Why Choose the MemorialCare Heart & Vascular Institute?

Deborah
This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here is Deborah Howell. Welcome. I'm Deborah Howell, and when it comes to cardiovascular care, there's a lot of factors and variables to consider. To find out about the comprehensive care at the Memorial heart and vascular Institute at Long Beach Medical Center today, we'll turn to one of its leading advocates. Our guest is Doctor Mark Sagawa, chief and medical director, adult cardiac surgery at Long Beach Medical Center and MemorialCare. Welcome, Doctor Sagawa.

Dr. Mark Sagawa
Thank you. It's nice to be here.

Deborah
So great to have you on. So, let's begin at the beginning. How has Long Beach Medical Center transforming heart and vascular care for patients that need cardiovascular care?

Dr. Mark Sagawa
Well, over the past year at Long Beach Medical Center, we've made some great strides and have changed a lot of the philosophical ways we examined patients with complex heart disease. We have the latest technology and the newest procedures available to treat complex cardiac issues, as well as complex aortic diseases. And our theme really is that we evaluate these patients for these newest technologies and new procedures. But we try to do things in the least invasive way, which promotes safer care, higher quality care, and earlier recovery.

Deborah
Sounds like a plan. How does the interventional cardiology care team change heart and surgery outcomes for patients?

Dr. Mark Sagawa
Well, by doing things in the least invasive way, we've been able to take complex problems and solve them in a, I would say, a safer way that allows patients who have been higher risk in the past to now have procedures which can improve their quality of life. Examples being that patients with valvular heart disease that normally would require a complex surgical procedure with dividing the breastbone, which creates longer recovery and longer length of stays in the hospital. These surgical procedures are now done at Long Beach through small incisions called minimally invasive approaches. These procedures are being done on a regular basis at Long Beach Memorial. And the patients recover much quicker. The outcomes have been excellent and much improved as well for even higher risk patients, who we may consider even to high risk for these surgical procedures. We now have multiple percutaneous approaches where we can treat complex valvular heart disease in these patients. To some of them can go home in the next day.

Deborah
That is absolutely wonderful. Now, I'd also be interested to know what unparalleled cardiac care and state of the art imaging technologies are used at the MemorialCare Heart and Vascular Institute. Could you tell me?

Dr. Mark Sagawa
I can so as well, in the past year, we have employed a new cardiology physician who actually specializes in imaging. And so, we have state of the art CT scans and MRI eyes, which allow us to evaluate these complex patients in the least invasive way. So, with the hiring of this individual, we have taken our imaging department. I can tell you the answer to the highest level. And really in this area, we're probably the only people who are doing these types of imaging procedures.

Deborah
Well, you've probably seen so much progress in your years as a physician in terms of the imaging.

Dr. Mark Sagawa
I have seen incredible changes for the number of years I've been doing this. For now, having a CAT scan that can look at coronary arteries, or we can quickly evaluate patients with chest pain in the emergency room to see whether or not they're having a heart attack or some type of aortic problem. The imaging has gotten so good that for these complex aortic problems, we can get to within a millimeter doing an endovascular or at least invasive, a less invasive way of approaching complex aortic diseases. We can actually put a graft in percutaneous now and be within a millimeter of where their problem exists. It's evolved and it's amazing what can be done today.

Deborah
Absolutely incredible. All right. Now as we know leading edge care begins with research. How is the MemorialCare Heart and Vascular Institute standing at the forefront of groundbreaking, lifesaving research?

Dr. Mark Sagawa
Well, that's a great question. In the past year, we've also been fortunate to have a new leader in cardiology who came to us from the LA area, from the University of Southern California hospitals. He has a tremendous amount of knowledge in terms of looking at complex heart disease and treating multiple problems. But he also brings with him a research background looking at different ways to treat congestive heart failure, complex aortic disease, structural heart disease. I also am fortunate to work with a surgeon who is an expert in treating atrial fibrillation from a surgical point of view and has been the author on the paper and then project that is done around the nation to treat atrial fibrillation, both surgically and a hybrid approach with the cardiologists to do cath lab oblations. So, we are on the forefront of research in many areas.

Deborah
It sounds like a definitely strong team. And, you know, heart surgery has traditionally involved the chest being cracked open, as you alluded to earlier. How has that approach changed at Long Beach Medical Center?

Dr. Mark Sagawa
Well, since my arrival, we have now created the minimally Invasive Valves Surgery program, and we do our operations through 2 to 3 inch incisions on the lateral or anterior chest wall. And we no longer have to break the breastbone to do valvular heart disease. We also have started a program where we do bypass surgery on the left side of the chest. And we do that by taking a robot harvesting the left initial mammary artery from underneath the breastbone, which we'll use for the bypass, and then to a small incision we hand so the mammary artery to bypass the coronary artery that's blocked. So we've made some great changes and great advances in the past year and a half.

Deborah
And sound surgery with all the bells and whistles and the technology. Incredible. So how serious is a leaky heart valve or mitral regurgitation?

Dr. Mark Sagawa
Well, it's serious in the sense that patients who have mitral regurgitation often have congestive heart failure. They often get short of breath serious fatigue. As it progresses, they can get swelling of their ankles at the end of the day, and over time, the heart can dilate, which can lead to a rhythm like atrial fibrillation. Or if the left ventricle, the main pumping chamber of the heart, dilates, the patients will have progressive congestive heart failure. So it can be very serious. And these patients because we can treat them minimally invasive. We now treat patients at an earlier stage in their life and earlier stage in their disease, which prevents them from having a lot of these issues. If patients present at a advanced stage in their disease and surgeries considered to be too risky, we now have a procedure where we go in through the vein in the leg puncture, across the septum, in the heart, and we take a clipped device, kind of like a closed pin, and we clip the two leaflets of the mitral valve together, which reduces the amount of regurgitation and can really improve someone's quality of life. It's not a perfect fix by any means. It's not like surgery, but sometimes you just have to make some patients just a little bit better in order to get them a much-improved quality of life.

Deborah
It's all about the quality of life now. That clip, is it called the Mitraclip?

Dr. Mark Sagawa
Yes.

Deborah
And so how is Mitraclip therapy replacing the need for open heart surgery to treat mitral regurgitation?

Dr. Mark Sagawa
I would say it's not replacing the need to do valve surgery, because we can still do the valve surgery to minimally invasive approach as well. The valve operation is still better than the Mitraclip. So, I would say it's an additive procedure, not a replacement procedure. It's additive in the sense that there are patients who are considered too high risk for surgery, but we don't think they'll tolerate the operation. They can't go through a rehab or recovery period. And so that's where the Mitraclip comes into play.

Deborah
Got it. That's an additional add on. Now why should people choose the MemorialCare Heart and Vascular Institute for their diagnosis treatment and management of their heart conditions?

Dr. Mark Sagawa
Well, that's a great question. So, I would say the reason is this we work together as a team. We have started a valve clinic or a structural heart clinic, which is multidisciplinary, meaning that we have cardiologists present. We have card surgeons present. We invite our anesthesia providers, we have our nursing team, our nurse practitioners, our physician's assistants all attend this. And what we do is we evaluate the patients as a team by getting multiple opinions. And by doing that, you can pick the best treatment for that patient. So it's not like you go see one doctor you're seeing like ten doctors and a whole disciplinary team that we can use to make the best decision and pick the right treatment for those patients. And all of us are on the same page in terms of looking at each patient on an individual basis and trying to see what's the least invasive way we can approach their disease or their problem in order to give them a better quality of life. So, I think coming to this clinic and coming to our program really is the future way that we are going to be looking at treating patients with cardiac problems.

Deborah
I can't imagine any patient not wanting that team approach to treat the whole person right.

Dr. Mark Sagawa
That's correct.

Deborah
And how can people learn more about comprehensive cardiovascular care at the MemorialCare Heart and Vascular Institute at Long Beach Medical Center?

Dr. Mark Sagawa
Well, you can go to our website, which is MemorialCare.org/complexheart.

Deborah
And one more time I'll give it Memorialcare.org/complexheart. Any final thoughts for our listeners today, Doctor Sagawa?

Dr. Mark Sagawa
I would just say that I think patients, when they find out that they have a cardiac problem, it can be quite frightening. And I think having the ability to come to a place where you're going to see multiple physicians from multiple disciplines, each with an expertise that can be used to look at your case and discuss as a group what we think is the best way to do it. We have the newest and best imaging tools, and many of those don't require going through the cath lab any longer. They can be done in a less invasive way. So, I think we offer really the best, most modern approach to treating complex heart disease.

Deborah
I love it. Well, you've made me feel better about anything that might happen in my family. So, thank you so much, Doctor Sagawa, for your time, your expertise today, and of course, your hard work on the front lines during this past year. We really enjoyed having you on the show.

Dr. Mark Sagawa
Thank you. I really appreciate it.

Deborah
For more info or to listen to a podcast of this show, please visit MemorialCare.org/podcast. That's MemorialCare.org/podcasts. That's all for this time I'm Deborah Howell. Have yourself a terrific day.