Open heart surgery is not as “open” as it used to be. Less invasive procedures are becoming more common -- like the McGinn Technique, which reduces trauma to the chest cavity and speeds up recovery time. On this episode of Baptist HealthTalk, the technique’s inventor, Joseph McGinn, Jr., M.D., chief of cardiac surgery at Miami Cardiac & Vascular Institute, joins host, Dr. Johnathan Fialkow, to talk about heart surgery advances.
More from Dr. McGinn can be found on the Baptist Health Resource Blog:
“Don’t Delay Your Heart Surgery in COVID-19 Era”
For more information about Coronavirus please visit https://baptisthealth-coronavirus.com/
Open heart surgery is not as “open” as it used to be. Less invasive procedures are becoming more common -- like the McGinn Technique, which reduces trauma to the chest cavity and speeds up recovery time. On this episode of Baptist HealthTalk, the technique’s inventor, Joseph McGinn, Jr., M.D., chief of cardiac surgery at Miami Cardiac & Vascular Institute, joins host, Dr. Johnathan Fialkow, to talk about heart surgery advances.
More from Dr. McGinn can be found on the Baptist Health Resource Blog:
“Don’t Delay Your Heart Surgery in COVID-19 Era”
For more information about Coronavirus please visit https://baptisthealth-coronavirus.com/
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Welcome to the Baptist Health Talk podcast, where our respected experts bring you timely, practical health and wellness information to improve your family's quality of life.
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Just how open is open heart surgery and how have new techniques improved, not just results, but recovery times as well? We'll get to the heart of heart surgery on this episode of Baptist Health Talk.
Dr. Jonathan Fialkow:
Welcome back to Baptist Health Talk, podcast listeners. I'm your host, Dr. Jonathan Fialkow. I'm a practicing preventive cardiologist and lipidologist at Miami Cardiac and Vascular Institute at Baptist Health South Florida, as well as Chief Population Health Officer at Baptist Health.
Dr. Jonathan Fialkow:
Preoccupation with the COVID-19 outbreak has shifted the attention away from other serious health issues we continue to face, like cardiovascular disease, which affects nearly half of American adults.
Dr. Jonathan Fialkow:
While we continue to emphasize that one should not delay their medical care for fears of exposure to coronavirus, we also wish to let folks know about the innovations in medical care that we at Baptist Health of South Florida lead.
Dr. Jonathan Fialkow:
Hundreds of thousands of heart surgeries are performed every year in the United States, and for years, doctors have been working on new techniques to make these procedures safer and more effective while also decreasing the person's recovery time.
Dr. Jonathan Fialkow:
Today, I'm very pleased to welcome one of these innovators, Dr. Joseph McGinn, Jr., our new Chief of Cardiac Surgery at the Miami Cardiac and Vascular Institute. Dr. McGinn is known internationally for pioneering minimally invasive cardiac bypass surgery. We will talk about that as well as his technique.
Dr. Jonathan Fialkow:
Welcome to the podcast, Joe.
Dr. Joseph McGinn, Jr.:
Thank you. I appreciate you having me, Jonathan. It's a real pleasure.
Dr. Jonathan Fialkow:
Thanks. So Joe, we use this term open heart surgery quite often, and it's kind of a wastebasket term. Can you speak a little bit about the evolution of open heart surgery and what it generally means when we're talking about these surgical procedures?
Dr. Joseph McGinn, Jr.:
The most common procedures we do that are called open heart surgery are coronary bypass surgery. That's where we bypass blockages on the arteries of the heart.
Dr. Joseph McGinn, Jr.:
The other more common surgeries we do that are considered open heart surgery are valve replacement surgeries. Those are probably the two biggest markets that you'll see labeled as open heart surgery.
Dr. Joseph McGinn, Jr.:
Open heart surgery has been around for quite some time. It started in the late '50s and really revved up in the '70s and '80s and now it's one of the most common operations done in this country; as you had mentioned, there are 250,000 coronary bypasses are the United States alone. So it's a very, very commonly done surgery.
Dr. Jonathan Fialkow:
And as you note, it's been around for a while, but we're still innovating. It shows that we haven't figured it all out. So where are the main areas of innovation in open heart surgery and what specifically have you developed in terms of your technique?
Dr. Joseph McGinn, Jr.:
So, all surgeries have been getting smaller and more minimally invasive through different technologies; engineering technologies, including robotic techniques, minimally-invasive video camera techniques, laser techniques, and a lot of different ways of trying to get the incision smaller, the patient's recovery quicker, less pain, and so on.
Dr. Joseph McGinn, Jr.:
Great examples of that are knee surgery, laparoscopic gallbladder surgery, GYN surgery has all been minimalized. So over the last decade or more in cardiac surgery, we've been trying to do just about same thing, really trying to get to a point where we can create a solution that is less invasive to our patients so they can get better quicker and back to their normal activities faster.
Dr. Jonathan Fialkow:
And that would be what we would call... One of the approaches would be minimally invasive cardiac surgery, and that would be opposed to what? What would be the previous or the alternative to minimally invasive surgery?
Dr. Joseph McGinn, Jr.:
Well, I call it traditional surgery. A lot of people jokingly call it the zipper. It's a classic incision that goes right down the front of the chest and just divides the big breastbone in half.
Dr. Joseph McGinn, Jr.:
It's quite a traumatic operation when you think about some of the people that are getting it. So the concept would be to create multiple smaller holes that on a whole have much less impact on the patient and have afforded a much better and faster recovery.
Dr. Jonathan Fialkow:
So you're able to bypass the arteries like the blocked artery, which is the concept of bypass surgery, quite frankly; but you're able to do it in a way that does not cut the middle of the chest through and through. And the benefits to the patient are, as you said, better recuperation. Can you speak a little bit about like what that means, better recuperation, what a patient could expect with your approach versus the zipper?
Dr. Joseph McGinn, Jr.:
The zipper. A lot of people have it, so if you walk around the pool, you'll see people showing it off constantly. Yeah.
Dr. Joseph McGinn, Jr.:
So the concept is that we want to keep the chest cavity intact, try not to cut or break any bones, try not to cut or damage any muscles; so at the end of the surgery, the patient's functionality is pretty much normal.
Dr. Joseph McGinn, Jr.:
The way we do it is by going in between the ribs and the ribs themselves are quite limited, but using some engineering designs and advances and using multiple small holes, we're able to get the same job done without breaking bones or ribs and going between the ribs.
Dr. Jonathan Fialkow:
And as a result, the patient has less pain or faster recuperation or again, in your experience, what are the patients that you operate on compared to those that have the traditional approach?
Dr. Joseph McGinn, Jr.:
Yeah. So the whole idea here is to get the patients back to normal activity quickly, and that involves less pain. So in all these patients, we put a Marcaine infusion pump. It's basically a pump that numbs the area for the first few days, which is the only painful period of time.
Dr. Joseph McGinn, Jr.:
But at the first few days, this operation is very much painless. It requires a lot less narcotics and people get back to their normal activity, much, much quicker. They can even get to work as quickly as a week after discharge.
Dr. Jonathan Fialkow:
Wow. Wow.
Dr. Joseph McGinn, Jr.:
As opposed to two to three months after the standard operation.
Dr. Jonathan Fialkow:
And we've seen that, which is fantastic. So I think a good take home point now to turn it into a COVID conversation is that of all the reasons why people may delay coming to the hospital and there are legitimate ones; although one of the ones I do want to make note of is not having visitors and we are now in the Baptist Health System allowing a visitor. So there's some relaxation of those restrictions, which were meant to help the patient.
Dr. Jonathan Fialkow:
But in terms of recuperation for people who need bypass surgery, can you speak a little bit about what could be any negative consequence if they inappropriately delay the surgery?
Dr. Joseph McGinn, Jr.:
Yeah. So one of the things I've been talking a lot about is we were doing a lot of these surgeries electively, and we have three categories of surgery: elective, urgent, and emergent.
Dr. Joseph McGinn, Jr.:
Emergent is pretty obvious. Someone who comes in in the midst of a heart attack, they need their surgery done right away. People who are urgent are those that can't go home, but don't need to go right away.
Dr. Joseph McGinn, Jr.:
The elective group is the one that is the most common and that's the one that I'm worried about the most, because we don't want elective cases to turn into urgent cases because then the surgery becomes much more difficult and the outcomes aren't quite as good. So we want to get the elective patients in before they get to a point where they're in trouble or even have a heart attack.
Dr. Joseph McGinn, Jr.:
We do these elective surgeries because we know that if we don't do them, that at some point or another, the patient's going to have a heart attack and that could be even a fatal heart attack. We want to get them before that point.
Dr. Joseph McGinn, Jr.:
So a lot of times patients are afraid to come to the hospital because of COVID and I certainly understand that, but not in lieu of a heart attack. We have to be mindful of the fact that these patients do need surgery and hopefully we'll get them in sooner then later.
Dr. Jonathan Fialkow:
I think that's a great point. I have that conversation quite often with patients who at the moment may feel well, but have something obviously which puts them at risk; which is if they wait several months, nothing good is going to happen. They may do fine and three months later be okay or something bad's going to happen, but it's not like the problem is going to go away or be resolved. So it does speak towards making that decision and acting quicker rather than later for those reasons.
Dr. Jonathan Fialkow:
What have you seen at Baptist? You've been here for several months now. First place, I'm asking you a question that hopefully we have an answer for. Are we seeing any people that have gotten COVID from exposure certainly in the cardiothoracic surgical space? So do you have any experiences at this point that you can relate?
Dr. Joseph McGinn, Jr.:
Yeah, actually I can say that the number of people who've got COVID is very small; I mean, amazingly small. All the staff members have been tested for antibodies and everyone's coming up negative. So the transmission from COVID patients to healthcare workers at Baptist is minimal at best, even if there is a couple of cases, I'd be surprised.
Dr. Jonathan Fialkow:
And we don't even know if they got it from working at Baptist; but as you said, the minimal, a handful of cases out of tens of thousands employees, which is quite encouraging. So I appreciate that as well.
Dr. Jonathan Fialkow:
Let's talk a little bit about going back to the surgical procedure now. I think you mentioned that people can get back to work, less pain. Cosmetically, it's better as well. You mentioned that around the pool, you see the people with the proverbial zipper, but do people decide to have this approach with you specifically because of a cosmetic outcome? Is that one of the drivers?
Dr. Joseph McGinn, Jr.:
Oh, without question. We're seeing younger and younger patients coming for coronary bypass surgery. It's scary, but it's true. They are younger and younger and many of them are diabetics or family history.
Dr. Joseph McGinn, Jr.:
They're not wanting to have the big old incision. They want to have something that's a little bit more cosmetic, especially for some women, we can make the incision in the inframammary crease so it's completely hidden. And for men it's a much, much smaller incision that's much easier to hide. So absolutely people are coming to that.
Dr. Jonathan Fialkow:
So I look at, as a preventive cardiologist, a failing of course, when one of my patients winds up needing bypass surgery, which does not happen that frequently, quite frankly.
Dr. Jonathan Fialkow:
But having said that, if I'm speaking to a patient saying, "Listen, I think you need surgery. I think this is the best chance for you to have a good quality of life and avoid significant cardiac consequences, and you may be a candidate for this approach versus the midline," the zipper again.
Dr. Jonathan Fialkow:
What are the things you look at that might say, "This is perfect," or, "Hey, maybe I can't do this approach in you because..."
Dr. Jonathan Fialkow:
What makes a person a candidate or a non-candidate.
Dr. Joseph McGinn, Jr.:
When I first started doing the surgery over a decade ago, I did have limitations on who I could do the procedure on and who I couldn't do it on. But at this point, I would say that most everybody is a candidate. I'll have some provisos, however.
Dr. Joseph McGinn, Jr.:
There are some patients who I find very difficult to do, challenging to do and those are the morbidly obese patients. I try my best to get those patients a minimally invasive solution, but sometimes it's almost impossible.
Dr. Joseph McGinn, Jr.:
The other case is where we have very diffuse coronary disease, where we are not 100% sure where the bypass is going to go; and if someone needs five or seven bypasses, typically those patients would be better served with a more open approach.
Dr. Joseph McGinn, Jr.:
But honestly, it's a rare occasion. It's one or two out of 100 cases I don't do minimally invasive. So it doesn't happen that often.
Dr. Jonathan Fialkow:
That's great. What's the most number bypasses you've put in the patient using this approach?
Dr. Joseph McGinn, Jr.:
Six. I've done a couple of patients with six bypasses. It's really a handful. It's not that common. Most common is three and four. And then strangely enough, a lot of single bypasses because of the failed stents. A lot of patients have proximal LAD stents and they don't work out after a year or two. And surgery is the next best option.
Dr. Jonathan Fialkow:
Right. Given the choice, most people choose a stent because it's not a true surgical procedure, but there are certain anatomical findings in an artery or limitations in the stent where surgery still provides a better long-term outcome. I think we have to be aware of that when we make those recommendations.
Dr. Jonathan Fialkow:
And can you speak to your outcomes? Again, you're new to Miami, but you've been doing this for quite some time in North Carolina and New York City. So what kind of results have you received?
Dr. Joseph McGinn, Jr.:
Yeah, well, we're actually very proud of our results. As I mentioned, we've been doing this for over a decade. I've been partnered with a professor at a University of Ottawa Heart Center and the two of us have been accumulating our results and publishing our results and they are very easy to look up on Google or whatever you want to check out the results.
Dr. Joseph McGinn, Jr.:
But we're very proud of the fact that our procedures actually come out to be better as far as the efficacy is concerned, than the sternal approach. And I have the world's largest series where we're almost at 2,000 cases.
Dr. Jonathan Fialkow:
Wow.
Dr. Joseph McGinn, Jr.:
So we have tremendous experience in this arena.
Dr. Jonathan Fialkow:
Well, it's great. It's great having you in our system. It's great having you as a resource, both as a colleague and as a friend. And I think you're bring in a really innovative and fresh approach to the South Florida for the patients that require this particular procedure.
Dr. Jonathan Fialkow:
I really appreciate your time, appreciate your expertise. Anything you want to add that we left out or any particular points you want to bring up to our listeners?
Dr. Joseph McGinn, Jr.:
I think one of the things about the candidates that I would probably like to enlighten everybody, I put them in two categories.
Dr. Joseph McGinn, Jr.:
One of the categories is patients who are breadwinners, need to get back to work quickly or get back to normal activity level. This is ideal for them. It's a lot of patients who can't afford the two or three months layoff to have a traditional approach just from a financial standpoint. So this is a big option for them.
Dr. Joseph McGinn, Jr.:
Then the other group of patients is patients who I believe would not do well with a big invasive operation. Those are debilitated patients, patients who have other disease entities going on. Some people have COPD or emphysema, for instance, or if people have other vascular problems, you don't want to put those patients through such a big operation.
Dr. Joseph McGinn, Jr.:
So I just wanted to let the audience know that there are certain categories that really, really benefit from this kind of approach.
Dr. Jonathan Fialkow:
So with the exception of being morbidly obese, which I guess can affect your access and wound healing and whatnot, as well as having more than extensively six bypasses necessary, which will be pretty infrequent, most people could be candidates for this improved approach. That's great.
Dr. Joseph McGinn, Jr.:
I think that's well put. I think that's exactly right.
Dr. Jonathan Fialkow:
Great, Joe. I really appreciate it. Again, Dr. Joseph McGinn, Jr., our Chief of Cardiac Surgery at the Miami Cardiac and Vascular Institute.
Dr. Jonathan Fialkow:
This is Dr. Jonathan Fialkow. Welcome you again to have listened to one of our podcasts and as usual, if anyone has any ideas or thoughts or any topics for our future podcasts, please feel free to email us at baptisthealthtalk@baptisthealth.net and as usual, stay safe and stay home.
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