difficult to treat, and we study these conditions, we study these procedures, and we come up with new operations. Dr. Svensson was mentioning the reimplantation to save your own aortic valve, that's a procedure that he has developed and perfected, and it is a very specialized sort of procedure.

We publish as a group within cardiology, cardiac surgery, vascular surgery, nearly 1,000 papers per year. That's about three a day! And each one of these manuscripts, these medical papers and journals, has new information. We are constantly striving to innovate, to develop new techniques, new technologies, and then to disseminate these to the world, so that something we discover and develop here in Cleveland, at the Cleveland Clinic, can be applied in Europe, in South America and Central America, everywhere around the world.

Lars Svensson, MD, PhD:

Yeah, that's a very important point to make, Marc, that we obviously see problems and we have the opportunity because of the large number of patients we see, to see rare problems, and then we try and address them. If we find solutions or better ways to treat patients, then we publish on that, and everybody in the world we believe will benefit from our research.

We use three research arms. We have what we call “Core,” which is our retrospective, site-based research. That is based on our outcomes, particularly for cardiac surgery. We then look backwards at our patients, what procedures they had and how they do long term, and that contributes to the medical literature. Then we have our prospective site-based research. These are research studies usually around devices of various sorts. We either come up with our own inventions, or companies come to us with the new devices, and they want us to be involved in doing research. We run a lot of trials for companies for devices, and then resulting in FDA approval. Our third group of researchers is what we call C5. These are the big drug studies, and they make headlines for publications, for example the New England Journal of Medicine or JAMA, on new breakthroughs and drugs. We typically have 10-15 publications like that on new treatments, whether that's for heart failure, diabetes, various medications to lower cholesterol, or patients who have trouble with cholesterol, and various other sort of rarer problems in preventing cardiovascular disease.

We are always thinking of new solutions. We spend a lot of time on research and enrolling patients in various studies so that we can share with the world what's important for better cardiovascular care. If you look at what's happened over time and the contributions of the Cleveland Clinic, the risk of death from cardiovascular disease in the United States used to run well over a million a year. That's come down significantly over time, partly due to contributions from the Cleveland Clinic. During COVID there was a slight uptick, and it remains to be seen how things are going to go over the next few years. But cancer, still, is very much up there with cardiovascular disease as far as causing death in the United States.

 One of the things that we love here at the Cleveland Clinic, Marc, is that we work in teams. As I said at the beginning, we all are on salary. We can consult with each other. We're not competing for cases, say, between cardiology and cardiac surgery or vascular surgery. We deliver the best for patients, and we will have a lot of discussions about the care of patients, particularly the complex ones. Do you want to talk a bit about how we work with cardiology in various aspects, and you mentioned about how we work as teams of surgeons, and we will often assist each other on cases or have senior surgeons mentoring junior surgeons – if you can just comment a bit about that.

Marc Gillinov, MD:

In an average year here, we get patients who come from all 50 states and generally about 80-90 foreign countries. When a patient comes here with a potential surgical problem, they will see both a cardiologist and a cardiac surgeon, so there is already a built-in team. If you come here, you have a team that has been established around you, and the cardiologists and the surgeon will discuss the case and go over all of your data to determine what is the very best therapy for you.

For example, just this morning I was talking to one of our cardiologists, a structural interventionalist who works on heart valves, and he had a patient who was referred to him. When he looked at the echocardiogram and the other data, he called me and said, "Would you mind looking at this? I think this patient might be best served by surgery.” It turns out that we agreed that the patient should have surgery rather than an intervention. That kind of teamwork before the patient even gets here doesn't happen in other places. Once the patient is here, the patient will have a built-in team that includes me, and I operate with another surgeon. When we do robotic surgery, the anesthesiologist will see the cardiologist, and it's really wonderful because there is no incentive to do anything but what we perceive to be the best for every patient.

Lars Svensson, MD, PhD:

So Marc, you touched a bit on this earlier, but let's just talk about the patient's journey through heart surgery here at the Cleveland Clinic. Maybe talk a bit about what we do for the families, because obviously we love to have families on board with the care of their family members, and also keeping them informed during the course – both pre, during and after the operation.

Marc Gillinov, MD:

Well, I think one of the most important things that you have, if you're a patient who is coming here or already here, is you've got the human touch – you've got the people who are here to talk to you. Let's say, from the very beginning, you've just found out that you need a heart surgeon. You've decided to come here, you give us a call, or you can get us on the internet, and we call you. You talk to an actual medical secretary who gathers your data, and then he or she shares it with a very specialized nurse practitioner who determines what sort of surgery, what other data do we need. Then that nurse and the surgeon meet, and the nurse practitioner and/or the surgeon will get back to you. You haven't even set foot here yet, and we are already having a personal touch with you and with your family. I If you have questions before or after surgery, we have 24/7 nurses on call.

Once you get here, you the patient, and your family or whomever you wish, meets with cardiology, cardiac surgery, anesthesia. Then for the family, while the person is in surgery, not only do you receive updates, but you receive a class designed by our cardiovascular nurses and our cardiac surgery nurses to give you an idea of what's happening, what to expect, what will happen. While you're in the hospital, we have people who visit you, physical therapists to help you, nutritionists. It’s, to me, a very sacred commitment. If you've come here for your heart surgery, you've got us for life. You can always get in touch with us. You can always come back. We welcome you back. We will make the appointments for you, so you and your family are taken care of, and not just with the technical aspects of the surgery and the medicines, but with the emotional side. I'm actually here because my dad had heart surgery here in 1978. My grandmother had heart surgery here in 1986. They both did fabulously well, living into their 90s. My father actually is about to turn 92, and the Cleveland Clinic took care of my family members and my family, and that's the reason I'm here – to do the same thing for patients and their families.

Lars Svensson, MD, PhD:

Some more details, if you want to find out more how we arrange things together with your families, you can go to ClevelandClinic.org/heart and find out more. You'll find information there if you're flying into the airport here in Cleveland, we will arrange for a limousine service to pick you up and take you to your hotel. We can help with those arrangements and also take you back to the airport. Often you might not be so mobile, so it's nice to have the limousine company take you back to the airport. That's our commitment to you. You're taking the trouble to come to Cleveland Clinic. We'll take the trouble to make sure you get back to the airport safely and can fly back home.

So let me also point out the government does surveys of patients after leaving hospitals and their experiences, and we run above the 85th percentile and sometimes well into the 90s. In other words, that means that of the patients who come here, they rank us among the very best in the United States for the care they receive here, not only in outcomes, but the way they're treated and also recommending to come back here to the Cleveland Clinic.

As I mentioned earlier, we do the most heart surgeries in the United States, at least twice as much as any other center in the United States. When it comes to valve surgery, we do the most in the world. When it comes to adult congenital surgery, we do the most in the world. When it comes to aortic surgery, we do about three times as much as anybody else. In fact, in one of the studies recently done taking everybody in the United States for aortic surgery on the aortic root, 10% of the patients were done here at the Cleveland Clinic. So, we are very busy, and many aspects are very advanced and complex surgery.

Marc Gillinov, MD:

The take home message is that if you want the best care possible to fix your heart and to ensure that you do well from surgery, survive surgery, and have a long life and increased life expectancy, if you want the best care possible, it is absolutely the most important investment you will ever make to come to Cleveland Clinic and give us the honor of taking care of you.

Lars Svensson, MD, PhD:

That's great. Marc, let me just add one comment, which I love referencing. The Society of Thoracic Surgery ranks programs across the United States for the straightforward operations like aortic valve replacement with or without coronary artery bypass, or mitral valve surgery with or without coronary artery bypass, or cardiology bypass operations. As Marc mentioned, we are a three-star program in every single category.

We are not aware of anybody else that is a three-star for every heart or lung operation in the United States. So that's very unique here at the Cleveland Clinic, and if you take our results, what are called the “observed to expected” results for the Society of Thoracic Surgery, if you come to the Cleveland Clinic, you are three times more likely to survive than the average program in the United States. So if that's important to you, and I think it would be, come to the Cleveland Clinic.

Thank you very much for listening to us. We're always available to keep in contact with you. Or if you want to contact us about coming here, we're always available. Thank you for listening.

Announcer:

Thank you for listening. We hope you enjoyed the podcast. We welcome your comments and feedback. Please contact us at heart@ccf.org. Like what you heard? Subscribe wherever you get your podcasts, or listen at clevelandclinic.org/loveyourheartpodcast.