There has never been a better time to have heart disease—medically and technologically speaking, that is. Today, even though heart disease is the #1 killer of men and women in the United States, patients referred for heart surgery have a higher chance of survival than ever before, thanks to many well-studied methods and amazing technology to surgically treat heart disease.
Yet it is still a scary situation to face. One of the best ways patients can mentally prepare themselves is by having a “heart-to-heart” conversation with their surgeon.
“No matter how complicated the case is, no matter what the disease is, I use a framework of three questions when consulting with my patients prior to surgery,” explains Dr. David Joyce, a cardiac surgeon with East Falls Cardiovascular and Thoracic Surgery. “These are the questions I would advise every cardiac patient to ask their surgeon, and they are the questions I train my medical students to review with their future patients.”
“First: is the disease, the condition, severe enough that surgery is necessary?”
Usually, this is the easiest of the three questions to answer. Nearly all patients referred to a cardiac surgeon have already seen a cardiologist and have gone through diagnostic tests such as an echocardiogram.
The most common forms of heart disease diagnosed by a cardiologist include aneurysm, arrhythmias, atrial fibrillation, coronary heart disease, heart failure, and heart valve disease. These conditions can all be treated with surgery, but the question of necessity still should be explored.
As Dr. Joyce put it, “Usually, when a patient has been referred for surgery, their condition is obviously so bad that surgery is necessary. However, there is a spectrum of severity. So, we need to ask the question: what is the medical evidence to support the decision to have surgery? A patient should ask, ‘Is my condition bad enough to justify surgery.’”
The one good thing about a nationwide pandemic of heart disease is the enormous number of studies that have been conducted on various surgical treatments. These studies have generated widely used, scientifically proven, and frequently reviewed recommendations that surgeons can rely on to answer that first question.
The second question patients should ask their surgeon can be the most difficult question of the three. It may require the patient to do some serious soul searching.
“Is the patient—am I—healthy enough to undergo open heart surgery? We assess the risk versus the benefit,” says Dr. Joyce. “It can be a difficult conversation to have, but it is crucial for the patient to be involved in the discussion and the decision. We ask things like, will they still be alive 30 days after the operation; will they be able to live for at least a couple more years? Do they have cancer or other risk factors? Generally, if a patient has an 8-10% risk of not making it through recovery, we won’t proceed.”
After establishing that surgery is necessary and that the patient’s chance of survival is good, the next question is how to do the surgery itself. There are often multiple options and methods available to the surgeon when performing the actual procedure. As Dr. Joyce explains, the answer to this question depends on many factors:
“For example, take a patient with aortic stenosis [heart valve disease]. There are several ways to surgically fix this, and there used to only be two options for valve replacement: tissue [pig, cow, or human] or mechanical. A tissue replacement valve only lasts for about ten years, so the patient will have to have another surgery. Mechanical valves last longer but require the use of blood thinners. So, a younger patient may be better off with a mechanical valve … a tissue valve may be best for an older patient.”
Along with asking their surgeon these three questions, patients should also research the quality of the cardiac surgery program at the hospital they plan to use. At EIRMC, patients can find high-quality heart care close to home. It is the region’s most comprehensive cardiology program, with many experienced specialists who can address most cardiac concerns.