Video Interview: Dr. Stewart's Advice for Heart Surgery Patients During COVID-19 Pandemic
Published: April 1, 2020
As coronavirus cases surge past 921,000 infections worldwide, patients in our community are asking important questions about COVID-19 and heart valve surgery. Those questions include:
- How do pandemics, like COVID-19, rise-and-fall over time?
- What resources are being re-allocated from cardiac surgery to COVID-19 treatment?
- How long might it take for heart valve surgeries to be rescheduled?
- What can patients do to manage stress and stay healthy as they wait for surgery?
- What role can telemedicine play for patients before-and-after heart surgery during a pandemic?
To answer these questions, I was fortunate to interview Dr. Allan Stewart, a leading heart surgeon in Miami, Florida. As you may know, Doctor Stewart specializes in minimally-invasive heart valve surgery and aortic aneurysm procedures. Dr. Stewart has successfully treated many patients in our community including Donna Herzek, Lilliam Filer and Ray Pipher.
Here are the highlights of my interview with Dr. Stewart.
Key Points from Dr. Stewart’s Interview
During our interview, Dr. Stewart provided several important learnings specific to the coronavirus and heart valve surgery including:
- The sharp rise of new COVID-19 cases happening across the world, including New York, is to be expected given normal growth and life-cycle patterns of viral pandemics.
- Social distancing has been shown to be an effective strategy for “flattening the curve” of pandemics. By reducing new infections, (i) hospitals are not overwhelmed and (ii) researchers and medical teams "buy time" to evaluate potential treatments and/or vaccines.
- To appropriately allocate resources for the management of rising COVID-19 cases, previously scheduled heart valve operations may be rescheduled if the medical team believes the surgery can be postponed without causing any risk to the patient’s health.
- Resources associated with a heart valve surgery include beds, operating rooms, ventilators, personal protective equipment (masks, gowns, gloves) and blood.
- People (doctors, nurses, perfusionists, x-ray technicians) are considered the most important resource to perform heart surgery. It is estimated that about 100 people will touch a cardiac patient between their office visit and their discharge.
- Dr. Stewart does not believe the delay to reschedule a heart valve surgery will be extensive (greater than 3 months) during the COVID-19 pandemic. Instead, he believes the rescheduling process may occur in several weeks.
- To manage patient stress and anxiety during the “waiting time” for a delayed heart surgery, Dr. Stewart recommends (i) meditation using smartphone apps including Calm, (ii) eating good, healthy foods, and (iii) exercise if approved by your cardiologist.
- Telemedicine has been a significant part of Dr. Stewart’s heart surgery practice for many years. Now, more than ever, telemedicine is a convenient way for patients to get educated about their upcoming surgery, learn about their recovery, and participate in cardiac rehabilitation classes.
Many thanks to Dr. Allan Stewart for taking the time to share his clinical experiences, research and thoughts about the coronavirus with our community!
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Keep on tickin!
P.S. For the hearing impaired members of our community, I have provided a written transcript of this video interview below.
Adam: Hi, everybody. It’s Adam with HeartValveSurgery.com, and this is a COVID update. As we’ve all have seen, this is a very difficult time and very trying time for people all over the planet, all over the world, including our community. I was just having a very interesting conversation with Dr. Allan Stewart who’s a leading cardiac surgeon from Miami. I wanted to bring him into the conversation. Dr. Stewart, are you there?
Dr. Stewart: I’m here, pleasure to be here, Adam.
Adam: Thanks for being with us today, and Dr. Stewart, you’re no stranger to our community. In fact, you’ve been celebrated by many, many patients here, whether it’s Greg O’Keefe or Bill Eaton. You’re known for a lot of the endurance activities that you do with your patients. Maybe you can just share a little bit about your – what you’ve done in cardiac surgery and how you’ve done these incredible events with patients in the past.
Dr. Stewart: Sure, well, first, it’s an honor to be here. I’ve always recognized the value of HeartValveSurgery.com. It’s been a wonderful resource for multiple patients that I’ve operated on who either came from your site or I’ve referred to your site to find a community after surgery. Heart surgery and heart valve surgery in particular has been a passion of mine. I look at it as a touchpoint in one’s life where it gives someone the ability to get back to a health they haven’t seen in years, and yes, I’ve encouraged patients to get into endurance athletics afterwards and have done triathlons and marathons with people who have had heart valve surgery. Yeah, I believe that surgery doesn’t necessarily define a human being but can be that cross-point in a road to encourage healthy living and a robust life.
Adam: I think one of the greatest things I’ve ever seen you say in context with a patient is how – if I remember right, how you say that heart valve surgery can be a reset button for patients, and we’ve seen that several times with your patients and a lot of the patients here in our community. Dr. Stewart, we were just getting back to COVID-19, which, obviously, such a critical situation for us here all over and here all over the world, was we were looking at some of the statistics that are now coming out.
Dr. Stewart: Sure, in any disease, whether it’s a viral pandemic or a bacterial illness, there’s an escalation phase where the curve looks like a dramatic rise, and then there’s a leveling off period and, ultimately, a decline. Our goal here is to try and push ourselves into that leveling off period as quickly as possible. That way we can decrease the number of cases, not overwhelm our hospitals, and hopefully, buy us some time that one or more of these promising medicines will actually come to fruition and help treat this illness.
Adam: When you talk about the rise, obviously – here’s a slide that shows the new coronavirus cases announced in the US each day. Obviously, yesterday was a very big day with over 14,000 cases. When patients see this, this is nothing short as alarming when you see this increase, but from what it sounds like, this was to be expected. That we were going to see this given what we saw in China and Italy, Spain, some of the other locations. Is that accurate, and if so, how could social distancing impact that leveling off that you reference?
Dr. Stewart: Absolutely, we were expecting to see this rise for a couple of reasons. One is that we’re testing more people than we did when it first started, and secondly, there is this few week latency period where folks don’t know that they have the virus. Before the resided home orders and before we should’ve shut down shop in the United States, we were exposing ourselves and others thinking, well, it can’t happen here, and now areas like Manhattan are really overrun with cases because there are a lot of people living in Manhattan. It’s a city where there needs to be interaction. People don’t keep large storages of food in their houses. They’ve got tiny apartments. We don’t have large storage facilities for paper towels or toilet paper. You have a roll or two in your apartment, so there is a constant need to have either things delivered or to go out to the store or market. Interaction is very difficult to limit, and it wasn’t limited initially. Now we have this huge spread of disease. Now, it’s interesting to see. When you look at the country, yes, there are blots of circles meaning higher density. If you’ll notice, the lion’s share of those are north in the United States in colder climates. Here in South Florida we are not seeing the same incidents of disease. We have an enormously populous city in Miami, but we’re not seeing nearly the spread as we do in Manhattan. I think in some portion because we did start the social distancing a bit earlier, and two, I believe the climate is unfriendly towards viruses. I don’t think we’re seeing the same degree of transmission as you would in a cold climate.
Adam: Dr. Stewart, when you’re talking about the transmission, the transmission leads to the progression of the disease, which leads to patients going to hospitals, unfortunately. Even though the large majority of folks have mild symptoms or no symptoms at all, they still could enter that point where they’re having critical issues with their healthcare. They’re going into the hospital, and as we know here, elective surgeries have been put on hold or postponed. We’re learning more about that every day. As patients, we initially think, wow, there’s just – all those beds are going over to the patients. Maybe I was going to have heart valve surgery for my aortic stenosis or mitral regurgitation. They’re now going to the COVID-19 patients. What I was really curious to know is, from the surgeons perspective, is it just about beds, or are there other elements of the value chain, the different elements of a heart valve surgery that are needed to really perform an excellent procedure?
Dr. Stewart: It’s a great question, Adam. The bed is really just one resource. Yes, we need to physically put a heart valve patient in a bed for four to six days after an operation. We need to have an operating room available for six hours or so. Now, that requires one or two ventilators, one in the operating room and then one in an ICU for a period of time. The bed and the ventilator is just really a small aspect of the resources required for heart surgery. Most importantly are people, and the people that perform a number of tasks are necessary in treating heart valve patients. It’s estimated that about 100 people will touch a cardiac patient between their office visit and their discharge, and those 100 people are finite resources, those who draw blood, those who take the pre-op X-ray or the X-ray afterwards. These are people that are now being deployed into the COVID patients where blood phlebotomy and X-ray technicians are being drawn into this stretch process of taking care of a multitude of potentially infected patients, so we don’t have access to those folks. We don’t have access to the necessary PPE, the personal protective equipment. Masks, gowns, gloves are in short supply. Blood is in shorter supply right now because blood donations have dramatically declined due to the social distancing. There are a number of areas both personnel and materials that are stretched thin right now, which is why we made the decision to hold off on elective surgery. That’s not to say that we won’t perform surgery that’s necessary. We’re not triaging lives and having needless death of heart valve patients who are uninfected. What we’re saying is that right now, with a finite amount of resources both beds, personnel, and materials, we need to put the brakes on those that can wait to take care of needy individuals during this time.
Adam: I can’t thank you enough, Dr. Stewart, for providing, really, the big picture of what’s required in this time of crisis and the mobilization and reallocation of resources who patients desperately need it right now and those folks, those patients who might be able to put off their surgery, in particular valve surgery. That brings about a whole other question which is for those patients out there and I can tell you there are going to be a lot of them watching this who were scheduled for a surgery or were on the path to being scheduled for a surgery who no longer have that available to them maybe at this moment. A big question they’ve got to be wondering is what should I be doing? What are the things that maybe I can do to support my health during this time of delay and postponement? They’re still going to get that treatment when things come down, that U-curve as you reference. Do you have any thoughts as to what patients can be doing right now as this period of postponement occurs? What do you recommend?
Dr. Stewart: Absolutely, it’s a great question, Adam, and first is this delay for surgery is not for a protracted period of time. We’re talking about a couple of weeks before we really start opening up the elected practice again, and yes, we will take preference of those who are sicker but could wait than those who are purely elective because we’ll have a backlog of patients to operate on. We’re not talking about delaying for a quarter of a year. We’re really talking about a few weeks. Now, in that period of time, one needs to de-stress as much as possible. Needing heart surgery is a stressful time, having an economic collapse, stressful time, and little of that is controllable. I talk a lot about the 90/10 rule. Ninety percent of events we have no control over, but we have control over the other ten. Now, we have very little control over COVID, and it’s spread outside of what we can do personally. We have very little control over the market, but we can control our own stress and our own reactions to those changes. That will define how we’re going to prepare so plenty of apps available for meditation, Calm. There’s one that it could take ten minutes while we’re stuck in a house and going to the bathroom if there’s no space. You’re in a small apartment. Go into one space that doesn’t have a child, or a spouse, or an in-law that’s living with you, and get away from it for ten minutes. Try and be mindful. Try and de-stress. Any of these apps can help do that, or just focus on one’s breathing, and do it yourself. The second is food choices. When I go food shopping now, I’ve noticed that the healthy foods tend to be in abundance, but the processed things are empty. All the Hostess CupCakes and Twinkies and pretzels and potato chips, they’re all gone, but there’s plenty of berries and apples and bananas that are floating about. Make healthy food choices, especially when there isn’t an ability to exercise properly and we’re stress eating, so we’re tending to eat more calories but burning less. That brings up the third thing which is daily exercise. It’s important for those in eminent need of heart valve surgery to talk to your cardiologist and say, well, what can I and can’t I do? After that, there are plenty of apps that are available and a number of gyms that are offering livestream free classes during this period of time that you just need a phone and a television to stand in front of in a pair of sneakers. One can exercise a half hour, 45 minutes a day during this time, and that will both make your – and it’ll give you the best health you can until you have your operation. Also make recovery a bit easier if your body’s in better shape going in the door.
Adam: I don’t think I can overemphasize how important cardiac rehab is for patients, and it sounds like your patients now in the social distancing setting are still going through with cardiac rehab. That’s one question that I have for you, and a quick follow up, Dr. Stewart, is we’ve been hearing just a ton about telemedicine, how that has really become a new opportunity through this experience. Can you talk about whether your team is doing that as well?
Dr. Stewart: Sure, I’ve been using a form of telemedicine since the iPhone existed. I have always operated on folks from other countries. I send them back well before that month follow up, and I would always FaceTime with them. It’s before we talked about telemedicine as an actual HIPAA compliant service, but it’s very easy to talk as you and I are talking right now. You’re in California, and I’m in Florida. We’re having a conversation now much in the same way I talk to my patients using Zoom, or WebEx, or telemedicine services that I can look at a wound. I can encourage them and answer their questions live and reassure. Also, cardiac rehab is doing online virtual rehab right now for patients, which is hopeful. In this time of isolation, we are still offering rehabilitation. We are still providing meaningful follow up for our patients. We can look at wounds, address any concerns live one-to-one.
Adam: Great, well, Dr. Stewart, I wanted to thank you for taking time out of your very, very busy schedule there, for sharing some of the insights that you have as a surgeon. I know this is going to help a lot of the patients out there. It’s definitely helped me. Again, a really special thanks and appreciation for not just you but your entire team there in Miami for being on the frontline and helping not just the patients you’re with but our entire society as we come together to really fight this war against COVID-19. Thanks for everything you do. We really, really appreciate it.
Dr. Stewart: My pleasure, great talking to you, Adam. Take care.
Adam: Great talking with you too. For all the patients out there, we’re going to put up a slide right now that’ll have Dr. Stewart’s contact information. If you’d like to reach out with him – reach out to him, you can do that very quickly and easily. Thanks again, Dr. Stewart, for everything you’re doing.
Dr. Stewart: Thank you. Take care, Adam.