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Welcome everyone to the Becker's Healthcare podcast series. I'm Ryan Mohammed,
she her pronouns with Becker's Healthcare.
I'm thrilled to have with me today Dr.
Mark Akwa from the Memorial Care Heart and Vascular Institute. Doctor,
it's so nice to talk with you today. How are you?
I'm good. How are you?
Good, thank you so much. Well, to begin,
would you mind please introducing yourself and telling us a bit about your
background?
Yes, thank you. My name is Mark Squa.
I am currently the chief of cardiothoracic surgery at Memorial Care Heart and
Vascular Institute,
as well as the medical director of the adult cardiovascular surgery program for
the Memorial Care Heart and Vascular Institute at the Long Beach Medical Center.
I've been here since two, early 2020,
and I came from Detroit from the Beaumont Hospital System.
I was the chief of cardiac surgery at Beaumont for many, many years.
I was actually at Beaumont in Detroit for 35 years.
We're working together with our cardiologist.
We were a top 20 US News and will report program.
In 2020, I saw an opportunity to join Memorial Care,
which seemed like a nice segue for that time of my life,
and I decided to come to California. My interests, uh,
in cardiac surgery, obviously I do everything,
but I'm mostly interested in minimally invasive approaches for cardiac surgery.
Not only coronary bypass,
but valve surgery and have done probably over 2000 to 3000
minimally invasive procedures,
which puts me near the top of the list in terms of experience probably in this
country.
Wonderful. Thank you so much for that introduction. And to begin,
what are the top three biggest issues in cardiology, cardiology today?
Any that you're facing? Anything that you're reading about continuously,
anything like that?
Well,
I'm gonna answer this based on what my personal opinion is on the three biggest
issues. And as a heart surgeon,
it may be different than what some of the cardiologists would think.
I think number one is that as heart surgeons,
we are seeing a population of patients that are now older that are sicker.
They have many more comorbidities than we used to see in the past.
And the reason for that is that medical management has improved, uh,
significantly as well as there being less invasive catheter technologies
that have sort of delayed some of the onset of heart disease or at least
been able to treat patients when they're younger so that when they require
surgery, now they're a little bit older and sicker than they have been.
So that would be number one. I think. Um,
number two is, uh, the,
with the onset of the new technology,
it's kind of our ability to disseminate the knowledge and to
train younger surgeons that can perform these less invasive either catheter
procedures or for me, less invasive surgical procedures for patients.
So the ability to train the next generation of heart surgeons is, uh,
a bit of a challenge and something that we need to do so that we can provide
these less invasive approaches to more and more patients.
And third, for me, uh, presently out in California is, uh,
being able to, uh,
achieve access for patients who have significant problems that require
intervention and being able to work with insurance companies to
allow patients to go to places and offer some of the newer
technologies and some of the newer less invasive procedures.
So allowing patients access to these procedures is extremely important and a bit
of a challenge.
Doctor,
could you go into more detail about consumers being unaware of
procedures,
especially because it's so important for them to be their own advocate?
Sure.
So I'm not certain that many patients are aware
that there's multiple options available to them when they get a diagnosis.
For example, when they were diagnosed with valvular heart disease,
let's say particularly aortic stenosis,
and they require a procedure to treat that,
I'm not sure patients are aware that there's not only less invasive technology
to do catheter approaches,
but there's also surgical approaches that can be done less invasive.
And there's not a lot of programs that offer the surgical aspects.
Many programs offer catheter base,
but very few programs will offer the surgical approach.
Yet if you look at our literature,
there's lots of data now that confirms that not only patients do better with
minimally invasive approaches, smaller incisions, quicker hospital stays,
they get out the intensive care unit faster,
but the overall cost of their procedure.
And insurance companies have not looked into this enough to know that this is an
option for patients and that if they refer patients to programs like ours at
Memorial Care Long Beach,
that we offer these procedures in the surgical realm as well as in the catheter
based approaches.
Yeah, absolutely. And what would you say professionals need to know,
uh, about minimally invasive procedures right now?
Well,
I think that most of the professionals should realize that these are available,
that they're not experimental, that, uh,
they are better for patients in terms of their quality of life.
They're equivalent, if not better in terms of outcomes. They're,
uh, proving to be more cost effective.
And I think most importantly,
I think that they should realize that there are surgeons who do this and do this
on a regular basis with lots of experience who can produce these excellent
results and they need to, can consider sending these patients to those programs.
And for you, how do you see heart care evolving over the next 18 months or so?
I know that healthcare is always changing. Um, so do you have,
do you see any foresight vision for, you know, how it's gonna evolve?
Well, I think it's pretty apparent that with the new technologies,
we're moving further away from more complex ways to treat patients to less
invasive ways.
We're moving towards more catheter-based approaches to treating not only corn
artery disease, but valvular heart disease.
And we're also looking at new technologies and ways to do surgical procedures
through small incisions, if you will,
keyhole type incisions so that people can have pretty much the same surgical
procedure but done in a less invasive way,
which is improving their quality of life for earlier recovery and getting back
to their quality of life that they experienced before they had to go through
surgery. So I think over the next 18 months,
we're gonna continue to evolve in this direction,
employing these new technologies in a less invasive way.
Yeah, absolutely. And before I let you go, doctor,
the last thing I wanted to ask you about is what are you excited about today?
And also is there anything that making you nervous,
whether it's a project you're working on or something you're seeing in the
field, anything like that?
Well, what I'm excited about and I'll continue to stress is,
is the ability to perform surgery through small incisions
in a less invasive way.
I've been doing this for about 20 years now and have made it the basis of my
practice. And I'm in the process of, uh,
training my colleagues so that at the Memorial Care program in Long Beach,
we continue to have a very large effort towards
surgery being done in these less invasive ways.
And what's exciting for us is we see all people, particularly elderly people,
getting back to their activities, their pickleball, their bike riding,
getting back to their quality of life and what they were doing much,
much quicker, and doing it in a much, uh,
more efficient and better way for them.
They're feeling better and it's a good thing for them in terms of how they're
recovering from these procedurals. In terms of what makes me nervous, uh,
I still am concerned about physicians knowing what is available at
other institutions,
knowing that they can refer patients to programs that have
these technologies and the ability to perform these procedures.
I'm concerned that there's, uh, not enough access to insurance companies to,
uh,
ha allow patients the opportunity to seek out these programs and at least
get an opinion. And I think as we look forward,
insurance companies are gonna need to step back and look at perhaps these less
invasive treatments are not only better for patients,
but are more cost effective in the long run for their companies.
So these are the things that, um, make me a little concerned,
but I think w are extremely important for us to look at for the future.
Absolutely. I completely agree. Thank you so much for those final thoughts.
Doctor, this has been an amazing discussion.
So I wanna thank you so much for coming on Becker's Healthcare and I look
forward to with you again soon.
Thank you very much. I appreciate it.
Of course.