Episode 16: Robotic Cardiac “Unroofing” with Dr. Husam Balkhy

SPEAKER_00 0:00

Whether it's in myocardial bridge or coronary surgery or valve surgery or arrhythmia surgery, all of that can be done using the robot. There is not a myocardial bridge that we can't handle robotically. It's not like we need to do a steronomy because of this or that or the other. The robotic approach allows you to do a more extensive, sometimes myocardial bridge on roofing than a non-robotic approach.

SPEAKER_01 0:56

We'll talk with healthcare professionals, those in related fields that support our condition, and others just like us with stories of their myocardial bridge experiences. It's my intention for this content to inform, educate, entertain, and even motivate or inspire you in your personal journey on dealing with a myocardial bridge. Most importantly is to have you leave each episode with hope, knowing you're not alone and that what you're experiencing is real. My guest this episode represents one of the hottest topics in surgical procedures of unroofing. Robotic surgery.

unknown 1:37

Dr.

SPEAKER_01 1:37

Hussam Balkey is professor of surgery and director of robotic and minimally invasive cardiac surgery at the University of Chicago Medicine. He received his cardiothoracic and vascular surgery training at Tufts New England Medical Center and Leahy Clinic in Boston, Massachusetts. He was chairman of cardiac surgery at the Wisconsin Heart Hospital in Milwaukee, Wisconsin prior to moving to the University of Chicago in July 2013. Dr. Balke is considered a pioneer of robotic cardiac surgery, having performed over 2,000 cases by mid-2022. He has the largest series of robotic totally endoscopic coronary bypass operations in the world with over 1,000 cases. With well over 100 peer-reviewed publications and book chapters, he is a frequently sought-after speaker and proctor worldwide and has trained multiple surgeons both nationally and internationally on robotic cardiac surgical techniques. Dr. Balke, welcome to the program.

SPEAKER_00 2:36

Thank you. Very happy to be here and thanks for the invitation and for the work you're doing.

SPEAKER_01 2:41

You know, there's really been no greater interest in a procedure, one that we get a lot of questions on through the website as well as on the Facebook group. And it's the opportunity to be on roof robotically. But before we get there, can you give us a little bit of the background on what brought you to robotic surgery versus traditional? Because you actually started out as a classically trained surgeon.

SPEAKER_00 3:05

Yes, that is true. So I went through the traditional cardiac surgical training pathway that requires one to be proficient in traditional techniques and open heart surgery. And that was remotely back in the 1990s. So I finished a first general surgery training program, which was five years, six years because I did some research, and then did a vascular surgery fellowship to learn how to operate on blood vessels, and then finally did my cardiac surgery fellowship all on the East Coast in Boston and came out a, you know, enthusiastic young heart surgeon ready to go and learned how to do all the techniques with opening people's chest. And it became very quickly apparent to me that the invasiveness of what I was doing was pretty significant. And even though we did a great job on the heart, patients would sometimes have lots of trouble with the sawing open of the breastbone. And I quickly, you know, decided that there were some operations that I really didn't need to saw people's chests open for us to get an efficacious result with. And I started about three years after my beginning practice, and I was in Milwaukee at the time, I started trying to minimize the invasiveness of my techniques. And the first thing that I did was I eliminated cardiopulmary bypass when I did somebody's coronary bypass surgery. And cardiopulmonary bypass is just a heart-lung machine and stopping of the heart and things like that. And so I basically decided that this is an epicardial operation, meaning it's on the surface of the heart and it does not require the heart to be stopped. And so the first thing I did was even with a sternatomy and with opening the chest, I said, okay, we don't need to really do this. And I learned how to do the surgery beating heart. And then a year later or two years later, I started working on uh patients who had atrial fibrillation and approaching their cardiac surgery through little holes using uh thoracoscopy, which is basically similar to a laparostopic cholosystectomy, but it's in the chest. And that was a new technique that was evolving at the time in the early 2000s, and it allowed me to observe the heart from a side, from the side as opposed to from the front. And that's one of the major things that I tell junior folks these days when they're learning to do these less invasive approaches, is familiarize yourself with what the heart looks like from the side, whether it's the left side or the right side. And then eventually I moved on to doing less invasive valve surgery. And then finally in 2006, I found a robot. And that was the epitome of less invasive heart surgery. And so I adopted my technique of off-prompt coronary bypass through astronomy, which is otherwise known as opcab, to off-prompt coronary bypass using a robot with no chest opening, just little holes. And that's called TCAB. And I started doing TCAB in 2006, and I now have the largest series of TCAB patients in the world and have been doing it for all those years and successfully. And in the process of doing TCAB, there were coronary arteries that were not accessible on the surface of the heart. If you look at the veins on the back of your hand and you can see the veins, that's where a coronary usually lives on the on the surface of the heart. But there are some coronaries that are deep, and they can be deep covered by fat, but they can also be deep covered by muscle. And in the process of doing TCAB, you know, we were approaching all different types of anatomies, and I was digging coronaries out under the muscle to do bypass surgery. So this is not people with bridges or anything of that nature, or symptomatic bridges, I should say. This is people who just had a deep coronary artery that we were going after to bypass. And we're doing that robotically with little holes, without a sternotomy, without a heart lung machine. And that was way back in 2008, 2009. And these cases are not that frequent, but as you increase your experience, you can basically do them successfully and safely. And so in probably 2010, when I was still in Milwaukee, one of my cardiologists presented a patient to me who had a myocardial bridge. And they had worked that patient up very, very aggressively. And the reason I say that is because myocardial bridge is a not uncommon condition that cardiologists see on the angiograms. And so that patient was worked up aggressively, and the cardiologist came to the conclusion that this is a significant and clinically relevant myocardial bridge. And I said, Well, you know, we've been digging coronaries out with the robot. Why don't we do this case? And there's no bypass involved, but we can go in and it's actually going to be easier for me because I don't have to bypass anything. I could just dig out the coronary and it'll be great.

SPEAKER_01 7:41

And that was the quick question right there. Yep. How is it different if you're digging out coronaries from heart, muscle tissue, and fat different from what would be considered a myocardial bridge?

SPEAKER_00 7:53

Not different at all. It's just it's it's the effect of the coronary being under the muscle that would be different. And how tight the muscle constricts it, maybe how thick the muscle band is, the act of of dividing the muscle on top of the coronary is exactly the same. The techniques, the precautions, the you know, the measures that we take when we do it one way or the other, it's it's exactly the same. And so to me, it was a no-brainer. The challenge then became which patients do you actually take to do that to? Because still it's invasive, it's anesthesia, it's heart surgery, and there's a lot of patients with bridges. And so the challenge wasn't necessarily can you do it? The challenge was who do you do it to? So we began doing that in 2009. And, you know, I moved down here to Chicago, University of Chicago in 2013. And in that 10-year period, now it's 2023. We've done about 40 patients. So we haven't done a lot. And one of the reasons is that we're very, very selective in who we think benefits from this operation, from unroofing in general, not just robotic unroofing. Who benefits from unroofing? And we've evolved a very kind of meticulous, if you will, angiographic testing in the CAT lab with one of my colleagues who actually has unfortunately moved away from here just this last couple of months, John Blair. And he was interrogating these bridges very, very closely. And we would collaborate and combine to figure out who would benefit, who actually is symptomatic from their bridge, because as noted, a bridge is not uncommon. You know, you and I, if we had a calf right now, maybe what one of us has a bridge. And if we do have a bridge.

SPEAKER_01 9:43

Oh, got a few extra complications, surprises while while we were at it.

SPEAKER_00 9:49

So yes, so you've come from the perspective of the. During the surgery itself, we insert little ports, the size of which is about eight to ten millimeters in diameter, so slightly larger than a bic pen. And if you were to say about the big pen. Yeah, take out the big pen, take out the inners of it, and and then you have now a hollow tube. That hollow tube is placed through the ribs very carefully. We then insert through those tubes, uh those ports, we call them, a camera that has 3D magnification, 3D imaging and ten times magnification with a very high quality picture, as well as wristd robotic instruments, and we work through that. In the case of a myocardial bridge, it probably takes about anywhere from two to four hours to unroof somebody's bridge. And we basically put a chest tube in at the end through one of the holes, and the chest tube is about the size of one of those 10 millimeter holes, and that chest tube stays in overnight. Now, they go to the intensive care unit. They probably could not go to the intensive care unit, they could go to the recovery room, but in our in our hospital we do it in the ICU. They usually get extubated, meaning the breathing tube comes out at the time of surgery in the operating room, so they don't wake up with a tube in between their vocal cords, which is extremely irritating and not fun. And then really they're in pain for about 24 hours until that tube comes out. The majority of the patients will go home on the second, on the day after surgery, or the day after that. And majority of our patients don't even fill the prescription that we give them for narcotic pain medicine because their pain is really controllable with, you know, Advil or ibuprofen or whatnot. And the majority are back to full activity within two to three weeks, definitely a job, but even some are back to, you know, exercise and those kinds of things. There's no restrictions after the surgery in terms of lifting and physical activity. I tell them to do whatever they feel like as long as they're not sore. There is some soreness in the left chest, obviously, from the holes that we made.

SPEAKER_01 13:09

I actually know some people who have had the robotic surgery who the second day out were out and walking around town and actually felt good. Yeah. And to your point, no narcotics. I think Tylenol is what you know, one of the gentlemen was using. He said it's just amazing. In the process, you had mentioned something about so many of us having a myocardial bridge. And I think the estimate is maybe as much as a third of the population could have a bridge. It's a much smaller percentage that are symptomatic. To the people who are listening and having that challenge of getting that diagnosis, is there anything that you particularly look for that says, okay, this is likely a surgical procedure that will benefit this individual versus trying the medical process or the fact that maybe the bridge isn't even the root cause of their problem?

SPEAKER_00 13:58

Yeah, good question. And in all honesty, I have had patients that came back positive from the angiographic stress testing that we do in the CAF lab. And I've still felt reluctant about doing surgery on them. And that's because their symptoms just didn't fall into what I would consider something that could be explained by poor blood supply to the heart muscle. So what we're talking about here is we're talking about a constriction that happens in the blood flow of the main coronary artery that feeds the heart muscle. And that constriction happens every time the heart squeezes. So on first encounter, that is an oxymoron because we know that blood flow to the heart muscle occurs not when the heart is squeezing, it occurs when the heart is relaxing. So who cares what's happening when the heart is squeezing in terms of the blood flow to the muscle? That's not when the muscle gets its nourishment, it gets its nourishment when the heart's relaxed. So many surgeons and cardiologists will say to you that unroofing myocardial bridges is a phantom operation. It's a sham because of that simple fact. And it's hard for us who wanna 100% avoid sham interventions to get beyond that simple fact. Now, the way we do get beyond it is by testing in the cath lab and demonstrating that when a patient is stressed and the heart is working overtime and and beating fast and hard, simulating an exercise or simulating a stressful situation, that squeeze lasts into the phase of diastole, which is the phase of relaxation to some extent, and actually contributes to poor blood supply during the phase when the heart needs to be to be supplied. And those of us who've done these operations and have seen the patients and have talked to them and listened to what they say are believers in the fact that this works. But not every heart surgeon will agree with that because of the prevalence of myocardial bridges that are asymptomatic in the community. So why are some symptomatic and some not? The other question is why would some become symptomatic at a later age in life? Because, you know, this didn't happen as an acquired thing. You're born with the course of your arteries, and maybe you could say, well, the heart muscle gets thicker and stronger over time, and that's why this kind of evolves over time. There's also this notion of endothelial change, and these are things that are a little bit beyond my understanding, to be totally honest. I'm just what I call the cutting doctor. And, you know, the smart cardiologists, they understand endothelial disease much better. And a lot of patients are treated with medications to help with spasm. So there are different things going on in this process that we don't understand yet. And I think patient selection, like I had mentioned earlier, is really the challenge as to who do you subject to this type of an intervention. And we try to minimize the number of people that we do it who are not going to benefit from it, because what you've done is you've just subjected them to an operation for which they could have complications and for no benefit.

SPEAKER_01 17:24

Unnecessarily. And to your point also of so many having the condition asymptomatically, one of the questions that just keeps going through my mind is if so many people have the condition, the myocardial bridge, they're asymptomatic. But is it possible that they're asymptomatic until they are and it's once. And this symptom happens and it's sudden cardiac arrest, and that's it. And we'll never know because we don't do autopsies on everybody that passes from what looks like a cornea occlusion.

SPEAKER_00 18:22

Yeah. That's interesting. I don't think there's anything that's been described that this condition can cause sudden cardiac arrest. Otherwise, you'd see a lot more people getting intervention for it. There are conditions that are dynamic in their, this is what we call a dynamic obstruction because it's not always there. And so there are patients who have other types of dynamic obstructions. For example, when the coronary artery comes off the aorta in an abnormal position, and it's positioned between the two main blood vessels, the aorta and the pulmonary artery. And when we exercise, those blood vessels get ever so more dilated. And so if you imagine that the two arteries are like this, there's a coronary artery in between them. And when you exercise, they get a little bit bigger and they can pinch the coronary artery. And when they're when you are done exercising and things go back to normal, then the path is fine. And so that's a dynamic obstruction. That condition has been known to cause sudden death. And so when somebody's diagnosed with that, anomalous coronary artery takeoff between the major vessels, that's an indication for surgery. We do bypass or unroofing or things of that nature to rectify that problem.

SPEAKER_01 19:38

You answered that question perfectly. In the actual process of surgery, so you're going in with a very small tool, so to speak, robotically. What happens to the chest cavity? How do you get enough room to work on top of the heart when you're in there robotically versus opening somebody up?

SPEAKER_00 19:58

Great question. And this is what I want to talk directly to your community. First thing we do is we insufflate carbon dioxide inside the chest in order to create the space. So normally our chest cavities are occupied by the organs, two lungs and a heart, and then all the mediastinal fat and things like that around it that completely occupy the space. So for us to get to the heart, we've got to collapse the left lung. And that's easily done. It's not a permanent condition, and it can be uncollapsed very quickly at the drop of a hat. So nobody needs to worry about the fact that we're collapsing their left lung. When you go on a heart lung machine for regular open heart surgery, you're collapsing both lungs, by the way. I always get that question, oh, you collapsed my lung. How's that going to go? I mean, am I going to be okay? And the answer is yes, you're going to be okay because it's a natural thing. So we collapse the lung, that gives us the space. Now imagine your chest with no lung occupying it. That's all the space we need. But the thing that facilitates this operation endoscopically using a robotic approach is something called an endorrist stabilizer. And it's an instrument on a version of the robot that is called the SI SI. That SI has been around probably now for about 15 or so years. And it's being replaced by the newer system, which came out in 2014 or 2015, called the XI. And the robot that I use for any coronary intervention, whether it's coronary bypass or myocardial bridge or a couple of several other operations on the surface of the heart, when I do it with the robot, I use the old system, which we still have at our hospital. Many surgeons don't have that old system anymore. And it's not, and when I say old, I don't mean it's old and outdated. It's a great system. It's actually in my mind, it's I like it better than the newer system. And I use the newer system for other types of robotic heart surgeries. But the message that I want to relay is that that system and the stabilizer are not available for. The newer generations of robot. And so my ability to do this operation will cease to exist once we phase out completely this SI robot, which will happen probably in about a year and a half. And because surgeons have not adopted this approach, whether it's for coronary bypass or for the other procedures of which bridge unroofing is one of, the company hasn't felt the need to make a stabilizer that can assist us in doing this operation totally endoscopically. And so because the myocardial bridge community is very active, which I've noticed, I think that they can be a voice, or you can be a voice, in helping industry understand that some of these instruments are vital to these operations, and they need to be, they need to continue to provide them to those of us who are interested. It may not be a huge amount of volume that they're going to get out of this type of an instrument. You know, it's not like prostate surgery that is done robotically, but it is a vital piece of what we do on the heart that when it goes away, I won't be able to do this operation anymore.

SPEAKER_01 23:18

Well, what we'll do is once we complete the discussion for the episode, I'll get this information from you. And for everybody, I will share this in the show notes so that we can mount our own cause to say, hey, this needs to continue for a variety of reasons. And if you can let me know the other surgeries it's necessary for besides just our condition of myocardial bridges, that would be wonderful. And we will mount the campaign because we have enough challenges getting cardiologists to accept the fact that our symptoms are real. Yeah. We certainly don't need the few that accept that they are real that are helping us challenged. True. That's just another consequence we just don't need to have at this point. You mentioned in one of the videos that I saw on the University of Chicago website haptic feedback, which is something that you don't get from the mechanics of the robot at this point. Whereas if you were surgically in there with your hands, you could feel the density of the tissue as you were you were cutting and you would understand a little bit more by feel. How has that challenged or how have you accommodated the situation where you don't have that sense of feel that you don't get from the robot?

SPEAKER_00 24:27

Yeah. So it it's it's a matter of experience and learning curve, if you will. When you first start operating with these tools, you have no clue how much pressure you're exerting on the tissue, and the cases will take longer because you're still kind of trying to develop your sense of dimensions and tension and pressure and things like that. As you get more and more experienced, you develop what is sometimes called uh visual haptic feedback. And so, for example, when I use a very, very thin, fine suture and I want to tie it, I can't really feel the tension that I'm exerting on the stitch or the thread. And so what I end up doing is using my visualization to understand different cues that generally then will give me the feedback that I need. If I, for example, want to see how hard or stiff a coronary artery is and whether it's calcified or not, I move it around and kind of see how it responds. So even though I can't really feel the softness or the hardness of the vessel, I know how hard it is by by just having done it hundreds of times. So visual haptic feedback is a thing, and that's kind of what we rely on to help us assess these things. And I think it's even though we don't know that we're doing that, it it comes naturally, I believe, and and you quickly overcome, you know. Would it be nice to have a haptic feedback system? Absolutely. There are some um robot companies that are working on that, but it's not there yet.

SPEAKER_01 26:04

Well, I figure if they can get the steering wheel in a car to tell you when you're crossing over the lane by vibration, I'm sure they're they're gonna get there with AI now and technology for the uh for the robot. True. Yeah, what are some of the concerns post-robotic surgery that may be different than traditional sternotomy recovery?

SPEAKER_00 26:19

Yeah, good question. There's a couple, and they're they're minor. One of them is the fact that we do, as I mentioned before, use uh carbon dioxide to insufflate the chest and create the space. That can be sometimes caustic on the tissues, the the pericardium, which is the lining of the heart and the pleura, and that can cause an inflammatory condition with maybe a little bit of a higher incidence of pericarditis. And that manifests in and of itself of a chest pain, which is different than the pain that somebody would have had before. And we treat that with medication for you know, four or five days after surgery. Sometimes it's a course of steroids, sometimes it's other medications anti-inflammatory. So the incidence is, you know, in in general open cardiac surgery procedures, if it's about 5%, it may be closer to 10% here, but it's not a high number.

SPEAKER_01 27:12

And of the 40 patients roughly that you've done so far for bridge repair, how many of them have said they experienced significant improvements in their capabilities or significant decreases in their pain or symptoms? 82.9%. Wonderful. And I would imagine the other 18, 17 percent has probably got some comorbidities or other issues that are plaguing them.

SPEAKER_00 27:40

Yes, exactly. And and that's I think as we're getting more experienced and we're learning, a function of better selecting the patients. And you know, patient selection is a word that you hear a lot in the medical literature and and in people who present their results. And to me, medical uh selection is like I would love to say to you, 99% of our patients have excellent improvement in their pain. But what it means is that I've excluded a lot of patients to get to that number. So in this case, I've included 17% that may or may not have had a positive result. And unfortunately they didn't. But we may have, in that process of decreasing our threshold, have included another 15% that did. There's this there's this notion in general surgery that you have to have a certain percentage of what they call negative laparotomies, which means you have to to be able, and this is in in the treatment of appendicitis, which we know is a terrible disease and it's a very easy fix, you get your appendix taken out if you have it inflamed. And so there are some patients who come in with belly pain in the middle of the night, and you just can't be sure. And so you got to take them to the OR. And you take them to the OR and you find that you have what they call a negative lap, meaning the appendix is perfectly fine and it's not inflamed, and you know, you didn't have to take them to the OR. But in order to get a certain to get as many appendicitises, which is a terrible disease to be left alone, you've got to have some negative laps. Does that make sense?

SPEAKER_01 29:18

Absolutely.

SPEAKER_00 29:18

Yeah. And so I, you know, if we were really, really selective, and I am very selective, as I mentioned before, we'd have a success rate of 99%. But we don't, and I think it's okay.

SPEAKER_01 29:31

And we do see people who have gone through the opportunity of submission to surgeons who are doing robotic surgery and get declined. Clearly, there are other issues that the surgeon is looking at saying, I I this just isn't going to work for you. And I think that's the best thing you can do because to have that false expectation of improvement is worse than understanding that you have some complications that may require astronomy, or you may have other situations where you may not even be a candidate for the unroofing procedure.

unknown 30:04

Trevor Burrus, Jr.

SPEAKER_00 30:05

Well, I want to explain one thing is that when people get denied robotics, myocardial bridge unroofing, in my practice, it's not because there are technical difficulties or that it cannot be done robotically, but I can do it with astronomy. That is not the reason that they get declined. The reason they get declined is because we don't think that they would benefit from an unroofing procedure because of their symptoms being not perfectly aligned with what this disease does, or because their angiographic interrogation, what we call provocative testing, is not positive. From the technical aspects, there is not a myocardial bridge that we can't handle robotically. It's not like we need to do a strenotomy because of this or that or the other. When you're experienced at robotic surgery, then you can handle pretty much the majority of bridges, all of them. Indeed, the robotic approach allows you to do a more extensive, sometimes myocardial bridge unroofing than a non-robotic approach.

SPEAKER_01 31:02

Aaron Powell So the depth, the length, the possible multiple bridges really is not of any significance in robotic.

SPEAKER_00 31:10

Nope. In endoscopic. Now there's two types of robotic surgery. I guess it doesn't really apply to the bridge because there's no harvesting of a mammary. But I was going to say that when we do bypass surgery to the LAD, which is the artery that is involved in the city. You've got to sometimes do a bypass. Did you have a bypass?

SPEAKER_01 31:34

I did, yes. Oh, okay. Yeah.

SPEAKER_00 31:36

So when we do robotic bypass, there's two types of robotic bypass. One is where the whole procedure is done with the robot, and we need that stabilizer. And so we harvest the conduit from the chest wall called the internal mammary artery, and we bypass endoscopically using the robotic instruments. The second variety, which is actually the more common, unfortunately, because of the lack of the stabilizer and the utilization of it, is where the robot is used just to harvest the conduit, and then the surgeon makes a small incision in between your fourth and fifth rib and goes in and does the surgery to bypass with the hands with the regular suture technique. And the reason that that can be limiting that non-endoscopic approach is because now you are limited in looking at the LAD through a small five to seven centimeter incision with a little bit of rib spreading. And all you have is one area where you can work on. And you can't go distally, you can't go proximally, you can't go to another area where there might be some pathology that you want to take care of. Whereas with the endoscopic approach, imagine having this 10 times magnification scope with 3D vision inside, in between the fourth and fifth rib or the third and fourth rib, and you can move that scope all up and down the chest and get to any part of what is inside the chest and deal with it. So if you've got a bridge up top and you've got a bridge down bottom, you can take care of both of them using that approach. What I like to liken it to is if you're at the Lou and you want to see the Mona Lisa, and all they gave you was a little hole in the wall to be able to kind of find the right angle to see that beautiful smile. Well, you're gonna have to really work hard to see it, and you may not even be able to see it. But if they gave you a high definition magnified scope and put it in through even a smaller hole, you can direct that scope wherever you want. You can magnify, you can bring it in, you can actually move it in, you can take it out, and you can see the Mona Lisa significantly better.

SPEAKER_01 33:34

It's that zoom on our phones that we all use to see something closer. Exactly. Exactly. Yeah, let's let's shift gears just a little bit. What do you do to relax? What's what's a little bit of downtime for Dr. Balkey when he's not literally saving lives? Oh downtime.

SPEAKER_00 33:54

I would say I cycle. That's good to do. I love listening to podcasts, which is, you know, a thing that everybody does these days, which is an interesting kind of revolution, if you will. And and I appreciate the the work that podcasters do. Yeah, yeah. So that's something we do. I like to ski. I'm a skier. I play some tennis. I played much more in the past, but but uh but those are the kinds of things that that I'll do, you know, if I have some time.

SPEAKER_01 34:26

Now, I'm sure many of you listening are going, how do we get hold of Dr. Ball? How do we find out more about robotic surgery? Could you tell me what the best process for anybody interested to go through to reach out to you?

SPEAKER_00 34:44

Yeah, I think the best way to just get a direct interaction as opposed to sending an email or going on the website or any of that stuff is just to call my office. And I have a wonderful robotic coordinator. Her name is Ruth Buckner, and I have a wonderful team. My nurse practitioners and my physician assistants. We're all kind of marshaled towards the what I call robotic revolution, whether it's in myocardial bridge or coronary surgery or valve surgery or arrhythmia surgery. All of that can be done in our practice using the robot. And the number to call is 773-834-1612.

SPEAKER_01 35:24

And we will also put that in the show notes for the benefit of anybody who happens to be driving as they're listening or cycling as they're listening. Yeah. Uh Dr. Balkey, I cannot thank you enough. I I know so many people have been anxious to learn more about robotic surgery, to get a little bit better understanding of it. And while we can all go and see stuff online and search, it's just much more personal to have a discussion and have somebody share that discussion from somebody who has actually had the surgery and understands the consequence of astronomy to going, it would have been nice if I didn't have to, you know, be opened up that way. And I was on pump and I had the the bypass. And so it will benefit many, many people as they go through, you know, their process of discovery and education. So thank you again. I I sincerely appreciate it. And we will get the information as well for the company that's manufacturing the robots, and I'll have that posted online as well.

SPEAKER_00 36:24

Very good. Thank you very much for doing this. And I'm happy that that we were able to to get into some, you know, good details. The fact that you've had the surgery yourself obviously puts you in a great position to ask these questions. And I think there's, you know, myocardial bridge is in my mind unequivocally a problem. And there is a great Hallelujah. Yeah, there's a just saying that almost seems kind of blasphemous, but but it's true. I have no qualms about it. I've seen enough patients to convince me. And the fact that we have at our fingertips a totally less invasive procedure for which the risk is very low and the encumbrance to recovery is also quite limited is I think it's a it's a it's a revelation, and and we should take advantage of it in some of the patients that it may not be clear because the downside. So if I had a patient who was equivocal in the indications for surgery, and all I had was a saw and a heart lung machine, I don't think I would subject that person to that. But if I can do it stealth with four little holes in a chest tube at the end of the day and they go home in a day or two, that might be the way to get to a larger number of people that, you know, you could say, well, if it was the bridge, thankfully the symptoms are gone and that the the problem has been treated. If it wasn't the bridge, then the encumbrance was not that severe. And the and the risk to you and to your you know health was not that significant. And you got, you know, four little mosquito bites to show for, and that's it. And then we'll go find what the problem really was.

SPEAKER_01 38:09

If that was a summary for what we just did for the last 35, 40 minutes, you could not have done it any better.

SPEAKER_00 38:16

That's great.

SPEAKER_01 38:16

That was absolutely fabulous. So thank you again, Dr. Balkey.

SPEAKER_00 38:21

Thank you, Jeff. Pleasure meeting you, and hopefully we'll continue to collaborate on these issues.

SPEAKER_01 38:26

Thank you for listening to Imperfect Heart. It's my hope that this information helped in some way to improve your situation or will help you better understand this condition. More importantly, that it gives you hope through stories that there is help and you most certainly are not alone. If you've been diagnosed with a myocardial bridge, please be sure to join the private Facebook group, Myocardial Bridge Support Group. For more information about our program or to reach me directly, visit the website myimperfectheart.com. If you like what you heard today, please give a positive review, thumbs up, high five, whatever your app likes. And be sure to share with everyone important to you so they understand what it is you're dealing with. Please subscribe as well. Welcome each day with gratitude and positivity. The views and opinions expressed in this program are solely those of the host and the guest and are not intended to provide, nor are they a suitable substitute for professional care by a doctor, therapist, mental health professional, or other qualified medical professional. Imperfect Heart is a production of Hear Me Now Studio.