The Comprehensive Robotics and Minimally Invasive Cardiac Surgery Program at Saddleback Memorial Medical Center

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. You're listening to Weekly Dose of Wellness, brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Jeffrey Lee, Medical Director of Robotics and Minimally Invasive Cardiac Surgery at the MemorialCare Heart and Vascular Institute at Saddleback Memorial Medical Center. Board certified by the American Board of Thoracic Surgery and a fellow of the American College of Surgeons, Dr. Lee has been practicing cardiac and thoracic surgery for over 15 years. He has performed more than 2,000 cardiac surgeries. Welcome, Dr. Lee.

Jeffrey Lee, MD: Well, thank you very much.

Deborah Howell (Host): Today we're going to talk a bit about the broad range of options now available to qualifying patients who need heart bypass, heart valve, or aortic aneurysm surgery. So if you could, please tell us a little bit about the comprehensive robotic and minimally invasive cardiac surgery program at Saddleback.

Jeffrey Lee, MD: Well, Deborah, the program here is a comprehensive program in that many patients, up to about a third of patients overall requiring heart surgery, can oftentimes have one of these minimally invasive or robotic options. For cardiac surgery, there are primarily a few problems that we have to deal with, such as aortic valve replacement, mitral valve repair, coronary artery bypass grafting, or treatment of atrial fibrillation. All four of those procedures can oftentimes be performed in a less invasive fashion. And we offer all those options here at Saddleback Memorial currently.

Deborah Howell (Host): And which kind of patients would qualify for this program?

Jeffrey Lee, MD: Primarily patients who have only one problem. Many times patients have, for example, an aortic valve problem and a mitral valve problem and also need to have heart bypass surgery. Those types of patients would be too complex for this type of approach, and we would recommend a traditional approach, which would be traditionally a standard sternotomy incision, which is a midline incision dividing the breastbone in the midline, and usually has an incision length of about 10 to 12 inches, but is a very safe option for all patients. What we're offering with these other programs and these less invasive approaches is just as safe, oftentimes safer, but those would be primarily reserved for patients who only have, for example, a need for an aortic valve or only have a need for a mitral valve repair.

Deborah Howell (Host): What are the different approaches offered, Doctor?

Jeffrey Lee, MD: The different approaches are depending upon the disease that needs to be treated. For example, if a patient needs an aortic valve replacement, we offer a minimally invasive aortic valve replacement which is essentially a three-inch incision enabling us to gain full access to the heart and replace the aortic valve with a new valve. Oftentimes patients need mitral valve surgery and usually repair is probably, is oftentimes possible, and we would offer actually three different approaches. One is minimally invasive in such that we're performing a hemisternotomy incision, one is via a right thoracotomy incision, mini thoracotomy incision, and one is a robotic approach using the da Vinci robot to repair the valve. The benefit of each approach has different applicability for a different patient population. Primarily how we choose between one or the other, for a patient for example needing a mitral valve repair, is we have to assess the valve to make sure it's a clearly repairable valve. And also that they don't have a significant amount of atherosclerosis, which is hardening of the arteries of the descending aorta. If the patients have a significant amount, and we estimate that based upon a CAT scan which we would perform preoperatively, then they would not be a good candidate for the robotic approach and they would be better suited for a mini sternotomy, hemisternotomy approach.

Deborah Howell (Host): So if it's not repairable you have to replace.

Jeffrey Lee, MD: Oftentimes it is repairable, at least 90% of mitral valves are repairable.

Deborah Howell (Host): Oh, that's great to know. Okay, so what are some of the differences between less invasive surgery and traditional surgery other than the size of the incision?

Jeffrey Lee, MD: Well, the size of the incision, of course, is what the patient sees and that's what they clearly are focused on. And it's... but I think there are a lot more clinical benefits that maybe aren't apparent to everybody, including the patient of course. We've actually studied this at the Cleveland Clinic where I trained and they found that the less invasive approaches and the robotic approaches are associated with less bleeding after the surgery, less need for blood transfusion after the surgery, a lot less pain, earlier time to getting off the breathing machine, earlier discharge from the hospital, and getting back to work sooner. Traditionally patients who have a minimally invasive or robotic approach to these types of procedures can be back to work in about two weeks versus the traditional method which would be at least two to three months.

Deborah Howell (Host): Wow, that's quite a difference in someone's life. It's certainly if you're trying to keep your job or if you're running a company or, you know, just trying to stay in the work pool. Are there any published studies that prove the benefits of less invasive cardiac surgery?

Jeffrey Lee, MD: Yes, actually there are several, and I actually have a website called miniheartsurgery.com where I post all these articles. And they can go there and see the articles pertaining to what I'm discussing, how, as I mentioned, the minimally invasive approaches to the mitral valve, the aortic valve are significantly beneficial to the patient in terms of those criteria that I just mentioned.

Deborah Howell (Host): miniheartsurgery.com?

Jeffrey Lee, MD: www.miniheartsurgery.com.

Deborah Howell (Host): Beautiful. And what are some of the benefits of robotic cardiac surgery over traditional surgery?

Jeffrey Lee, MD: I think the robotic surgery is quite a revolution for cardiac surgery. And it's really the ability to repair the valve, specifically for the mitral valve. Robotic mitral valve repair is associated, at least at the Cleveland Clinic where I trained, with an over 99% repair rate. And that's unheard of in traditional approach. And I think it's because of our ability to visualize the valve in three dimensions, and you can imagine, what is a robotic mitral valve repair, it's actually going through port holes, and instead of making a large incision to put my hand and, you know, stick my head down into the chest, we're actually sticking placing a three-dimensional camera through this porthole incision and putting me inside the heart, if you will, on a console five feet away. So you're really able to really figure out what's wrong with the valve and repair it with an incredible success rate, 99%.

Deborah Howell (Host): How long do you train on the robotic machinery?

Jeffrey Lee, MD: I've trained over two years with the robot. I've done two years of formal fellowship, one at the University of Maryland at a robotic heart bypass fellowship, and most recently at the Cleveland Clinic where I did a robotic and minimally invasive valve fellowship. So for over two years I've focused my attention and training on less invasive approaches as well as the robotic heart surgery.

Deborah Howell (Host): I just can't imagine anything more fun than working that camera and getting those results for your patients.

Jeffrey Lee, MD: Oh my goodness, it's really revolutionary. The results are so satisfying to us as physicians and the families are just so ecstatic to see their loved ones out of the hospital so soon, and really it's really a wonderful approach.

Deborah Howell (Host): Win-win-win. So what advice can you give to someone who is researching their options on where to get their heart surgery performed and what kind of heart surgery to undergo?

Jeffrey Lee, MD: Well, I think depending upon the situation of the patient, obviously we would welcome them to see us in consultation, but if that's not possible because of their logistics or whatever, it's important to just let the surgeon do what he knows best to do. It's kind of... it would be I think a difficult thing to do and not not wise to ask a surgeon, 'can you do a less invasive approach' when he's not really experienced in it. So whatever he knows how to do best is what you should have them do. But obviously if you're looking for these types of technologies and approaches, go to a center that has a lot of experience with it and certainly we have that experience here at Saddleback.

Deborah Howell (Host): Absolutely, you know, trust the experts. You can go online and be informed but really when it comes to the decisions, it's gotta be up to the physician team.

Jeffrey Lee, MD: Right, I think many times patients look online and they say “oh can you do this?”, and the surgeon wants to feel like he wants to satisfy the patient, so he'll look up how to do it and he'll do it but it just will not be his best clinical result. Let the surgeon do what he knows how to do best. But obviously if you're looking for these types of technologies and approaches, go to a center that has a lot of experience with it and certainly we have that experience here at Saddleback.

Deborah Howell (Host): And don't try this at home, right?

Jeffrey Lee, MD: No. Not yet.

Deborah Howell (Host): Thank you so much Dr. Lee, it's been so informative to have you on the program today to talk to us about the comprehensive robotic and minimally invasive cardiac surgery program at Saddleback Memorial Medical Center. Have a wonderful day, sir, and thank you so much for being here.

Jeffrey Lee, MD: Thank you so much.

Deborah Howell (Host): To listen to the podcast or for more info, please visit memorialcare.org. That's memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have a fantastic day.