Cardiologist Roundtable: Collaborative Insights from Heart Valve Clinic Experts

Deborah Howell (Host): Welcome. I'm Deborah Howell, and when it comes to cardiovascular care, there's so many variables to consider. To find out more about heart and vascular care, for our Cardiologist Roundtable today, we'll offer up some collaborative insights from two Heart Valve Clinic experts. Our guests are Dr. Mark Sakwa, Medical Director of Adult Cardiovascular Surgery and Chief of Cardiovascular Surgery, Memorial Care Heart and Vascular Institute. He's also Medical Director, Adult Cardiovascular Surgery Memorial Care Heart and Vascular Institute at Long Beach Medical Center.

And Dr. David Shavelle, Chief of Cardiology at Memorial Care Heart and Vascular Institute and Medical Director, Adult Cardiology and Interventional Lab at Memorial Care Heart and Vascular Institute at Long Beach Medical Center.

Welcome Dr. Sakwa and Dr. Shavelle.

Marc Sakwa, MD: Thank you. Nice to be here.

David Shavelle, MD: Thank you.

Host: Let's dive right in with you, Dr. Sakwa. What is heart valve disease?

Marc Sakwa, MD: Well, the human heart has four heart valves, which over the years can become diseased either because of congenital anomalies that occur at birth that cause the heart valve to fail or because of acquired conditions where the heart valves either sort of degenerate and leak or become stenotic because they become calcified.

Host: Got it. And why is heart valve disease a dangerous condition?

Marc Sakwa, MD: The problem is, is when these valves become affected with disease that requires them to, they can't do what they're supposed to do. So, the valves become stenotic, meaning that they can't open properly, making the heart work harder. Or they leak, making the heart full of volume, which again, the heart valve, when it does that, the ventricles of the heart cannot function properly.

And this can lead to shortness of breath, it can cause arrhythmias and congestive heart failure, which is a condition where the patient's heart starts to fail and blood backs up into the lungs. They become short of breath and can't really do their daily functions.

Host: And Dr. Shavelle, how does the Heart Valve Clinic at Memorial Care Heart and Vascular Institute at Long Beach Medical Center benefit patients looking for heart valve treatment options?

David Shavelle, MD: We started the valve clinic approximately three years ago. It's a weekly clinic that we do with a number of different doctors, including cardiologists, imaging specialists, and cardiovascular surgeons. So the concept is the patient comes for a visit, and will see a number of different doctors. The previous diagnostic tests, including echocardiograms, EKGs, et cetera, are all reviewed. And then during the visit, the patient will be evaluated and given recommendations on what we think is the best treatment for the patient.

Host: Okay. And what two types of treatment do cardiologists at the heart valve clinic discuss?

David Shavelle, MD: So, in general, we can break the treatments really into two. One would be a surgical approach to the valve problem, and the second would be a non-surgical or a percutaneous approach to the valve problem. And for each of the valves, there are different treatment options that are specific to the patient's condition and the patient in general.

Host: Dr. Sakwa, how is minimally invasive heart surgery performed?

Marc Sakwa, MD: So, if we determine that the patient is best suited for surgery, the first thing we do at Memorial Care is try to offer a minimally invasive approach. The reason for that is that patients just recover better. They get back to their life activities sooner. A minimally invasive approach will depend really on which type of, which valve we're operating on, but basically make a three inch incision on the right side of the anterior chest or a little lateral for a mitral or tricuspid valve.

And we go into the patient's groin where we identify the femoral artery and vein and that's how we access the heart lung machine. Then once we make our incision, we get our exposure. It's actually the same operation that everybody else does through the full median sternotomy incision. It's extremely beneficial to patients to have a minimally invasive approach, as I said earlier, because of the quickness in recovery and getting back to their activities sooner.

There's less blood loss, less risk of transfusion. Patients come off the ventilator quicker. They just seem to have a shorter hospital stay, tolerate the pain better, and do much and quicker than patients with full sternotomies.

Host: Sure. Dr. Shavelle, how is interventional cardiology performed?

David Shavelle, MD: It would depend on the valve that we're talking about, but in general, the concept is to do things without a surgical incision and to do things through the groin vessels. So, we use ultrasound to identify the vessels and then we put small tubes called sheaths into the vessels. And then through those sheaths we'll access the heart. If it's the mitral valve, we'll go from the right side of the heart to the left side of the heart. If it's the aortic valve, we'll access it through the femoral artery in the groin.

Host: Okay, and Dr. Shavelle, can you tell us some of the benefits of interventional cardiology?

David Shavelle, MD: If we do these procedures in this non-surgical percutaneous approach, in general, it's less invasive for the patient. The recovery tends to be a little bit faster. Patients tend to be discharged the day following the procedure. So overall, patients that are a little bit older, a little bit sicker can tolerate it a little bit easier.

Host: Got it. And that's always, you know, that's the key, getting back to your regular life as quickly as possible after surgery. Dr. Sakwa, how does the Heart Valve Clinic differentiate the Memorial Care Heart and Vascular Institute at Long Beach Medical Center from other heart institutes?

Marc Sakwa, MD: Well, I think this is a huge differentiator for Memorial Care for many reasons. First, when Dr. Shavelle and I came here about three to four years ago, part of our vision was to have this multidisciplinary clinic. Because the advantage is, we can discuss all the valve patients with cardiologists, with our surgeons.

We have the, occasionally, the anesthesia team. We have our administrative team. And overall, we can put together a plan that is not only the least invasive approach for the patient, but we think the best approach, and we have a quorum of people who will talk about it and come up with what we think is the best plan.

So imagine being a patient, you have a serious problem, you can talk to one doctor, you could talk to another doctor, but here you come to the clinic; you not only see a surgeon and a cardiologist in person, but then we go to a meeting, we discuss this with the entire team, so you get the entire team approach for a decision making process for your problem.

Host: That's just wonderful. I think everybody and every single patient really knows being part of a team makes a difference in recovery for sure. Dr. Sakwa, is there anything else you'd like to add for our listeners to know?

Marc Sakwa, MD: The only thing I would like to add is that, heart valve disease has clearly changed over the past 10 to 15 years and it continues to evolve with less and less invasive procedures. We have the expertise here with our cardiology team led by Dr. Shavelle to offer all the latest state of the art less invasive catheter based technologies for valve treatment. And with our surgery team, we have an entire team of surgeons dedicated to less invasive surgical approaches so that really our patients get a real evaluation for less invasive approaches, which is unique, I think, in this area.

Host: And Dr. Shavelle, final thoughts?

David Shavelle, MD: So final thoughts, the other elements that I think to make the program very successful besides the team based approach, the administrative support, the other two big areas to me are letting patients share in their decision making, so presenting patients to different options or recommendations and then seeing what their thoughts are.

And then the final thing is we have two phenomenal coordinators, that staff the clinic, that serve as patient liaisons. A woman named CJ, who's been in the business here for about 30 years, and a former CCU nurse named Brianna. And as soon as the patient comes to the clinic, they'll meet these individuals, and both CJ and Brianna, will help the patient navigate whether it's through surgery or whether it's through a non-surgical percutaneous approach.

And that would include coming to the hospital, getting the procedure, discharge, everything they need. So I, I think those, final two things are essential elements of the program here to make it successful.

Host: Absolutely. And what is the best part about your job, Dr. Shavelle?

David Shavelle, MD: Going home to see my kids, no, uh, working with, uh, working with Dr. Sakwa, working with the team here, you know, taking care of patients with very complex medical issues.

Host: And Dr. Sakwa, to you?

Marc Sakwa, MD: Well, I think it's obvious that working together with Dr. Shavelle has been the highlight of my time here at Memorial Care. We seem to understand and think about diseases in a very similar way, and it's great to have a colleague who has a skill set that we can offer all these things to patients.

And I think that's what's key, as Dr. Shavelle just said, it's a seamless operation for patients. It's so simple and they get really good opinion as to what can be done for them.

Host: Can't ask for more than that. Thank you so much, Dr. Sakwa and Dr. Shavelle, for your time and expertise today. We really enjoyed having you on the show. Where can consumers learn more about heart valve treatments to weigh out their options, Dr. Shavelle?

David Shavelle, MD: So consumers or interested patients can call an access number 844-662-6484. They could also visit our website on the web memorialcare.org/lbheart.

Host: Love it. And for more information or to listen to a podcast of this show, please visit MemorialCare.org. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.