Cardiovascular care from hospital to home

Q. What do you think the future of cardiovascular care looks like?
 

I’m very excited about the future. I see the path in cardiac and vascular change accelerating and continuing to grow in a very significant way in the direction of minimally invasive therapy. Some people believe surgery will be gone and that no one will be performing surgery anymore and that we won’t need surgeons. But that’s not true. We need vascular surgeons more than ever. I think we will continue to need all aspects of the multidisciplinary team. We want to take the most severe, the worst cardiac disease, the worst aneurysm disease, the worst cardiovascular problem you can have, and treat that as an outpatient and send those patients home. That’s where we want to go.

Q. How close are we now to treating patients at home?

Five years ago, I was speaking to our foundation about how we imagined this in the future and I said something like ‘Can you imagine one day where we treat a patient with an aortic aneurism and they go home the same day?’ This is a procedure that, 10 or 15 years ago would have required 5 days in the ICU, 7 days in the hospital and 30 days of recovery.

I can see the day where a patient can come in, have an aortic valve replaced, have an aneurism repair done, then go home in 2 or 3 days, they generally have reached full recovery by the period of 2 to maybe 3 weeks, and are back to normal activity. It is our goal to take everything that can occur in the cardiovascular system, be able to treat it in the least invasive way, the most effective, cost-effective way, and get these patients back as quickly as possible.

Q. How much of a big leap forward has this been for cardiovascular care?

One of the real advantages of this revolution in cardiac and vascular care has been our ability to treat patients that were not treatable in the past, that were too sick to be treated.  They couldn’t tolerate open surgery, and now we can also get them home in very rapid fashion. Something like 85% of the work that’s done here at the Institute is done on an outpatient basis, in fact. We have a number of goals around therapeutic innovation, and our goal is to take specific diseases and make them treatable as an outpatient such as aneurisms. We hope, one day, to have most of our patients who suffer from aneurism disease be able to be treated and go home the same day. That’s one of the goals around the innovation that we’re trying to apply here at Miami Cardiac & Vascular Institute.

Q. Does that give Miami Cardiac & Vascular Institute a greater role in preventative care?

It’s part of our responsibility to prevent disease and not just focus on treatment of disease. We are spending considerable efforts in our communities to deal with those patients who are 20 years old - patients who aren’t yet patients - and trying to prevent the devastating effects of cardiovascular disease in the older ages.

Q. What advice would you give your peers based on your 30 years leading Miami Cardiac & Vascular Institute?

Well, if I had to give someone any type of advice about decision-making, and we make decisions in all different areas, clinical decisions, equipment purchasing decisions, management decisions, it’s always about the future. It’s not about the present. If you make decisions based only on the present, you’ll never be prepared for the future.