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How to Know If You Need Heart Surgery · Meaningful Medicine with Novant Health

• 0:03
  Joey Wahler (Host): Heart failure is the leading cause
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  of death in the United States.
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  So, we're discussing heart surgery.
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  Our guest is Dr.
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  Peter Kane.
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  He's a cardiothoracic surgeon.
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  This is Meaningful Medicine, a Novant Health podcast bringing you
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  access to leading doctors who answer questions they wish you had asked.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  Thanks so much for joining us.
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  I'm Joey Wahler.
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  Hi there, Dr.
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  Kane.
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  Welcome.
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  Peter Kane, MD: Thank you.
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  Nice to be with you today.
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  Joey Wahler (Host): Great to have you aboard.
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  We appreciate the time.
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  So first, give us a, an idea of what drew you to healthcare initially and
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  specifically cardiothoracic surgery.
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  Why
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  this for you?
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  Peter Kane, MD: When I was younger, I wanted to be a doctor.
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  I thought it was exciting.
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  When I was a teenager, I worked on an ambulance crew, and I
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  thought that was great and that sort of steered me into medicine.
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  And initially, I was very drawn to surgery because of the
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  hands-on nature of the field.
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  And, As I progressed at each step, I found myself gravitating towards cardiac
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  surgery, just because I really enjoyed the technical aspect and hands-on
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  approach and also because I really liked, enjoyed the outcomes that patients got.
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  It's, one of the really, rewarding specialties in medicine where you see
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  the direct relationship to the work that you do in the patient outcomes
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  and patients really feel better and, get on and enjoy their lives.
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  Joey Wahler (Host): And It seems like so often those that go into healthcare do
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  so largely because of an early experience like you as a teenager on an ambulance.
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  So, not unusual at all.
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  How common is coronary artery disease, and what are some
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  of the risk factors involved?
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  Peter Kane, MD: Cor-coronary artery disease is one of the most common
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  conditions in the United States.
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  The risk factors are really age.
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  And then, there's other important factors like diabetes, then environmental
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  things like tobacco use, which is still relatively prevalent in our society.
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  High blood pressure, high cholesterol, the things we eat,
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  inactivity, the list really goes on.
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  And then of course, the, the underlying unanswered question is the genetic
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  component that is very strong.
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  And we certainly see people who are doing their very best in every aspect of
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  their life to, have a healthy lifestyle, but yet still have a genetic component.
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  of course, coronary artery disease is very strong
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  Joey Wahler (Host): Now, speaking of which, naturally, family history is out
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  of our control, but so many of those other factors you just listed are controllable.
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  So, how important is lifestyle and prevention here?
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  Peter Kane, MD: Well, they're critical, Joey.
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  It's, We only get one body, and we only get one shot at this.
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  So, You know, we really have to take care of ourselves.
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  And so, eating well, exercising, sleeping, avoidance of stress, avoidance
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  of the triggers of high blood pressure.
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  and, all of those things are things that we can do, to, despite what
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  our underlying genetics may tell us will, lead to a better outcome.
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  You know, I often-- Sometimes I see this small percentage of patients that
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  are really upset because they're having heart surgery, and they say, "You
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  know, Doc, I did everything I could.
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  How did I get here?
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  why did I get this?"
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  And, I always tell those folks, "You know, imagine if you didn't
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  take care of yourself, you would have been here ten years ago, and
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  you'd be in much worse condition."
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  And so, you know, truthfully, we're able to make an impact on people with an
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  underlying genetic predisposition that actually take care of themselves as well.
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  So, You know, it's not one of those things where you say, "Well, I got
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  a strong family history, so let me just bury my head in the sand.
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  and I'll deal with this when I get-- when it comes to me."
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  I mean, It's really important to take care of ourselves.
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  It adds an advantage at every step in the process.
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  Joey Wahler (Host): No question about that.
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  So a stent placement versus coronary artery bypass surgery.
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  What are the differences here that those joining us should be aware of?
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  Peter Kane, MD: Sure.
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  so they're really different approaches to treating the same problem.
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  and what I try to go over with every patient is in general, when you have
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  coronary artery disease or blockage in the, arteries that lead to the heart
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  muscle, there's really three approaches.
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  One is, a pure medical approach that, involves all the things we were just
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  talking about in addition to, you know, certain medications that we
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  know are, helpful for your heart.
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  but the, you know, lifestyle changes and all of those important things.
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  and Then, the the technical things that we can do to fix the coronary
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  arteries involve using a stent to open the arteries up from the inside.
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  So, the cardiologist will come into the artery from either a large vessel
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  in your arm or your leg, typically the radial artery or the femoral artery.
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  And they'll put a small catheter inside your coronary artery and then
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  expand that blockage with a balloon and then prop-- put a stent in there
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  to prop up the work that they just did.
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  And then, surgery, is, the alternative to that is, to reconstruct that pathway.
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  So rather than trying to go within the congested artery, we're building
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  a bridge around it with using extra conduit that we have in our body And
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  we kind of use plumbing terms because, these-- that's really in, in the most
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  simplistic way, that's what we're doing.
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  we're taking redundant plumbing in our body, whether it's the arteries that live
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  on the inside of our chest right next to our sternum or the artery from our
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  radi- our radial artery or often veins that we take from our, lower extremities.
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  We use that extra plumbing or conduit to build bridges around the blockage.
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  How we decide what's the right path for each patient is actually, i- is actually
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  a pretty straightforward set of guidelines that's, that have been constructed over
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  time with evidence, based medicine by the American Ca- College of Cardiology.
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  And they're very easy to review.
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  They're, guidelines in, regards to, to the blockages, and it depend on
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  how many arteries are blocked and the degree to which they're blocked.
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  And then, there's some characteristics that gets a little more technical
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  about the types of blockages and where they're located.
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  But we can come up with a score for patients, and we can simply look at like,
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  do you have one blockage in one artery?
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  That's the simplest form and that's clearly gonna get a stent.
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  Or do you have all three arteries blocked or the left main coronary
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  artery blocked in a more complex way.
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  And that's sort of the easiest case for surgery.
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  And then, everything else in the middle, the guidelines are actually
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  pretty good at helping us arrive at the right procedure for the right patient.
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  And sometimes you get to the, to that with the patient and there's
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  some wiggle room for, for folks to make the decision on their own.
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  But we try to lead people in the right direction to say, this is
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  what the guidelines would most support for you and your condition."
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  Joey Wahler (Host): All Right.
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  So, it sounds like a very tried and true scientific process to get them.
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  Now, bypass surgery is being used more commonly today for
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  patients older than in years past.
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  Why is that?
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  Peter Kane, MD: Well, First of all, people are living longer.
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  There, There's no question about that.
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  And people are living longer, and they're living better, and
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  they're in better condition.
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  And, techniques and modern medicine allows us to to, operate safely on patients.
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  And that's the key there is And, what we've shown over time is
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  that, by collecting huge amounts of data, you know, every place in the
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  United States submits all of their data to a large national database,
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  which helps us develop risk models.
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  And what it's really shown is that older people do almost as well as younger people
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  with a very small variation in risk.
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  So at each increment of age over five years, like seventy to seventy-five
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  to eighty-five, there's a small incremental increase in risk.
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  But in truth, when we look at all the data, older folks have done really
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  well, and that's why we're able to offer them surgeries that in the past
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  were reserved for younger people.
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  There's a couple of other techniques that that, have developed over time that, that
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  also seem to be safer for older patients.
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  Sometimes we use off-pump surgery without the heart-lung machine
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  in some of our older people to preserve their brain and kidneys
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  and, to be a little gentler on them.
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  and that's, had a marginal increase in, safety.
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  And there's some minimally invasive techniques that we're able to use
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  for some of our older people that may have trouble with, larger operations.
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  So, it's really a combination of lots of factors.
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  But what we've really shown with evidence is that those folks do really almost
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  as well as, younger people with very small variation in increased risk.
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  Joey Wahler (Host): Well, Very interesting stuff there indeed.
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  So, I want to go back for a moment to something you touched
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  on earlier regarding prevention.
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  What screenings should patients who may have higher risk factors consider here?
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  What should they consider having?
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  Peter Kane, MD: Well, first thing is a relationship with a doctor.
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  That's a good, That's a good place to start.
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  I wish I could say that that everybody I meet has had a long-standing relationship
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  with their doctor, and they've, sort of built their way up to to this
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  the critical time in their lives.
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  But unfortunately, I still meet a lot of people that their introduction to
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  medicine is, is-- has all taken place over the course of either maybe just
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  a couple of days or, hours but, maybe just a couple of weeks because they're
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  just getting involved with their doctor and finding out they have a problem.
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  So, general healthcare care screening is, critical, and making sure that we
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  have our weight under control, that our d-diabetes, which is obviously a huge
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  problem in the United States, that people are really caring for their diabetes and
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  avoiding other risk factors, particularly tobacco use, which is really still
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  prevalent again and still very directly related to coronary artery disease.
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  But then, there's some other things that that, your primary doctor
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  may do for you, which is over over fifty, is a calcium score.
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  And particularly, there's a whole set of settings in which that may be appropriate
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  as early as age fifty or maybe a little bit later if you have no family history.
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  And then, there's some other symptomatic things.
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  Like if you're having some mild symptoms of angina, you might
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  be referred for a stress test, which is a good screening tool.
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  And then, in conjunction with your primary doctor or your cardiologist,
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  you may suggest a more invasive test like a cardiac catheterization.
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  And interestingly, in the last few years, the the cardiac CT has also become a very
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  important tool that the cardiologists use as a non-invasive way of getting some
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  really good images of your heart that that may ultimately suggest whether you need
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  a more invasive test or whether you need.
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  sur-surgery
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  Joey Wahler (Host): And of course, whether or not someone has
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  risk factors, it's important to understand concerning heart symptoms.
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  Which are the main ones you see that people should not ignore if they pop up?
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  Peter Kane, MD: Well, sure.
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  Ch-chest pain is, obviously the one that jumps out at everybody first, although
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  it's not quite as common as we once m- or, maybe we initially believed it to be.
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  But certainly, any chest pain with exertion, pain that radiates into
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  your back or down your arm, or into your jaw or teeth or ears.
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  Angina can be really strange, you know, the sort of funny feeling,
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  that, that comes with some exertion and usually goes away with rest.
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  If you're having those symptoms, even and you're not exerting yourself,
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  that's even more more concerning.
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  Some people may notice weight gain, in their-- but particularly
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  that feels like fluid retention.
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  And that might be also a sign, a a little bit more serious sign, of maybe some
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  chronic, heart disease that's leading to some heart failure as you alluded
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  to at the beginning of this talk.
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  But swelling in the ankles and fluid retention.
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  And certainly fatigue.
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  You know, a lot of people say, "Well, hey, I'm older.
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  I expect to be more tired."
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  But that's not really the truth.
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  We don't really suddenly say, "Hey, six months ago, I was fine.
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  And now, I'm really, like, having a lot of trouble getting through
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  my day because I'm just exhausted."
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  So, fatigue can really be one, certainly a symptom that you wanna explore with
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  your primary doctor and then, and then maybe ultimately, your cardiologist.
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  And then, finally, like keeping an eye on your blood pressure.
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  You know, folks will have normal blood pressure for years, and then
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  suddenly you see your blood pressure creeping up and you say, "Well,
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  maybe I'm just getting older."
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  But no, that's something that certainly needs attention.
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  Joey Wahler (Host): A couple more questions for you.
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  First, you were named in 2025 to Newsweek's list of America's Leading
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  Doctors for Cardiothoracic Surgery based on areas like performance data, peer
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  recommendations, and quality scores.
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  So First, congratulations on that.
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  And what does that recognition mean to you?
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  Peter Kane, MD: Well, thank you.
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  that means a lot.
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  It mean, it means a lot.
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  it's, It's just a culmination of a lot of years of work.
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  and, you know, I have great partners and a great team And, we-- you know, I've
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  been here in Wilmington for twenty years.
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  And so, to be recognized nationally is, feels great.
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  But it's really a shared thing with, our team.
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  it's meant a lot to the team.
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  It's meant a lot to me personally, And I think it's really just a reflection
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  of a collective work and effort by, all the folks at our hospital to
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  take care of our local community.
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  Joey Wahler (Host): And always so important to recognize
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  the rest of the team.
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  And Then, in summary here, Doc, you touched earlier on the fact that
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  naturally the work you do is so rewarding.
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  What's most rewarding about it?
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  It's amazing to me that someone like yourself, heart surgeon, gets up in
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  the morning, has his breakfast, goes to work, perhaps saves someone's
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  life or at least extends or improves someone's quality of life, and then
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  you, go home to your family, I presume.
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  You have dinner, you go about your business.
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  It's amazing to me that within the things that the rest of us lay folks
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  do on a regular basis, that you're doing something pretty extraordinary,
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  to say the least, in between, right?
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  Peter Kane, MD: Well, that's it's very nice of you to say it that way, Joey.
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  That's, it, But you know, I think what's really the, the rewarding thing is,
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  taking care of patients, ho-honestly.
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  Like, it's funny, I often say to patients, I meet-- when I meet them,
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  when I'm fortunate to meet them in the office, I usually say, "Hey, you know,
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  nobody actually wants to be here."
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  Like, there's nobody that walks into my office and is, like,
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  happy, gre- glad to meet you.
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  But when you see the results and you see people get better and they
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  feel better, that's truly rewarding.
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  And on the hospital side, when, you know, I probably meet about half of my
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  patients in the hospital and half of them in the office, ab- roughly fifty-fifty.
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  and, you know, people in the hospital are, terrified.
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  You know, They've just been given a diagnosis that scares them
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  and then, and rightfully so.
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  And then, you know, within a short period of time, they're just not feeling great,
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  and then suddenly someone's telling them, "Hey, you have to have a big operation."
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  and, to see them g- be-- when they leave the hospital feeling better, moving
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  better, understanding that they're on the other side of this huge event
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  is really the most rewarding thing.
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  So, it's really just the-- well, seeing patients get better is,
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  the mo- is absolutely the most satisfying part of the job.
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  Joey Wahler (Host): Well, what may seem routine to you is certainly still
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  pretty remarkable to the rest of us.
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  Folks, we trust you are now more familiar with heart surgery.
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  Dr.
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  Kane, keep up all your great, amazing work.
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  and thanks so much again.
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  Peter Kane, MD: Thanks very much.
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  I really enjoyed being here today.
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  Thank you.
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  Joey Wahler (Host): Appreciate.
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  it.
• 17:12
  Same here.
• 17:12
  To find a physician, please visit novanthealth.org.
• 17:17
  For more health and wellness information from our experts,
• 17:20
  please visit healthyheadlines.org.
• 17:22
  If you found this podcast helpful, please do share it on your social media.
• 17:26
  I'm Joey Wahler.
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  And thanks so much again for being part of Meaningful
• 17:30
  Medicine, a Novant Health podcast.