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HEARTBURN: Best ways to keep chronic acid reflux in check, D2 EATING: Incorporating more heart-healthy foods in your diet, D3 TRAVEL: Mexico’s last countercultural coast, D5
| SUNDAY, FEBRUARY 16, 2020
Passion
for Perfection defines Baystate’s first female cardiac surgeon Dr. Kelly Wanamaker, who is among three percent of such women surgeons.
Cardiothoracic surgeon Kelly Wanamaker, M.D. recently became Baystate Health’s first female heart surgeon. By Anne-Gerard Flynn
Special to The Republican
Baystate has a number of women surgeons, including thoracic surgeons, but the Virginia-born physician is the first female hired specifically to do cardiac surgery at Baystate Medical Center which eight years ago opened its state-of-the art Davis Heart & Vascular Center. It is an impressive distinction, especially given national estimates that only about 21 percent of U.S. surgeons today are women, only about seven percent of active cardiothoracic surgeons are women and only three percent of cardiac surgeons are women. Dr. Nina Starr Braunwald, who became the country first female heart surgeon in 1963, is credited with a number of pioneering advances in the field of cardiac surgery. Braunwald, the first woman to perform open-heart surgery, was associate professor of surgery at Harvard Medical School and held appointments in the cardiothoracic surgical divisions of Brigham and Women’s Hospital as well as a number of other Boston area hospitals. As a board-certified cardiothoracic surgeon, Wanamaker is qualified to operate on the heart, lungs and other chest
organs as well as do general surgery. Being Baystate’s first female cardiac surgeon is not a distinction that so much defines Wanamaker as adds to a resume that reflects years of hard work in the field of medicine where she started as a registered nurse after switching from earlier plans to be a math teacher. She holds two undergraduate degrees from Virginia’s Old Dominion University in Norfolk as a result of her switch, one in psychology and mathematics awarded in 1994 and the other in nursing awarded three years later. It is a passion for perfection in what she does that comes through when Wanamaker talks about her work and career path that includes being credentialed recently as a fellow of the American College of Surgeons. A 2008 graduate of Pittsburgh’s Drexel University College of Medicine who did her residency in general surgery at Allegheny General Hospital - Western Pennsylvania Hospital as well as a year’s research fellowship in cardiothoracic surgery there, Wanamaker went on to do a two-year residency in cardiothoracic surgery at Brigham and Women’s Hospital/Boston Children’s Hospital and then did a one- year fellowship in cardiac surgery at Brigham, a teaching affiliate of Harvard Medical School. Before coming to Baystate, she worked as a cardiothoracic surgeon as well as staff surgeon at Lehigh Valley Health Network Heart Institute in Allentown, Penn. “The Brigham fellowship was no doubt the highlight of my life,” said Wanamaker of
a hospital where the late Dr. Lawrence Cohn, a pioneer in cardiac surgery who trained many cardiac surgeons during a five-decade long career, served as chief of cardiac surgery. “It is such a polished, wellthought out, well-structured program with meaning every step of the way in the systematic manner in which they train you.” Cardiac conditions in many patients today may be addressed through catheter-based procedures performed by interventional cardiologists, while openheart surgery is required for other patients. For example, Wanamaker said such surgery, in which the chest is opened and the body placed on the heartlung bypass machine, may be recommended for younger patients needing a new aortic valve or those patients with coronary artery disease affecting a number of arteries or done to fix a structural defect in the heart as well as trauma to the heart. Wanamaker keeps a model of the heart in her office to help patients understand the surgeries she performs to improve blood flow to the heart muscle impeded by a blocked or weakened artery as well as replace, or repair, a heart valve that can no longer regulate proper blood flow through the organ. “By far, coronary artery bypass grafting is the most common procedure across the board in the field of cardiac surgery,” said Wanamaker of the frequency of the operations she performs. “The second most common would be aortic valve replacement for aortic stenosis and mitral valve repairs for mitral
regurgitation. I also do aneurysm repairs.” She adds, “There are also diseases like aortic dissections that need to be emergently repaired and which we also see a lot of.” A dissection, that is, a tear, in the inner most layer of the aorta, the body’s largest artery that begins at the top of the heart’s left ventricle, can create a “false” channel for blood flow and impact the heart’s output of blood. A dissection can be caused by a number of conditions including chronic high blood pressure as well as a pre-existing aortic aneurysm, that is, a bulge in the artery wall that could rupture. Baystate has a dedicated aneurysm clinic where patients are closely watched for aneurysmal disease in order to prevent such ruptures. Aortic dissection surgery often addresses tears in the wall of the ascending aorta that can affect coronary arteries supplying blood to the heart, which is life threatening. “Mortality for this condition is quite high without or without surgery,” Wanamaker said. “The goal of dissection repair is complete resection of the tear, replace the aorta with a tube graft and restore normal blood flow.” The patient is put on the heart-lung machine for this surgery and the heart stopped, but for a time the machine itself is stopped during this surgery as space is tight for suturing and clamping off blood flood. The solution, Wanamaker said, is to stop the bypass machine from pumping once the body is cooled down to “quite a low temperature” to allow
for the temporary suspension of blood flow while selectively allowing some blood flow to the brain. This protects the body from neurological injury and is known as “hypothermic circulatory arrest.” “Hypothermic circulatory arrest temporarily suspends blood flow under very cold body temperatures,” Wanamaker said. “At cold temperatures, cellular activity levels slow significantly so blood circulation can be stopped for up to 40 minutes without harm to the patient. This allows surgery to safely be performed on the aorta when clamping to contain blood flow that is not desirable.” She added, “We are expedient in opening up the aorta.” “We look for the tear, cut out an extended area, sew in a tube graft, and basically create a new aorta,” Wanamaker said. She added that if the echocardiogram shows the aortic valve is leaking “oftentimes we can preserve the valve by just resuspending it once the dissection is fixed as that is what causes the valve to leak in many cases.” Wanamaker said the heart-lung bypass machine’s complex circuitry allows for blood from the body to be replenished with oxygen and its temperature controlled under a team of specialists. “It incorporates an extracorporeal circuit to provide physiological support in which venous blood is drained to a reservoir, oxygenated and sent back to the body using a pump. A team effort among surgeon, perfusionist and anesthesiologist is paramount for the successful use of the
cardiopulmonary bypass,” Wanamaker said. “Basically, the de-oxygenated blood comes out of the heart’s right atrium, goes into this machine, circles around, enters into the oxygenator and then comes back out and goes into the aorta.” She adds, “I tell patients that the heart-lung machine allows me to operate on a bloodless, motionless heart.” “It keeps the rest of the organs rich with oxygen and nutrients,” Wanamaker said. “And we give a solution to protect the heart every 20 minutes so it is protected when the heart is stopped.” Wanamaker said she feels her childhood has helped her “feel comfortable” working in a field still dominated by men. “I grew up with three older brothers and a father who was a Marine who coached my brothers in sports,” Wanamaker said. “I was always around men in my life and I think that has helped me to feel comfortable in my skin around all the guys.” She credits her mom with developing in her an interest “to look at the details.” “I do operate as a perfectionist,” said Wanamaker, the first in her family to graduate college. “I am very precise when I am sewing during surgery and at the end of the operation I go back and look several times to make sure nothing is bleeding. I have a natural instinct in wanting to look at the details, the fine details, and I think that comes from my mother. She would coach me as a child in cheerleading and make sure I had all my moves perfectly right as well as doing SEE PERFECTION, PAGE D3