Special Interview: The Importance of Cardiac Rehabilitation For Heart Valve Surgery Patients With Dr. Ram Dandillaya

While the patient benefits of attending cardiac rehab after heart valve surgery are well documented, the utility of these post-operative programs remains disappointing — as only 20% of patients who could benefit from cardiac rehabilitation are referred to outpatient facilities.

Cardiac Rehabilitation After Heart Valve Surgery

For this reason, I contacted Dr. Ram Dandillaya, a cardiologist at Cedars-Sinai in Los Angeles, to learn more about the benefits and the issues that surround the use of cardiac rehab after heart valve surgery. (As you might recall, Dr. Dandillaya was instrumental in Kato Pomer’s MitraClip procedure.)

I thought you might want to review the highlights from my interview with Dr. Dandillaya so I provided them below.

Dr. Ram Dandillaya
Dr. Ram Dandillaya, Cardiologist

Adam: Thanks so much for taking time to speak with me today. I’d like to ask you a few questions about cardiac rehabilitation programs for heart valve surgery patients.

Dr. Ram Dandillaya: Thanks Adam, it’s a pleasure to be talk with you today about this most important topic.

Adam: But first… I’m curious… Why did you chose cardiology as your specialty?

Dr. Ram Dandillaya: Cardiology always had the most intellectual appeal to me. The ability to integrate the physical exam, history, and other data was fascinating. I also saw it as a field where one can develop a niche, whether it be in prevention, imaging, or intervention.

Adam: I understand you have a special interest in heart valve treatment and research – especially some of the newer transcatheter approaches. Is that accurate?

Dr. Ram Dandillaya: That’s correct. I started at Cedars-Sinai around the time when catheter-based valve interventions were getting started for disorders including stenotic aortic valves and mitral regurgitation. I was fortunate to make a connection with Dr. Raj Makkar and Dr. Saibal Kar, world renowned experts in their respective valve intervention programs. Although I don’t perform the actual intervention, there is a lot of careful, medical management before and after these cases — which is where I get involved.

Adam: Specific to cardiac rehabilitation, do you think patients should attend these programs during their recovery from heart valve surgery?

Dr. Ram Dandillaya: We encourage strongly all of our patients to enroll in cardiac rehab. However, many of our patients are not from Los Angeles so it’s a little hard to keep track. From the patients I see, they definitely attend and reap great benefits from such programs.

Adam: What do you see as the key benefits of cardiac rehab?

Dr. Ram Dandillaya: In addition to cardiovascular conditioning, I see cardiac rehab as building the confidence of my patients. For many, heart valve surgery is a truly transformative journey. There is also an incredible amount of education to be gained during these sessions–about eating habits, lifestyle, risk factor reduction etc.

Chart About the Benefits Of Cardiac Rehabiliation Classes
Cardiac Rehabilitation Goals (The Cleveland Clinic)

Adam: I’ve read that – in addition to the physical benefits of cardiac rehab – there are mental and social benefits of these programs. Is that an appropriate statement?

Dr. Ram Dandillaya: Absolutely. I have seen this on several occasions. Post-surgical depression, also known as cardiac depression, is not uncommon. I have seen significant improvements on this front after patients enter cardiac rehab. These programs also provide a community where patients can share experiences with one another as well as their rehab team.

Adam: What do you think are the key ingredients of a good cardiac rehab program?

Dr. Ram Dandillaya: One key ingredient would be the staff — highly trained and experienced cardiac rehab nurses that are able to communicate with the referring doctors. Additionally, quality equipment and a conducive environment for exercise is helpful.

Adam: During my recovery, I had to beg and plead to get into a cardiac program after experiencing ongoing incision pain and cardiac depression. I was originally told, “You don’t need that. You’re young.” Is this a common mistake? Do you recommend cardiac rehab for younger patients as well?

Dr. Ram Dandillaya: Given the low referral rates to cardiac rehab in general, I am sure that younger patients are also passed over. I would absolutely recommend rehab for my younger patients. They will recover their strength, endurance and confidence faster with it.

Patient On Bicycle During Cardiac Rehab
Me (Adam) At Torrance Memorial Cardiac Rehab Program

Adam: Considering all the advantages you just detailed, why is cardiac rehab referred to only 20% of patients that could benefit from these programs.

Dr. Ram Dandillaya: Great question. The importance of cardiac rehab has just not entered into the mainstream thinking for many doctors. We often think that once surgery is over and patients are on the right medications, then our job is done. With reimbursement cuts, hospitals are unfortunately downsizing their programs as well. Additionally,  some patients have a hard time keeping up with the frequency of rehab appointments as well.

Adam: Is there anything we can do together to help improve awareness to this issue?

Dr. Ram Dandillaya: On a health policy level, we need to raise awareness among our advocacy groups about the importance of this often neglected area. Patients need adequate access to cardiac rehab programs and we need to incentivize hospitals and providers who participate in these programs. A directory of cardiac rehab programs on the web would be a great start as well.

Adam: Sounds like there is a good amount of work to do. I really like the idea about a cardiac rehab database.

Dr. Ram Dandillaya: Great. Maybe we can work together on it.

Adam: Dr. Dandillaya thanks so much for chatting with me today about cardiac rehab. We really appreciate all that you and your team are doing to pursue healthy hearts!

Dr. Ram Dandillaya: Thank you Adam.

Adam Pick
Written by Adam Pick

Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.

To learn how Adam has helped millions of people with heart valve disease, watch Adam's video, subscribe to his free newsletter, or visit his Facebook, or Twitter pages.

  • Doug Watson

    In my case cardiac rehab was referred but insurance would not cover it.

    It is amazing how often insurance companies practice medicine without a license these days.

    Doug

  • http://www.heart-valve-surgery.com/about-adam-pick-author-heart-valve.php Adam Pick

    Doug,

    Agreed.

    My insurance did not cover my cardiac rehab sessions either. (However, there are insurers that do cover this very important, post-operative form of therapy.)

    In total, I had to pay about $400 for my sessions. Looking back on it, I would have paid $4,000 considering the benefits I received as a result of cardiac rehab. :)

    Keep on tickin!
    Adam

  • Anne Shannon

    Hi Adam,

    I’m glad you have brought this subject up! Four weeks after my surgery I asked my cardiologist about Cardio-rehab and was told that I was already “past that.” Well, I wasn’t and still don’t think I am. I could definitely benefit from some monitored cardio type exercise. I try to walk daily but – as the walking tapes Fran recommended have proven – I am not going at a clip that is raising my heart rate sufficiently.

    After reading this, I think I will find a program in Denver and pay for it myself. I just don’t think we can ever have too much of this type of rehab.

    Thanks,

    Anne Shannon

  • John D.

    Adam, As you know, Cardiac Rehab is the best investment you or your insurance company can make in helping you recover faster and keeping you healthy longer! If more insurance companies invested in this program upfront, they would likely save money later by creating healthier, long-term, post-op patients! John D.

  • Karen Pomer

    Adam,
    Thank-you so much for a wonderful post on cardiac rehab. You could not have picked a more caring and competent cardiologist than to partner with Dr. Ram Dandillaya, to help create more awareness regarding issues around accessing cardiac rehab for heart valve patients. It’s not just the young who face discrimination, my own mother Kato Pomer 93, who was mentioned in this article faced discrimination post-MitraClip procedure at one of the cardiac rehab facilities she tried to get into. They had recently downsized and did not have the staff to accommodate someone who needed individualized attention. To her credit she did not give up. We found a great cardiac rehab and she is getting stronger every day.
    Karen

  • Marlane Holtshouse

    Hi All, I had to beg and beg to get to go to rehab. I’m 68 and I felt that they maybe thought I was to old. I did go and it was the best thing that has happened to me other than my new aortic valve. I am able to do so much more and with so much more confidence than i had before. I wish it could have lasted longer. The real test comes after your finished. Do you continue to work out. I did lapse but now I’m back. Hope every Surgeon heeds this . Marlane

  • Paul Klaassen

    Nice to see a frank discussion about cardiac rehab. In my case it was the excellent staff at the cardiac rehab centre who first encouraged me to get going, then kept my enthusiasm in check as I started to push to hard. My Left Ventricular Hypertrophy slowly diminished as they eased me back to my pre-surgical exercise levels (and beyond). One thing they told me at the centre that really struck me was that the great majority drop out without completing the program. And that most never move to the new dietary habits they are taught in the rehab’s nutrition seminars. Too bad.

  • Helen Webb

    I’m a 44-year-old woman, four weeks post-surgery for mitral valve repair. For the past two weeks I’ve been hiking 2 to 3 miles/day through hilly terrain (which I never had time to explore before!); I have no pain; and my energy level isn’t *quite* what it was presurgery, but it’s pretty close.

    My diet is largely farm-share driven; my weight is fine; I haven’t had any post-surgery depression; and though I only know one person who’s had heart valve surgery, that’s been enough support (a WWII vet! If I can be in anything close to his shape at his age, I’ll be very happy.).

    I know you really advocate cardiac rehab, but I can’t think what it would do for me. But I don’t want to be missing something important…

  • Maureen Lamarche

    Thank you for this article. I had aortic valve replacement Nov. 8 so not quite a month yet. I was dischaged from hospital Nov. 22 and my progress has been remarkable. I was called in to rehab for a cardiopulmonary exercise test (Score 9.7 out of a possible 28). Up to this point insurance coverage is included. Now I will rejoin the Sports center I usually went to before surgery to continue rehab on the exercise bike as well as getting out for a walk everyday. I am 72 and feeling great these days. I live in Japan and had the surgery here. I also received a DVD of the surgery so I know just how much my heart was handled. Gives me great respect for the surgeons and my heart.

    Nutrition guidance was also provided.

  • Jennifer

    I think cardiac rehab is a vital step to reaching our new “Normal” and a safe new normal. I have HCM and at 32 came out of open heart hoping to just have a septal myectomy but I also had a new mitral valve. Apparently I was too young for rehab. So I put myself through my own rehab with a treadmill and weights. I know I did too much too soon, which continued to cause me to take one step forward and three steps back. Physically I had constant aching pain in my chest that took years and alot of yoga classes to finally heal properly. Mentally and emotionally the whole ordeal was rather overwhelming. I felt like I was going through a death in the family but the secret was I was the only person who knew about the death. Three years later I attended the Annual WomenHeart Symposium. This is where the real healing began when I knew that I wasn’t the only one dealing with heart disease. That all being said I think Cardiac Rehab would be beneficial to All.

  • Joe Fresch

    Adam,

    I too had to push to get into Cardiac Rehab, but my insurance is covering 20 sessions although I will have to start my job which is a lot of traveling before I finish them all. I really appreciate having them monitor me and they take any pain felt very seriously. I would be going too fast I am sure if my heart rate wasn’t monitored and they didnt give me heart rate and METS targets to aspire to. Cardiac Rehab should be done by all, even stent patients, I am trying to get my dad to go, he had a stent two weeks before my problems started, and to my knowledge, no one mentioned rehab. One last thing, I am not sure I would have been so insistent about rehab had I not read your book Adam, thank you.

  • Sharon Randles, RN (UCLA Health System’s Cardiopulmonary Rehab manager)

    There is a database for all the cardiac rehab programs in California. It can be accessed at http://www.cscr.org (lower case) and then click on searchable program directory. CSCR stands for the California Society for Cardiac Rehabilitation and we have been around for over 25 years. Our national organization is the American Association for Cardiovascular and Pulmonary Rehabilitation (AACVPR). They also have a searchable program directory available. Go to http://www.aacvpr.org, click on the Resources and then searchable program directory.

  • Gladys

    On June 16th I Had my Mital Valve replaced at Union Memorial hospital in Baltimore Md.I was released on june 22nd,would have been released earlier,but the had to get my INR @ a level between 2.5 and 3.5.I Will be on coumadin the rest of my life,but that’s ok,I was on it for 10 yrs before my replacement.I started cardic rehab on Aug.2nd,had 36 classes,really enjoyed it.It was very helpful.I have so much energy,I Fell good,had a good recovery,family and friends could not believe that I had open heart surgery when thy saw me 6 weeks later.i highly recommen cardic rehab.medicare paid 80%and my insurance paid 20%.I am blessed,haven’t had any problems,i’m enjoying my new life at 58 yrs old.

  • Winter, C.A.

    I am an 84 year old widow, live on my own, and had an emergency porcine aortic valve replacement six years ago in South Africa where I live. After ten days in hospital I was released with the minimum of instructions and no rehab. I had resident care for three weeks and after that I was on my own.

    Since then I have travelled to England, Italy, Russia, Scotland and twice to France. I have just finished writing my biography which is published on my blog site in instalments. It is full of humour and adventures so look for it on http://onthewayto84.blogspot.com

    The valve is now calcifying slowly, and further surgery is not an option. BUT I have had a jolly good six years so far, and thank God for every day he gives me on my way to 85.bles

  • Anne Shannon

    Hi Adam,

    Just a PS to the post above when I said I was going to find a cardio-rehab program. I did locate one about 35 minutes from the house and began going over the holidays. It was over five months since my AVR when I enrolled. The program is providing exactly what I had hoped it would. They administered a stress test and now have me wired up and working within the prescribed parameters for 30 minutes 3 times a week.

    I had been exercising prior to the classes but had no idea what my target rates should be. Now I know and I am looking forward to increasing my fitness level.

    Anne Shannon

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