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Welcome everyone to the
Becker's Healthcare podcast
series. I'm Ryan Mohammed,

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she her pronouns with Becker's Healthcare.

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I'm thrilled to have with me today Dr.

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Mark Akwa from the Memorial Care
Heart and Vascular Institute. Doctor,

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it's so nice to talk with
you today. How are you?

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I'm good. How are you?

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Good, thank you so much. Well, to begin,

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would you mind please introducing
yourself and telling us a bit about your

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background?

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Yes, thank you. My name is Mark Squa.

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I am currently the chief of cardiothoracic
surgery at Memorial Care Heart and

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Vascular Institute,

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as well as the medical director of the
adult cardiovascular surgery program for

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the Memorial Care Heart and
Vascular Institute at the
Long Beach Medical Center.

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I've been here since two, early 2020,

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and I came from Detroit from
the Beaumont Hospital System.

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I was the chief of cardiac surgery
at Beaumont for many, many years.

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I was actually at Beaumont
in Detroit for 35 years.

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We're working together
with our cardiologist.

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We were a top 20 US News
and will report program.

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In 2020, I saw an opportunity
to join Memorial Care,

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which seemed like a nice segue
for that time of my life,

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and I decided to come to
California. My interests, uh,

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in cardiac surgery,
obviously I do everything,

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but I'm mostly interested in minimally
invasive approaches for cardiac surgery.

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Not only coronary bypass,

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but valve surgery and have
done probably over 2000 to 3000

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minimally invasive procedures,

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which puts me near the top of the list
in terms of experience probably in this

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country.

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Wonderful. Thank you so much for
that introduction. And to begin,

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what are the top three biggest issues
in cardiology, cardiology today?

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Any that you're facing? Anything that
you're reading about continuously,

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anything like that?

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Well,

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I'm gonna answer this based on what my
personal opinion is on the three biggest

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issues. And as a heart surgeon,

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it may be different than what some
of the cardiologists would think.

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I think number one is
that as heart surgeons,

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we are seeing a population of patients
that are now older that are sicker.

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They have many more comorbidities
than we used to see in the past.

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And the reason for that is that
medical management has improved, uh,

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significantly as well as there being
less invasive catheter technologies

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that have sort of delayed some of the
onset of heart disease or at least

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been able to treat patients when they're
younger so that when they require

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surgery, now they're a little bit
older and sicker than they have been.

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So that would be number one. I think. Um,

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number two is, uh, the,

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with the onset of the new technology,

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it's kind of our ability to
disseminate the knowledge and to

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train younger surgeons that can perform
these less invasive either catheter

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procedures or for me, less invasive
surgical procedures for patients.

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So the ability to train the next
generation of heart surgeons is, uh,

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a bit of a challenge and something that
we need to do so that we can provide

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these less invasive approaches
to more and more patients.

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And third, for me, uh, presently
out in California is, uh,

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being able to, uh,

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achieve access for patients who have
significant problems that require

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intervention and being able to
work with insurance companies to

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allow patients to go to places
and offer some of the newer

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technologies and some of the
newer less invasive procedures.

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So allowing patients access
to these procedures is
extremely important and a bit

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of a challenge.

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Doctor,

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could you go into more detail
about consumers being unaware of

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procedures,

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especially because it's so important
for them to be their own advocate?

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Sure.

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So I'm not certain that
many patients are aware

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that there's multiple options available
to them when they get a diagnosis.

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For example, when they were diagnosed
with valvular heart disease,

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let's say particularly aortic stenosis,

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and they require a
procedure to treat that,

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I'm not sure patients are aware that
there's not only less invasive technology

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to do catheter approaches,

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but there's also surgical approaches
that can be done less invasive.

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And there's not a lot of programs
that offer the surgical aspects.

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Many programs offer catheter base,

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but very few programs will
offer the surgical approach.

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Yet if you look at our literature,

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there's lots of data now that confirms
that not only patients do better with

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minimally invasive approaches, smaller
incisions, quicker hospital stays,

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they get out the intensive
care unit faster,

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but the overall cost of their procedure.

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And insurance companies have not looked
into this enough to know that this is an

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option for patients and that if they
refer patients to programs like ours at

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Memorial Care Long Beach,

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that we offer these procedures in the
surgical realm as well as in the catheter

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based approaches.

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Yeah, absolutely. And what would
you say professionals need to know,

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uh, about minimally invasive
procedures right now?

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Well,

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I think that most of the professionals
should realize that these are available,

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that they're not experimental, that, uh,

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they are better for patients in
terms of their quality of life.

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They're equivalent, if not better
in terms of outcomes. They're,

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uh, proving to be more cost effective.

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And I think most importantly,

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I think that they should realize that
there are surgeons who do this and do this

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on a regular basis with lots of
experience who can produce these excellent

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results and they need to, can consider
sending these patients to those programs.

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And for you, how do you see heart care
evolving over the next 18 months or so?

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I know that healthcare is always
changing. Um, so do you have,

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do you see any foresight vision for,
you know, how it's gonna evolve?

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Well, I think it's pretty apparent
that with the new technologies,

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we're moving further away from more
complex ways to treat patients to less

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invasive ways.

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We're moving towards more catheter-based
approaches to treating not only corn

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artery disease, but
valvular heart disease.

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And we're also looking at new technologies
and ways to do surgical procedures

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through small incisions, if you will,

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keyhole type incisions so that people
can have pretty much the same surgical

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procedure but done in a less invasive way,

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which is improving their quality of life
for earlier recovery and getting back

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to their quality of life that they
experienced before they had to go through

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surgery. So I think
over the next 18 months,

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we're gonna continue to
evolve in this direction,

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employing these new technologies
in a less invasive way.

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Yeah, absolutely. And
before I let you go, doctor,

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the last thing I wanted to ask you about
is what are you excited about today?

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And also is there anything
that making you nervous,

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whether it's a project you're working
on or something you're seeing in the

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field, anything like that?

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Well, what I'm excited about
and I'll continue to stress is,

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is the ability to perform
surgery through small incisions

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in a less invasive way.

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I've been doing this for about 20 years
now and have made it the basis of my

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practice. And I'm in the process of, uh,

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training my colleagues so that at the
Memorial Care program in Long Beach,

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we continue to have a
very large effort towards

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surgery being done in
these less invasive ways.

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And what's exciting for us is we see
all people, particularly elderly people,

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getting back to their activities,
their pickleball, their bike riding,

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getting back to their quality of
life and what they were doing much,

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much quicker, and doing it in a much, uh,

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more efficient and better way for them.

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They're feeling better and it's a good
thing for them in terms of how they're

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recovering from these procedurals. In
terms of what makes me nervous, uh,

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I still am concerned about physicians
knowing what is available at

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other institutions,

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knowing that they can refer
patients to programs that have

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these technologies and the ability
to perform these procedures.

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I'm concerned that there's, uh, not
enough access to insurance companies to,

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uh,

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ha allow patients the opportunity to
seek out these programs and at least

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get an opinion. And I
think as we look forward,

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insurance companies are gonna need to
step back and look at perhaps these less

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invasive treatments are not
only better for patients,

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but are more cost effective in
the long run for their companies.

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So these are the things that,
um, make me a little concerned,

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but I think w are extremely important
for us to look at for the future.

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Absolutely. I completely agree. Thank
you so much for those final thoughts.

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Doctor, this has been
an amazing discussion.

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So I wanna thank you so much for coming
on Becker's Healthcare and I look

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forward to with you again soon.

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Thank you very much. I appreciate it.

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Of course.