ZurMed: Dr. Paul Saunders

Dr. Paul Saunders is a cardiothoracic surgeon who operates out of Brooklyn’s Maimonides Medical Center. In this episode, Dr. Saunders discusses his expertise as a cardiac surgeon.

Host: What are some of the common procedures that you do?

Dr. Paul Saunders: Cardiothoracic surgery entails operating on the heart, lungs, and other organs in the chest. I specialize in cardiac surgeries for adults. Bypass operations, numerous valve operations, and placing mechanical hearts in people who are having issues with heart failure.

Host: What is LVAD?

Dr. Saunders: LVAD stands for “left ventricular assist device.” It is commonly used by people who are awaiting heart transplant surgery. LVADs are pumps that we sow into patient’s hearts. It’s a new technology but it’s very effective. It can save patient’s ego are otherwise dying of end-stage heart failure. People with this condition might not be able to walk or lie down flat. The LVAD helps ease their suffering by assisting their own failing heart in pumping blood to the rest of their body.

Host: Is this something that’s inside the chest or exterior to the body?

Dr. Saunders: The pump itself is all inside the heart but there are some external features because the pump is a mechanical device and it requires electrical power to operate. Hence, patient’s need to wear a pouch that contains the batteries. However, with the LVAD, patients can walk around their neighborhoods, they can travel, they can fly, they can take cruises all free of the symptoms they were having due to their heart failure. It really improves the length and quality of their lives. We’ve been doing this since 2012 and the devices are getting better and better.

Host: Can you tell us a bit about aortic valve disease and ways that technology has helped treat this issue?

Dr. Saunders: Sure. In the past aortic valve disease was treated with pumps and surgery. Today we can do a much simpler procedure with just a small puncture and a cardiac cauterization procedure. We call this TAVR which stands for “Transcatheter Aortic Valve Replacement.” This is most effective to treat severe aortic stenosis which occurs in older people since calcium builds up in the aortic values over the course of your life. Eventually, this will cause the heart valves to be unable to open properly which can lead to heart failure. We used to correct this by performing a surgery where we would cut out the calcifies value and sew in a healthy new one. That surgery worked very well and is quite safe. However, it is invasive and many patients are too old and too sick to survive such an operation. TAVR is a technique that can be used to clear calcified valves. TAVR is delivered via being loaded and deployed on a very small catheter that is then inserted into an artery in the groin, placed across their diseased valve, and essentially blown up inside the old valve. The new valve is then secured with a stent. It’s being done more and more frequently with even younger and less sick patients. The TAVR results are positive and comparable to those from the traditional full surgery.

Host: How big is the catheter that goes through the groin?

Dr. Saunders: It’s very small. It’s about the size of a sharpie highlighter tip. We do this as a team with the cardiologists and the cardiac surgeons.

Host: How much does doctor teamwork play a role in your profession?

Dr. Saunders: A lot, cardiac surgeons and cardiologists frequently team up to create treatment plans that benefit each individual patient. We work together very closely. Most teams are made up of two board-certified cardiologists who specialize in heart failure and two cardiac surgeons plus a few nurse practitioners. Aside from that core team, pharmacists and social workers can also play a role in aiding the needs of a heart failure patient. The goal is keeping them out of the hospital more and in better condition as they go through treatment.

Host: How does someone know when they need to see a cardiologist or a heart failure specialist? What are some of the signs and symptoms of cardiac illnesses?

Dr. Saunders: Heart failure occurs when the heart is inefficient and too weak to effectively pump blood to the rest of the body. Warning signs of this include difficulty breathing, leg swelling, low blood pressure, and difficulty sleeping or lying flat. If they have these symptoms, they should speak to their regular medical doctor who can refer them to a cardiologist.

Host: Aside from surgeries, what other ways can heart disease be treated?

Dr. Saunders: Diet plays a big role in heart disease patients. We monitor their diets and fluid intakes and make sure they watch out salt. Staying in compliance with the medications, like pills, they have been described also helps patients stay healthy and put off or avoid needing a transplant or an LVAD.

Host: How do you patients find you? Do they call up to make an appointment or do they need a referral?

Dr. Saunders: I see patients a number of ways. Many come in on their own and some have been referred by their primary doctors. We enable patients to stay with their trusted doctors and we work with their primary care doctors to monitor their care.

Host: How can support groups help patients and their families cope with heart disease?

Dr. Saunders: Disease processes like end stage heart failure doesn’t just affect the patient, it affects the whole family. While the patient might be the person who is very ill, the whole family has to take time off to tend to their needs. It can take a big toll. We have a very popular and very successful support group for patients who have LVADs. The group meets once a month and it’s a great way for the patients and their loved ones to connect with other people who are in the same situation. Our patients actually consider themselves a family—an LVAD family.

Host: Aside from heart failure, what other new and exciting cardiothoracic surgeries are being performed where you work?

Dr. Saunders: We have a lot of new and less invasive approaches to treat conditions like mitral valve disease, which causes leakage in the body, especially in people who are too frail to undergo open-heart surgery. We now have a clip called the mitral clip which can be implanted through a small puncture in the groin and it clips the mitral valve leaflets together to dramatically reduce leakage.

Host: What are some of the symptoms of a mitral valve leak?

Dr. Saunders: Difficultly breathing and shortness of breath, fatigue, and fluid building up in the lungs are all warning signs. It can produce similar symptoms to heart failure.

Host: Does mitral valve affect all ages?

Dr. Saunders: Yes, patients of any age can develop mitral valve conditions, even young people, and it affects men and women equally. Luckily, mitral valve repair surgery is very safe. It’s actually one of the safest and most effective operations that I do and its results can last people until the end of their lives.

Host: So, what are some of the risk factors associated with aortic stenosis, heart failure, or mitral disorders? What can predict the onset of these conditions?

Dr. Saunders: Heart diseases are largely influenced by genetics. In that case, it’s not modifiable. However, there are other risk factors that are modifiable such as choosing not to smoke, monitoring cholesterol levels, and maintaining a healthy diet and exercise. If you’re diabetic, it’s important to watch your sugar levels.

Host: If you need a transplant, how tough is it to get one?

Dr. Saunders: It’s difficult. Doing the transplant surgery isn’t the tough part, the problem is getting an organ. The world is suffering from a lack of organ donors so we try to encourage everyone to raise awareness about that. By becoming an organ donor, you can save a life. The biggest impediment to heart transplant is the lack of organs compared to the people who need them. A single organ donor can actually save up to eight lives!