Cardiac Surgery Requires Increasingly Skilled Team

By Dan Teller, PA-C, Vice President of Cardiac Services

I started my career in cardiac surgery nearly 40 years ago. The advances that I’ve witnessed in terms of procedures, medicines and machines have transformed the nature and the effectiveness of the cardiac OR. While we still have heart and lung machines in the OR that pump and oxygenate blood, the technical sophistication of an operation has increased dramatically. The result is that more patients not only live but return to their normal lives much sooner.

In the early 1980s, the average cardiac surgical patient was intubated for 24 hours and then spent three days in the ICU. If they did well, they went home about a week later. Today, that patient is only intubated for four hours, are up and walking on day one and go home typically on day 4 or 5.

Back then if you had a complicated heart problem, the only device that was used was the intraaortic balloon pump. While we still have them, they are used much less frequently because we have so many more tools in our arsenal. We used to do frequent surgical aortic valve replacements, which requires opening up the chest; However, those have been essentially replaced by transcatheter aortic valve replacements (TAVRs), which are less invasive and offer faster recovery times.

Similarly, endoscopic procedures to harvest a vein for use in bypass surgeries have also made those procedures less invasive. We used to open up someone’s leg to get the needed blood vessel through a long incision and now it is done through a couple of small incisions. Today, we’re more aggressive about complete arterial revascularization and endoscopically remove the radial artery in your arm through a small incision by your wrist.

Advances in medicines have also improved outcomes and the quality of patients’ lives. Historically, you could count the medicines we had in our arsenal on one hand; now we have dozens, and they keep getting better. For example, it wasn’t that long ago that statins, aspirin, and Beta blockers were not a standard drug for heart disease. Now they are prescribed by your primary care physician and have helped stave off surgery for thousands of patients.

Of course, the devices and machines that enable these advanced procedures have and continue to evolve as well. Many people have heard of the ECMO (Extracorporeal Membrane Oxygenation) machine due to the pandemic because it provided oxygen to the blood of severely challenged COVID patients. Those machines are placed by the cardiac teams on staff. We also have a variety of devices such as the left atrial clip which reduces stroke risk in atrial fibrillation, as well as left and right ventricular assist devices (LVADs) (Impella) to assist the heart in pumping blood.

Advances Require Increasingly Sophisticated Surgical Staff

As cardiac surgery has become more advanced, the surgical staffing role has also become more challenging. The skills needed have become more complex such as vent management, intubation, chest tube insertion, central lines and vein harvesting. While school provides a foundation, there is so much more to learn and skills to be developed for cardiac surgery that schools simply don’t provide. There is ongoing CME to keep up with the latest information. The device companies frequently have small seminars to keep us refreshed in the latest information on their devices.

At AP Health, we staff the cardiac surgery programs at three hospitals in South Florida: Holy Cross Health, Jupiter Medical Center and Bethesda Hospital. These are major cardiac surgery programs on the forefront of cardiac care. To serve our customers, we have a program to develop staff.

Not every practitioner comes to us with the same skillset. They might have surgical experience but have never worked with an ECMO. Or, they have may have worked in cardiology, but never done endoscopic graft harvesting or worked in the ICU.

We give our practitioners the knowledge and experience they need to be successful in an advanced and complex cardiac surgical program. Some of this comes from training by the manufacturers of the machines and devices we use on a daily basis. Some of it is on-the-job training where I, along with other staffers, share our knowledge and help them develop the skills needed.

After 40 years, I still love working in cardiac surgery. It has been rewarding to witness the advancements made and to continue to develop my skills to improve outcomes for the patients in our care. I also enjoy working with younger practitioners so that they will not only be successful today, but in the future as new procedures, medicines and devices continue to advance the treatment of coronary disease.