Participants: Dr James Marcum (Host), James Zellner
Series Code: BRX
Program Code: BRX00003B
00:01 Welcome back to Bible RX for Biblical prescriptions!
00:04 Today's topic is Healing Hearts.
00:08 We are glad to have witnessed Dr. Jim Zellner,
00:11 who is a Cardiothoracic Surgeon.
00:13 He has been answering our questions.
00:15 Our last question was from Thelma in Vermont.
00:17 I think it is very useful regarding how your brain
00:20 works after you have a bypass surgery.
00:22 Let's want our next question now.
00:24 It's actually from a gentleman named Jeff in Texas.
00:27 He says this will be short and quick.
00:47 So Jess question Dr. Zellner, is in general what is the
00:50 chances of dying from a bypass surgery?
00:53 Well let me just touch on this
00:55 a little bit in that one thing
00:58 that has been notable in the field of bypass surgery,
01:02 heart surgery in general, is that the chance of dying,
01:05 what we call mortality, after bypass surgery,
01:08 has come down rather dramatically and
01:11 continues to fall.
01:12 This is remarkable in the light that we are getting
01:16 sicker, more elderly, and patients with more and
01:20 more problems that we have to operate on.
01:22 It is a real tribute to the people who are doing
01:25 investigations in helping us help other people
01:29 with their heart disease.
01:30 In general, I tell people there are 3 major factors
01:33 to determine the likelihood of them having a major
01:36 problem or dying with the operation.
01:39 The first of these is what sort of shape
01:41 the patient is in?
01:43 The second of these is what sort of shape
01:45 the heart is in?
01:46 And the third of these is what operation
01:48 are we doing exactly?
01:50 So I break it down that way and if you are in good
01:54 shape and have not had a stroke,
01:56 your kidneys are performing well,
01:58 and you do not have bad lungs from years and years
02:00 of cigarette smoking, those are all good things.
02:04 The most single and important factor to determine
02:07 the likely that it had a major problem
02:09 or dying with heart
02:10 surgery though is how good the heart pump is.
02:13 The heart pump, as you know, is a pump that fills up
02:18 and squeezes to push out the blood.
02:20 If that is significantly impaired or weak,
02:23 as we call it, or you have a severe congestive
02:26 heart failure, then that's significantly raises
02:29 the risk of the operation.
02:31 The third factor is what operation, exactly,
02:34 are we doing?
02:35 Bypass is probably the most routine, most commonly
02:38 performed operation on the heart that we do.
02:41 It therefore has the least complexity
02:44 associated with it.
02:45 In addition we do a lot of valve operations now.
02:49 This is actually increasing in our aging population.
02:52 The complexity of those operations and the mortality
02:56 likely of dying, goes up slightly.
02:58 But by far, and by the way the most important factor,
03:00 that I use is how good of a heart pump
03:02 you have before the operation.
03:04 So Jeff is asking us, if you had to tell me,
03:07 my heart function is normal,
03:09 I have no other medical problems,
03:11 I'm just doing a bypass in three bad blood vessels.
03:15 What would you say an average mortality
03:17 might be for him then?
03:18 The average mortality today is probably in the
03:21 neighborhood of 2 to 4 percent.
03:24 2 to 4 percent, okay.
03:25 Is that up front mortality during the first year,
03:28 or is that during the operation?
03:29 We call that operative mortality and that is
03:33 defined by either within the hospital
03:35 and not going home after the operation
03:38 for any length of time, or up to 30 days
03:40 after the operation.
03:41 I hope that answers your question, Jeff.
03:44 The next one is from Wayne and Wayne writes:
04:03 that is from Wayne in New York City.
04:05 Right, we get asked that a whole lot.
04:07 Wants to get back to work!
04:08 I would want to take some time off.
04:11 Everybody has different opinions on how much time
04:14 they really need off, but most of the people in his
04:18 position who are CEOs or rather type A would rather
04:21 get back sooner then later.
04:22 In general we tell people, or I tell people it takes
04:25 at least four months for them to get over the surgery.
04:28 It is like getting over the flu,
04:30 you will be weak and tired,
04:31 food will not taste right,
04:33 they will wear out easy, and important to their family
04:35 the patients will be crappy.
04:37 So they can expect that.
04:39 Getting back to the job, a CEO or someone who leads
04:43 somewhat at a sedentary or does not actively do heavy
04:47 lifting, or drive a truck, that sort of occupation,
04:51 they can usually return to work in
04:53 6 to 8 weeks after surgery.
04:55 In the situation today where we have computers at home,
04:59 and being able to do things at home,
05:01 that can happen as soon as 3 or 4 weeks
05:03 after the operation.
05:05 You want to stay away from making crucial decisions
05:08 if you are handling quite a few pain medications
05:11 after surgery for sure.
05:12 So Wayne, if it was me, I think it would take a full
05:15 2 months off, I think I would.
05:17 Okay let's move on to Barbara and Barbara is writing
05:20 us from California and she says:
05:44 That is a hard question.
05:45 I get that one quite a bit in my practice too.
05:49 As you know as a cardiologist yourself,
05:52 generally the patients don't come to see the
05:55 heart surgeon until it is determined
05:57 that is what they need.
05:59 When I look at patient like that,
06:01 and a lot of what I do,
06:02 is I look a lot and other issues.
06:04 I look at their overall health.
06:05 I look at their overall qualities.
06:07 How much symptoms they are having.
06:08 I look at their age.
06:11 I look at the big picture.
06:12 Right, and there are certain groups that we know do
06:15 better with certain things.
06:17 In general if you have more than one vessel that is
06:20 diseased and needs to be addressed with some
06:22 intervention, then probably an intervention either bypass
06:26 surgery or a stent or angioplasty is probably needed.
06:29 This is debated today.
06:32 If you have diabetes and have 3 vessels or
06:35 3 major arteries that feed the heart involved with the disease
06:38 then things I think, I'm being prejudiced because
06:42 I am a heart surgeon, I think things are better off
06:45 in that arena than with stents or angioplasty.
06:50 In general, the more vessels you have involved,
06:54 the other problems that are going on with the patient,
06:57 favor surgery more than medical therapy or
07:01 intervention like a stent or angioplasty.
07:04 But Barbara this is a very complex question and I think
07:07 it is going to take all your doctors working together
07:10 and talking, to really get the best answer.
07:13 Now you touch a lot of hearts, okay?
07:16 In cardiology usually we don't get to
07:19 physically touch the heart.
07:21 I've heard that it must be a spiritual accounting when you
07:25 actually have a heart of some one beating with life
07:29 and you stop the heart and it comes to go
07:34 spirituality when you do this day in and day out?
07:37 I guess the first couple times it must be really
07:40 moving when you see how God made the system and how
07:43 the heart hearts start up, hopefully,
07:44 it's going again.
07:46 All the medicine and God has blessed us with technology,
07:50 but how do you feel on a daily basis when you are
07:52 operating on, and not only dealing with their physical
07:55 hearts, but you are also dealing with spiritual hearts
07:58 because they are not ready spiritually,
07:59 and the physical heart is not going,
08:01 we have some major problems.
08:03 Right, well it is a very moving experience the
08:07 first few times you do the operation and you have
08:11 a heart that is absolutely still and not moving.
08:14 They are on the heart and lung bypass machine.
08:17 Then you go ahead and get your work done on the heart,
08:23 what ever it is a bypass, or valve work
08:25 that you're doing.
08:26 Then to get the heart started again.
08:28 That to me is still the thing that brings
08:31 me back every day.
08:32 It is just amazing and moving.
08:36 People do not understand, they say if you do
08:37 300 to 400 heart surgeries a year,
08:40 it must get boring and routine after a while.
08:42 It really doesn't because each heart has individual
08:46 characteristics and is a beautiful experience
08:50 when everything works.
08:52 That is really the beauty of heart surgery.
08:54 We get to see right away if the heart is going to do
08:57 the things that we expect to do after our operation.
09:00 Because unlike operating on somebody's femur,
09:04 or their intestinal track or anything, you can let
09:08 those organ systems rest for a while.
09:11 But the heart has to start working right away.
09:14 Has to be strong enough to come off or separate
09:18 from the heart lung bypass machine
09:20 and help the patient survive.
09:23 Now in your practice have you ever seen miracles?
09:26 What you consider a miracle?
09:27 Yes - was it always scientifically explained?
09:30 No, I think that this is one of the really remarkable
09:34 things that makes me believe my belief in God.
09:38 And then I has seen miracles and things that
09:41 I fully did not expect to turn out well
09:44 and have done amazingly well.
09:46 So when you touch physical hearts, you also touch,
09:49 everyone who comes back after bypass surgery has
09:52 changed spiritually and it always gives me a chance
09:55 to say you have been through this.
09:57 They usually appreciate life more and are much more
10:01 compliant with the regiment because
10:02 they do not want it to happen again.
10:04 After they have had surgery and have had someone
10:06 touch their hearts and gone through this,
10:08 almost always, I notice a change in the person.
10:11 Almost every single time.
10:12 That is probably true.
10:13 Well let's go to another question here.
10:15 This comes from Indiana, old they should be an easy one.
10:26 A lot! And there are different pathways to being a
10:31 Cardiothoracic or Cardiovascular surgeon now.
10:35 After you have finished college for 4 years and go
10:40 to medical school for 4 years, you have to complete
10:44 up until recently a general surgery residency.
10:47 That is you have to be a fully boarded or qualified
10:50 General surgeon before you can split off and continue
10:52 to train and eventually become a heart surgeon.
10:55 That can take anywhere from 5 to 7 years.
10:58 For me it was 7 years.
11:00 That is when I stopped and did some research on the heart.
11:04 Then training in heart surgery is an additional 2 to 3
11:08 years, so in my case it was 4 years of college.
11:11 4 years of medical school.
11:13 Then 10 years of training after that.
11:16 So 18 years after college?
11:19 Right! 18 years after college.
11:23 You know you want someone that knows what's going on.
11:25 You want someone that is well-trained.
11:27 Right! - not something that you just go and pick up
11:28 a manual and figure it out, right?
11:30 I offer that to my patience frequently and they can
11:32 do the operation, but most of them don't.
11:34 Let's move on to our next question.
11:53 No, actually it is not chicken wire, it is a heavier
11:56 grade steel, it is more like bailing wire for hay bales.
12:01 It is truly a foreign body, if you will, a steel band
12:05 that goes around the breastbone to keep it in place.
12:08 It is no different than when you break your leg,
12:11 they put you in a cast or put a rod in the leg
12:14 to keep the bones together while they are healing.
12:16 The same process has to go on with the breastbone.
12:19 Does it ever poke them afterwards?
12:21 It does, and sometimes we have to remove these wires.
12:24 We like to wait 4 to 6 months afterwards.
12:26 Until the bone is completely healed up.
12:28 To remove those.
12:29 People who have pain for an extended period after the
12:33 operation, usually this is the sign that something is
12:36 not right in a healing process of the bone and it needs
12:39 to be evaluated because sometimes we have to go back in
12:43 and re-wire the actual breastbone together because it
12:47 has not healed straight or completely.
12:49 But that is rather rare isn't it?
12:50 Yes it is rare.
12:52 Our next question comes all the way
12:55 from Melbourne Australia.
12:56 So I'm going to have to work on an accent if they are
12:59 watching an Melbourne Australia.
13:08 Let's say the veins in the leg are bad,
13:10 so you do not have anything to bypass with,
13:12 is it still possible to have a bypass surgery?
13:14 Yes it is.
13:16 Are there artificial conduits?
13:18 Right, we have different options.
13:20 You have the veins in the leg which is traditional
13:22 and I think most of the bypasses are still done.
13:25 But we also use will we call, chest wall arteries that
13:28 line the inside of the breastbone.
13:31 We can use arteries from the arms, okay?
13:35 so really to count all 4 of those, the 2 arms and the
13:38 arteries that line the inside of the chest wall,
13:40 there is 4 vessels that we can bypass.
13:44 In addition you can use, be creative in the way that
13:47 you bypass the heart so that you can do more than one
13:51 bypass with more than one pipe.
13:53 That is to say we can get 2 bypasses done with this
13:57 chest wall artery, 2 bypasses done with arm arteries.
14:00 They don't use artificial tubes or plastic are we?
14:03 That has been tried a number of times and actually
14:07 we call Cadaver veins.
14:09 A Cadaver that is a dead - a dead person who donated
14:14 their body to help other people.
14:16 Sort of like a heart transplant, but those don't work.
14:20 Those pipes generally do not hold up very long at all.
14:23 So the best bet and still the most frequent bypass,
14:27 we should use is the chest wall artery.
14:29 We do use a lot of veins,
14:31 but there are a lot of other options.
14:33 I think we have time to answer one more question.
14:35 This is from, this is actually from Tennessee.
14:37 This person says:
14:58 So is it reasonable to have surgery as 82 with
15:00 a tissue valve, it is not a mechanical valve,
15:03 which sometimes we use?
15:04 As you know we break the valves in the tissue,
15:06 and a mechanical for an 82-year-old,
15:08 certainly a tissue valve would be appropriate.
15:10 I think what she has to do is think about
15:13 her quality of life today.
15:14 If she has a lot of problems getting around because
15:17 of shortness of breath or chest discomfort,
15:19 then I would think that her quality of life would be
15:22 a lot better if she had her valve replaced,
15:25 if the doctors recommending it.
15:27 The quality of life is not impacted very much by
15:30 the valvular disease or the problem with the aorta valve
15:32 that she has, then you have to question and say,
15:35 why am I getting the operation?
15:37 Is it just to fix the valve or to help my life?
15:39 But an 82-year-old that is not too old is it?
15:42 Oh no, we welcome 82-year-olds.
15:44 That is great!
15:45 Well I think we have answered all the questions
15:48 we have right now and I want close here by saying
15:51 thank you for joining us.
15:52 If you want to join in part of this Ministry and ask
15:55 some questions with our specialist, Dr. Jim Zellner,
15:58 who specializes in Cardiovascular Disease.
16:01 You can contact us at:
16:14 We will be happy to answer your questions.
16:16 We might do it personally.
16:17 We might even do it on air next time and we are hoping
16:19 Dr. Zellner will be in.
16:20 As we close today we have been talking about touching
16:24 hearts, we have touch the heart physically,
16:27 but we also want to make sure that our
16:28 spiritual heart is healed.
16:30 You know that healing is going to happen
16:32 for everyone someday.
16:33 Of course we want more healing here on earth,
16:36 but we know that those who have God in their lives and keep
16:38 close to Him ultimately will have healing.
16:41 We want to wish you good health and once again thanks
16:43 Dr. Zellner for joining us today on Bible Rx.