Malias: Community commitment to excellent care is a great thing

Just over a year ago, Dr. Mark A. Malias came to Vero Beach to join Dr. Cary L. Stowe as the second cardiac surgeon at the Indian River Medical Center’s new Heart Center. Malias, a cardiovascular and thoracic surgeon, performs lung surgery as well as cardiac surgery, and has introduced some new approaches in this area. We recently talked to him about his first year in Vero Beach:

Q. As the Heart Center completes its second year, it has compiled a very impressive record.

Malias: I think we do a very good job of getting the patients through with extremely low morbidity and mortality. When you look at cardiac surgery in general, we really provide all the services available out there with the exception of some robotic surgery. We perform a variety of pretty major operations that usually are only taken care of at major tertiary referral centers. But Dr. Stowe’s expertise, and our knowledge and the growing team that we have amassed here, enable us to take care of even that here.

Q. Do you find most Vero Beach residents now are comfortable having complex surgeries performed here rather than going to major medical centers.

A. If a patient has a preconceived notion that they need to go to Hopkins, or Mayo Clinic, or Mass General, we encourage and try to help them get care there if indeed that is what they want. But Dr. Snow has 20 years of experience with heart surgery, and I have 15 years of heart surgery experience. The institution now has done over 350 hearts, so every patient has his own threshold of feeling comfortable, but that initial year experience is behind us, and the great news is we had excellent mortality data and morbidity data, and people should be quite comfortable having their case taken care of here.

Q. What are some of the most important changes taking place in cardiac and lung surgery?

Malias: We are trying to bring some minimally invasive techniques where the incision we make in the patient is minimized. That goes for cardiac surgery as well as lung surgery. We call this video assisted thoracic surgery, or VAT surgery. We stick a lighted telescope into the chest and (can perform the surgery) without spreading the ribs, which is a huge advantage for the patient. They do have an incision into their chest, but the ribs are not spread and typically the old thoracotomy incision would start back behind your scapula (shoulder blade) and run across your side, and we’d divide the ribs, and spread one rib over the other, so the surgeon could get his whole hand inside the chest, or even two hands. Today, we do it through telescopes and an incision no bigger than three inches. I had done some thorascopic surgery up at Holmes but not a formal lobectomy where we remove a lung for cancer. I started that when I came down here a year ago.

Q. Presumably this minimally invasive surgery speeds recovery time?

Malias: Recovery times are definitely shorter, but the big benefit comes in much less pain that the patient has to endure, and getting back to an active life-style afterwards. During my residency 15 years ago, I would do a thoracotomy on somebody and see them back in the office one month after their operation and they still couldn’t wash their hair. Now I will see somebody a week after they are discharged here and they have their arm above their head doing everything they like to do. That’s from not dividing the chest wall muscles. So it’s a real advantage from an activity standpoint after surgery. They still stay in the hospital five to seven days, but their ability to go back to a full and active life style in a week or two as opposed to four to six weeks is a big advantage.

Q. We also understand that you have increased the interaction here in Vero between surgeons and oncologists.

Malias: We have instituted a thoracic oncology group that meets two mornings a month every other Thursday and we discuss the oncology patients – not just surgical patients, but all patients with tumors of their chest. It is a multidisciplinary conference where the physicians present their cases, and they get input from the various different disciplines on how best to treat that individual. The surgery itself still takes place in the operating room with the thoracic and cardiac surgeons. But there is an awful lot more interdisciplinary planning and post operative interaction with the oncologists. It has been a very good thing for the patients.

Q. How does it work?

Malias: Last Thursday we presented seven cases at the oncology conference. I just saw one of the patients today in the office where I reported to him the findings of the conference, and he has opted for radiation therapy. We are going to consider combining radiation therapy in a pre-operative setting, restage him in a month, and see if the tumor has shrunk any. If it has, we will proceed with surgery at that time. So it is trying to meld different disciplines into the optimal care for a patient.

Q. Do you see more top specialists coming to Vero?

Malias: I do think the number of specialists will increase with time. I think there is a need for good quality physicians in almost every community, but in this community in particular, it is a very knowledgeable community. They have very high standards set and they expect to get excellent care. It is what the community is accustomed to. It is not uncommon for me to be questioned by patients in the office about what’s the gold standard therapy for this disease process. They’ve done their homework before they come to the office.

Q. What has most surprised you in your first year here?

Malias: I think the thing that surprised me most has been the community’s commitment to health care delivery in this neighborhood. I didn’t find that in other institutions. I guess being at a big academic center, you lose that community commitment because 70 percent of the patients are referred in from elsewhere. But Holmes Regional Medical Center is not that far from here, it is not that much bigger, it is a similar type hospital, but there was very little community commitment to the facility itself. I find that vastly different here. The Foundation’s input, the community’s stewardship and commitment to a program, has been eye opening to me. I didn’t think I would have as many engagements with the community as I have had in the past year. There are almost weekly meetings that I speak at, or if not me, Dr. Stowe. I think that is a great thing.

Q. What do you think the future holds for cardiac surgery?

Malias: I think we are going to see the pendulum start to swing back in favor of surgery over stenting or angioplasty (for treating clogged arteries). We may wind up with more people being sent for surgery rather than being sent for angioplasty this month, and then again six months from now, and again a year from now, and again two years from now. So I do think the pendulum will swing back more to surgical revascularization rather than percutaneous interventions.