Repairing Thoracic Aortic Aneurysms - SUNY Upstate Medical ...

SUNY Upstate Medical UniversityCardiac RehabilitationDenise Killius, RNDirector of Cardiac RehabilitationCardiac Rehabilitation is a programdesigned to help people recover from heartdisease and reduce the risk for future heartproblems. People who follow a cardiac rehabprogram feel better, live longer, and lead ahealthier life!Heart patients who benefit include thosewho have had:• A heart attack• Coronary artery disease or otherforms of heart disease• Stable angina• Bypass surgery, coronary angioplasty,stent placement• Valve replacement or repair• A heart transplantThe Cardiac Rehab program at UniversityHospital focuses on exercise, education,counseling and behavior change. Exercise ispersonalized to each patient’s specific needand is prescribed to help build strength,flexibility, and endurance.Education focuses on managing heartdisease, meeting dietary goals,understanding self management andfollowing a treatment plan.Counseling identifies high risk behaviors.Behavior-change skills are taught on how toAerobic ExerciseEquipment:What’s Right for You?Erin Pieklik, PT, MPTPhysical TherapistYou are determined to exercise, and youdecide to purchase a piece of exerciseequipment for home. But, what shouldyou buy? A treadmill, stationary bike, skimachine, elliptical trainer? Here is someinformation that might make selecting theright piece of equipment a little easier.• First and foremost, exercise shouldbe fun and enjoyable. If you dreadexercising, you’ll probably find yourexercise equipment posing as aclothes rack or just collecting dust.• Make sure to measure thespace you have available forthe equipment.You don’t want to end up with apiece of equipment that is too largeand doesn’t fit. Check the dimensions4adopt low risk healthy behaviors.Other lifestyle changes can include quittingsmoking, reducing stress, controllingweight, and lowering blood pressure andcholesterol.Benefits of Cardiac Rehab• Improved exercise tolerance• Improved functional status• Improvement in symptoms of angina• Decreased symptoms of heart failure• Lower cholesterol levels• Decrease in cigarette smoking• Improved self image• Reduction in pre-mature mortality• Weight lossThe Three Phases of Cardiac RehabPhase I: InpatientThis program is started when a heart diseasepatient is in the hospital and begins withlight exercise education and counseling.Phase II: OutpatientThis phase is a supervised, monitoredexercise program including education ofrisk factors and an individualized supervisedexercise program three days a week forapproximately 12 weeks. Phase II CardiacRehab is offered at University Hospital atthe state of the art Institute for HumanPerformance. This facility with nearbyparking is just two blocks from the hospital.Participants need a physician’s referralbefore purchasing it.• Try out similar equipment that a friendor family member owns to see if youfind it enjoyable.• Try the equipment out in the store.Make sure you play with all of thecontrol buttons. Can you easily see thedisplay and reach the controls?Now some tips on each piece of equipmentto help to narrow down your decision.Treadmill• A good option if you are at alower conditioning level.• Take note of how slow thetreadmill is capable of going.You are more likely to use alower speed than themaximum speed.• Make sure the belt of thetreadmill is wide enough andlong enough for acomfortable stride.• If you plan on holding ontothe handrails for support, make sure youcan reach them comfortably.Institute for Human Performance in Syracuse(usually a cardiologist) to begin Cardiac Rehab.Most health insurance plans, includingMedicare, will pay for some of the cost ofCardiac Rehab (Phase II) for patients who:• Begin the program within 12 monthsafter a heart attack• Had coronary artery bypass surgery• Have chronic stable angina• Had heart repair or replacement• Had coronary angioplasty orcoronary stenting• Had a heart or lung transplantPhase III: MaintenancePhase III is also offered at UniversityHospital’s Institute for Human Performance.Phase III is outpatient cardiac rehabfollowing completion of Phase II.This program is designed to promotemaintenance of physical activity and riskfactormodification for graduates of themonitored exercise program.For more information contact DeniseKillius RN, Nurse Coordinator, CardiacRehabilitation Program (315) 464-8369.Stationary Bike• Try out the seat for comfort.• Note the sturdiness of the bike.• A recumbent bike may be morecomfortable. It allows you to recline.Ski Machine• Allows you to exercise with your armsand legs.• Durable ones will be costly.Elliptical Trainers• This machine simulates the body’snatural movements.• Allows you to exercise with your armsand legs. Some models give theoption of moveable and/or stationaryarm handles.• Reduces the impact on your jointsbecause the footplates move around anaxis in an elliptical pattern.• Durable ones can be costly.Always consult your physician beforebeginning any exercise program.Good luck with your quest, and enjoy!

University HospitalSurgery Update for Referring PhysiciansRobotic Cardiac Surgeryat UpstateThe daVinci surgical system, or daVincirobot as it is commonly called, is a $1.5million complex device that allows a varietyof complex surgeries to be performedthrough small incisions. The daVinci robotfacilitates this by greatly enhancing thesurgeon’s visualization and instrumentdexterity. Controlled remotely, the robot,in essence, places the surgeon’s eyes andhands at the surgical field. The surgeonsits at a console separate from the patientand views a 3D image of the surgicalfield while controlling instruments thatmimic the complex motions of the humanhand. The surgeon’s technique is actuallyenhanced by the daVinci robot’s abilityto scale motion and filter any tremor,thereby allowing very precise movements.The daVinci robot never functionsindependently; it is completely controlledby the surgeon.The cardiac surgery team at Upstate wasthe first in Central New York to use thedevice in 2004 and is currently a regionalleader in robotic cardiac surgery. Giventhe complexity of robotic surgery anexperienced team is a requirement. Whilethe daVinci robot is a state of the art,high-tech device, the success of roboticsurgery is very much dependent on thepeople operating the device. Upstate’srobotic cardiac surgery team consists ofthe cardiac surgeon, physician’s assistantsand nurse practitioners, perfusionists,anesthesiologists, operating room nursesand surgical techs, and intensive care unitnurses. Each is a necessary componentof a successful robotic cardiac surgicalprocedure. The Upstate team has helpedtrain other centers in the Northeast,including the Cleveland Clinic, as theybegan performing robotic cardiac surgery.Not every patient is a candidate for roboticcardiac surgery. The device is currentlyused in about 10 percent of all cardiacprocedures performed at Upstate, althoughthis percentage is likely to increase inthe near future. The following questionsand answers should help patients andphysicians understand the state of roboticsurgery at Upstate.What cardiac surgical procedures areperformed with the daVinci robot atUpstate?The following procedures are performedwith the daVinci robot.• Mitral Valve Repair• Coronary Artery Bypass: Single vessel• Atrial Septal Defect (ASD) Repair• Myxoma (or tumor) removal• Tricuspid Valve Repair• 3-vessel CAD treatment (hybrid)“The da Vinci system reducesthe size of the surgical incision,the length of stay, postoperativepain and risk of infection,”reports Charles Lutz MD, the firstUniversity Hospital surgeon tooperate with the new system.Unfortunately, at the present time patientsrequiring aortic valve surgery, multiplevalve procedures, or a combination ofvalve and coronary bypass surgery are notcandidates for the robotic approach. Astechnology advances, however, this willcertainly change.What are the benefits of robotic surgery?Since robotic surgery is performedthrough small incisions, the time to fullrecovery is much shorter. Conventionalcardiac surgery is performed througha sternotomy (or breast bone dividing)incision, which limits the patient’s activityfor 2-3 months as they recover. Withrobotic surgery there is no broken bone toheal so most patients are fully recoveredwithin one month. For most patients thistranslates into a faster return to work andother activities such as running, biking,and golf. The patient’s length of time inthe hospital is also shorter, averaging 3to 4 days as opposed to 6 or 7 days withconventional cardiac surgery.Mitral Valve ProlapsePatients with isolated mitral valve prolapseand severe mitral regurgitation arecandidates for robotic surgery..5

SUNY Upstate Medical UniversityMitral valve prolapse isa common abnormalityof the mitral valve. Themitral valve separates theleft atrium from the leftventricle and is a parachutelike structure consistingof leaflets and chords thatconnect the leaflets to theventricle. Normally whenthe heart contracts theleaflets of the mitral valveseal and prevent bloodfrom leaking back to thelungs (regurgitation). In Athe case of severe mitralvalve prolapse the leafletsdon’t seal and mitralregurgitation occurs.Patient’s with severe mitralregurgitation are usuallyfollowed by a cardiologistand evaluated with atest called an echocardiogram. If themitral regurgitation is severe and thepatient experiences symptoms such asshortness of breath, surgery is usuallyindicated.Patients with mitral valve prolapse andsevere mitral regurgitation are fortunatein that the valve can usually be repairedwhich is preferable compared to valvereplacement.Off-pump or Beating Heart SurgeryPatients who need a single vesselcoronary bypass procedure are alsocandidates for the robot. Most ofthese surgeries are performed withthe heart and lungs stopped and withthe patient supported on a heart-lungmachine. The heart-lung machine isalso called cardiopulmonary bypassor “the pump.” The invention of theheart-lung machine made moderncardiac surgery possible but in certainpatients it’s associated with increasedcomplications such as stroke, lung andkidney failure, as well as bleeding. Withadvances in technology coronary arterybypass surgery today can be performedwithout the heart-lung machine. Thisis called off-pump or beating heartsurgery. At Upstate, more than 50%of all coronary bypass proceduresare performed using this technique.6BEPatients with single vessel coronaryartery disease involving the left anteriordescending (LAD) coronary artery arecandidates for a robotic coronary bypassprocedure. This procedure is also calleda robotic-assisted minimally invasivedirect coronary artery bypass (MIDCAB)procedure.For patients with 3-vessel coronary arterydisease who want a minimally invasiveapproach, a hybrid approach is availableand is becoming more popular. Thisapproach involves the cardiac surgeonand cardiologist working as a team to treatthe patient’s coronary artery disease inthe most minimally invasive way possible.The cardiac surgeon performs a roboticassistedsingle-vessel coronary bypassand the cardiologist places a stent to treatthe disease in the other coronary arteries.This procedure is currently performed atUpstate.FYI: Other robotic procedures performedat UpstateUpstate Medical/University Hospitalurologists perform robotic-assistedprostatectomy for prostate cancer andgynecologists perform robotic-assistedhysterectomy for uterine cancer.ABCDEDCThe surgeon, who works at aconsole several feet from thepatient, views the highresolution,3-D surgical field on the consolescreen.With hands and wrists naturallypositioned, the surgeonmanipulates instrument controlspositioned below the displayscreen.InSite ® vision software seamlesslytransmits the surgeon’s hand, wristand finger movements to the ultrasensitiveEndoWrist ® instrumentspositioned inside the robotic arms.Through 1-CM ports, theinstruments immediately executethe commands. Each instrumenthas a specific mission – such asclamping, suturing or severing –and is designed with seven degreesof motion to precisely mimic thesurgeon’s dexterity.The InSite Vision System – alsovisible on the surgeon’s display –enhances, refines and optimizes3-D images of the operative field.

The Role of theSocial WorkerJennifer Kite, CSWThe social workers at University Hospita aremaster’s prepared (MSW), state certifiedand licenced. Social workers are consultedon a wide variety of psycho-social issuesrelevant to our patients and families.University Hospital social workers assist with:• Facility placements for nursing homesor rehabilitation• Crisis intervention• Locating supportive housing• Finances/Insurance issues• Conflict resolution• Decision-making regarding health careproxies and advance directives• Adjustment to illness andnon-adherence to treatment• Family distress and conflict resolution• Coping with loss, end of life issues,including hospice, death, bereavement• Advocacy to obtain community resources• Stress managementUniversity Hospital social workers workwith the cardiovascular case manager,nurses, physicians and support staff toachieve the best outcomes for patients andtheir families.For more information contact us at(315) 464-6161.University HospitalCase ManagementTanya Hicks, MS, RNCase ManagerAll case managers at University Hospitalare baccalaureate or master’s preparedRNs with at least 5 years of acute careclinical experience.It is our role to guide you and your familytoward common goals of shortenedlength of stay, decreased resourcesand increased satisfaction. UniversityHospital was the first hospital in thegreater Syracuse area to institute casemanagement. The case manager workshard to make sure you get the educationand care that meets your specific needsbefore you come to the hospital, duringyour stay, and post-discharge.Case managers constantly surveythe care given in the hospital and askthe questions: Can we do it better?Can we do it more efficiently withoutcompromising the quality of our care?For example, we used to keep patients inthe hospital two weeks after open heartsurgery. The cost to the patients wasvery high and so were infection rates, sowe looked to improve services. Patientsnow go home in 4-5 days. Researchshows that people recover mentally andphysically better and faster at home.About 97 percent of patients surveyed feltcomfortable going home 4-5 days aftersurgery, especially when they knew thesocial worker had made arrangementsfor visiting nurses to look after them athome.Our inpatient cardiovascular casemanagers provide the following services:• Screening of all admissions for highrisk and complex discharge issues.• Discharge planning for patientsneeding home care and rehabilitationservices• Consultation with nursing staffregarding patient education• Consultation with nursing staffregarding the prevention ofcomplications• Data collection and participation inquality improvement activities• Coordination and development ofcritical pathways (a plan for yourhospital stay)If you or anyone you know is expectedto have open heart surgery and hasquestions, please do not hesitate tocontact me at (315) 464-6161.Mending HeartsJulie Glaza, RN, BSNOpen Heart Intensive CareWhy did I become a nurse?It probably won’t surprise anyone thatit was difficult to pinpoint one specificreason. After twenty years of being aprofessional nurse I am now able to sharemy motivation and what attributes I bringto nursing.I work as a nurse in the Open HeartIntensive Care Unit at University Hospitalin Syracuse. The initial post op period is extremely challengingboth medically and technically. Although this is an importantaspect of my job, the real rewards come from helping the patientsand their families through the recovery period. I believe I canprovide the guidance and comfort to help them through thisdifficult time. I along with my colleagues provide a comfort levelthat allows questions, concerns, and teaching to take place. Wepride ourselves in the attention to detail in everything from thepatients blood pressure to that extra piece of toast in the morning.I remain in nursing because I have a role in my patient’s recovery.I remain in nursing because I change patient’s lives in a positiveway. I remain in nursing because I make a difference. Technicialexpertise is what you can expect from my colleagues and me atUniversity Hospital but it is the attention to detail that sets us apart.DID YOU KNOW?SUNY Upstate Medical University is Onondaga County’slargest employer with approximately 7000 employees.It is one of only 125 academic medical centers inthe country and the only one in central New York. Itshospital, University Hospital, is the region’s only Level1 Trauma Center as well as the first NYS-dedicatedstroke center in the area. It is home toan outstanding open heart surgeryprogram. University Hospitalis an invaluable resource forthe entire central corridor ofNew Yorkstate.7

SUNY Upstate Medical UniversityHeartfeltOn November 29th, 2007, I hademergency open heart surgery at UpstateMedical Center. I am so grateful for myphysicians. They were so professional,caring and always listened intently. Theyconsulted with their colleagues and eachother when my perplexing symptoms didnot fit the normal medical textbook.Dr. Barbara Clayton, Dr. Matthew Gorman,Dr. Charles Lutz and Dr. Joseph Battagliaare truly “saints” here on Earth.I would also like to commend the nursesand staff on the CardiopulmonaryIntensive Care Unit at Upstate. I havenever received such wonderful care inmy life. The staff on that unit are a greatinspiration to our medical and nursingprofessions. Everyone of you contributedto my daily progress, and sometimes itwas only with a gentle touch or smile. Ican never thank you enough for giving mesuch wonderful care, and attending to myfamily’s and friends’ needs during such avery difficult time.Last, I would like to thank my family, myNP, and RN friends, and everyone whohas been there to help me recover.Dr.Clayton, Dr. Gorman, Dr. Lutz and Dr.Battaglia, I would like to publicy thank allof you for the greatest gift. I wish you andall your family safe and happy and thehealthest 2008! You are so wonderful!Kathy MulcahyFormer Patient of the Open HeartIntensive Care Unit at University HospitalUniversity Hospital Heart VolunteersWho are we? What do we do? We are the volunteers who sport the zippered heart patchon our volunteer jackets and share the distinction of having recovered from open heartsurgery. We are now enjoying post-surgery life. Many patients come to the hospital ladenwith anxieties and trepidations. In fact some are so frightened that they have strongsecond thoughts; some patients consider going home and scrubbing the surgery. Wemeet our patients in the Admissions area or at the Pre-Testing facility. In either case,we introduce ourselves as open heart veterans. We escort the patients and families tothe testing locations, e.g., x-ray, EKG, lab, etc., prior to surgery. It’s a time when we cangetacquainted and hopefully allay some anxieties and get patients thinking positivelyaboutthe experience. Visiting the family during the day of surgery is important to usandto them. It’s a time for support and reassurance. We advise them when they canexpect phone calls telling them about the progress of the surgery. When patients are inIntensive Care, we visit them when they are sufficiently awake. We also inquire abouttheir condition so that we can share our conversations with family and other visitors.Finally, we visit patients after they leave the Intensive Care Unit. This is the time when wecan talk and perhaps compare notes: food, appetite, walking, pain- How will I feel whenI get home? How long before I can drive?-and many more concerns and questions. Itis a time to support whatever patient education is taking place. It is our hope as HeartVolunteers to make the surgery a positive experience. For further information call TheHeart Volunteers at 464-5180.University Hospital HeartVolunteers from front left:Mary Andriello, Herb IsaacsMarcia Hannett, MorrisGroskin, Carm Spadaro,Ginny Haynes, Joan Scholl,Joe Cunningham andJohn Henderson& HeartNon Profit Org.U.S. PostagePAIDPermit No. 110Syracuse, NYEDITORS:Karen A. Gibbs, RNC, MSNNurse Practitioner(315) 464-6255Melanie RichDirector of Marketing & UniversityCommunications(315) 464-4831PRODUCTION STAFF:Graphic Designer: Sabra Snyder