Venice-Ocala Heart Institute

Your Heart Our Hands

706 The Rialto, Venice, Florida 34285Phone: (941) 484-8004

Fax: (941) 484-8869www.VeniceOcalaHeart.com

Our WorkWorkingexclusivelywithVeniceRegionalMedicalCenter,thephysiciansoftheVenice-OcalaHeartInstitutecontinueto build a program and a team that provides the highest quality care using the most appropriate and latest technologies – including robotic surgery.ThisstandardofexcellencewasaffirmedasVeniceRegionalMedicalCenterhasbeencontinuallyrecognizedasa‘Top50CardiovascularProgram’nationally.Additionally,thehospitalitselfhasbeendesignatedasoneofthecountry’s‘Top50Hospitals’byThomsonReuters,anationallyrecognizedobjectivebusinessratingorganization.The goal of the Venice-Ocala Heart Institute is to draw upon the expertise of two specialties – cardiovascular surgery and anesthesia – and to deliver the best quality of care to the heart, lungs and vascular needs of the patient.We care for our patients as we would our own loved ones.

Your Cardiothoracic Team

Jonathan C. Fong, M.D., F.A.C.S.Cardiovascular, Thoracic & Vascular SurgeonDr.FongisamemberoftheAmericanBoardofSurgery,andiscertifiedbytheAmericanBoardofThoracicSurgery,theAmericanMedicalAssociation,theChristianMedicalandDentalAssociationandisafellowoftheAmericanCollegeofSurgeons.

Dr.FongwasalsotherecipientofthePatients’ChoiceAwardfromtheAmericanRegistry.

Mateo B. Dayo, III, M.D., M.B.A.Cardiovascular, Thoracic & Vascular SurgeonDr.DayoisBoardCertifiedbytheAmericanBoardofSurgeryandtheAmericanBoardofThoracicSurgery.Dr.DayowasalsotherecipientofthePatients’ChoiceAwardfromtheAmericanRegistry.

Jonathan Dreier, M.D., M.B.A.Cardiac, Vascular & Thoracic AnesthesiologistDr.DreierisBoardCertifiedinAnesthesiaandCriticalCareMedicineandisaFellowoftheAmericanCollegeofChestPhysicians.HehaswrittenmultiplejournalarticlesandbookchaptersintheareasofAnesthesia,CriticalCareandTrauma.



You have aCHOICE

when it comes to heart surgery.

Can your heartprogram say this?

“Your follow-up visits were most helpful and I am grateful thatyour expertise brought methrough this recent procedure.”

“Dr. Fong is the greatest.

He has given me mylife back.”

“It was a pleasure to see such a

well-run, efficient, yet very caring

group of health care providers perform

as a seamless team.”

“Dr. Dayo is wonderful! He isvery down to earth and great with patients. From the point of surgery to long after, he was excellent. Great experience!”

Choose your heart surgeon based on the facts.

• Voted in the top 1% of heart programs in Florida

• The area’s best success rates and patient outcomes

• The proven reputation of Dr. Fong and Dr. Dayo

Why not give yourself the bestchance at Venice-Ocala Heart Institute?

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the driveYour Heart | Our Hands

HOT TOPIC

MiniMally invasive Mitral valve surgery


The Venice-Ocala Heart Institute is proud to be one of the only local practices performing Minimally Invasive Mitral Valve surgery.

What does Minimally Invasive Valve surgery offer your patients? Less pain Shorter hospital stay Faster recovery and return to normal activity Less risk of complications Better cosmetic results Greater satisfaction



COULD YOUR PATIENTS BENEFIT?

IS YOUR PATIENT A CANDIDATE?Many patients are unaware that they have mitral regurgitation; however, symptoms most commonly identified with Mitral Valve Disease are fatigue, shortness of breath, decreased exercise capacity, and arrhythmias or atrial fibrillation.Indications Isolated mitral valve procedures The patient is seeking a minimally invasive option

Contraindications Ascending aortic dilation > 4 cm Severe aortic regurgitation Aneurysm of ascending aorta Aortic stent Grade II-IV aortic atheroma Otherwise contraindicated by CPB

Minimally invasive valve surgery enables cardiac surgeons to perform a wide range of minimally invasive procedures through small openings in the spaces between the ribs, eliminating the need for a full sternotomy.

Scar resulting from traditional open heart surgery.

Scar resulting fromminimally invasive mitralvalve surgery.

HOT TOPIC

MiniMally invasive Mitral valve surgery


The Venice-Ocala Heart Institute began its work in thoracic and vascular surgery in 2003. Working in complete cooperation, exclusively with Venice Regional Medical Center, the physicians continue to build a program that provides the highest quality care using the most appropriate and latest technologies.This approach to delivering care was affirmed as Venice Regional Medical Center has beencontinually recognized as a Top 50 Cardiovascular Program nationally.

Additionally, Venice Regional Medical Center itself has been designated as a Top 50 Hospital by Thomson

Reuters, a nationally recognized objective business rating organization.The goal of the Venice-Ocala Heart Institute is to draw upon the expertise of two specialties – cardiovascular surgery and anesthesia, and to deliver the best quality of cardiothoracic and vascular care to the heart, lungs and vascular needs of the patient.



How is it done?As with other minimally invasive procedures, our expert surgeons complete the valve repair or replacement technique through much smaller surgical incisions than the larger incision needed for open-chest surgery.Two to three small incisions are made between the ribs.Muscles in the area are divided in order to reach the heart.A small cut is then made in the left side of the heart to gain access to the mitral valve.

OUR COMMITMENT TO YOUR PATIENTSThe Venice-Ocala Heart Institute’s commitment to continued training in advanced surgical technologies and patient care make it possible for us to bring the benefits of minimally invasive valve surgery to your patients. We share a common goal: to provide your patients with the best possible treatment and the best possible results.

Mitral Valve Disease

Caring for the Whole Patient


Venice-Ocala Heart Institute offers a full-range of surgical interventions for those in need of heart surgery, lung surgery and peripheral vascular disease treatment, including cancer patients. We are proud to offer patients and providers the most up-to-date and advanced techniques, including a growing number of minimally invasive and robotic surgery options. Before, during and after surgery, patients are cared for in close collaboration with cardiologists, pulmonologists, oncologists and other internal medicine physicians. From tumors and blockages, to leaks, atrial fibrillation and much more, Venice-Ocala Heart Institute represents a full-service cardiovascular and thoracic surgery team with broad capabilities.

We perform a wide variety of cardiac, vascular and thoracic procedures:



No Case is Too ToughWe have experienced an increase in acute emergent aortic patients, elderly patients, and other challenging cases. Though

they are associated with greater risk, we have welcomed the challenges of these very complex patients. Despite this difficult caseload, our mortality has remained low, due in part to our

dedicated team and philosophy of treating the whole patient – providing the best care possible.

Full range of thoracic surgery including: •DaVinciroboticlungsurgery •Aorticaneurysmsurgery •Minimallyinvasivelobectomy for lung cancer •Pleurxcatheterplacement

Full range of vascular surgery including: •Surgicalrepairofthecarotidsand other major arteries •Carotidendarterectomy •Angioplastyandstentplacementof the peripheral arteries •Peripheralarterybypasssurgery oftheleg •Endovascularaneurysmrepair (EVAR) •Thoracicaneurismrepair(TEVAR)

Full range of cardiac surgery including: •DaVinciroboticheartsurgery •On-andoff-pump(onthebeatingheart) coronary artery bypass •Minimallyinvasivevalverepairandreplacement •Atrialfibrillationsurgery(MAZEprocedure) •Pacemakerplacement,includingAICD andBI-VAICD •Pericardialwindow(SubxyphoidPericardiostomy) •Dorprocedure •Transcatheteraorticvalvereplacement(TAVR) •ASDrepair •VSDrepair

•Thoracotomy•Decortication•Pneumonectomy

he Maze Procedure is a com-plex heart surgery performed to

treat chronic atrial �brillation, a form of arrhythmia in which the

atria quiver instead of beating e�ec-tively. While there are several variations of atrial �brillation, each with di�erent causes, they all involve irregularities in the transmission of electrical impulses through the heart. Maze heart surgery is performed to control the patient’s irregular heartbeat and restore the heart’s normal rhythm. CREATING THE MAZE�e Maze Procedure involves the creation of lesions in both atria. When these heal, scar tissue forms and prevents the abnormal electrical impulses from passing through the heart. �e Maze Procedure essentially works by creating barriers that the electrical signals cannot cross. In so doing, it improves all the major issues associated with atrial �brillation. It stops the atrial arrhythmia, restores normal rhythm between the atria and the ventricles, as well as maintains the atria’s ability to contract on its own. �ere are two forms of the Maze Procedure: open-chest and minimally-invasive. At Venice-Ocala Heart Institute, we perform both forms of the procedure. Open-chest maze procedure involves the division of the sternum to allow access to the heart. During this proce-dure, the heart is stopped and a heart-lung machine is used.


Fax: (941) 484-8869www.VeniceOcalaHeart .com

Your Heart | Our Hands

�ere are two variations of the open-chest form:

Cox-Maze III involves making incisions in the atria in an intricate pattern resembling a maze. �ese are immediately sutured and scar tissue forms as they heal. Cox-Maze IV, or surgical ablation, involves the use of radiofrequency, cryo, ultrasound or microwave energy to create the scar tissue instead of creating incisions in the heart tissue.

�e open-chest form of the Maze Procedure is often done in conjunction with other heart procedures, such as bypass surgery and valve repair. Minimally-invasive maze surgery is performed through small keyhole incisions created between the ribs. �is form of the surgery eliminates the division of the sternum, does not require the heart to be stopped, nor a heart-lung machine to be used. �is often results in shorter recovery time and a lower risk of infection associated with open-heart surgery. During the procedure, a tiny camera is guided inside the chest, where energy-based techniques are aimed at precise areas in the heart tissue, creating lesions that interrupt the paths of the abnormal impulses that cause atrial �brillation. We would determine the best treat-ment option for a patient based on a thorough evaluation and the e�ective-ness of other treatments that have previously been used to treat the atrial �brillation.

CASE STUDY

MAZE PROCEDURE

RESULTS

�e Maze Procedure has good long-term results. �ese include:

Correction of atrial �brillation in most patients

Restored regular, coordinated heartbeat

Reduction in the need for long-term use of blood-thinning medications

Lowered risk of developing blood clots and having a stroke

Decrease in symptoms, such as fainting or near-fainting

CASE STUDY

ConComitant Carotid Coronaryartery disease with aortiC ValVe stenosis


What is the best methodfor surgical correction? When evaluating the clinical problem, a surgeon should consider which entity is the more symptomatic.

Patient background:76-year-old male

Bilateral bruits and a systolic ejection murmur

Ultrasound evaluation reveals greater than 95% stenoses in both carotid arteries

ECHO demonstrates aortic stenosis with valve area of 0.7 cm2

Patient has symptoms consistent with TIA

Catheterization reveals left main disease of 70% with tandem 90% lesion in the LAD circumflex distributions with moderately depressed ejection fraction of 40%

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Our plan for surgery: We chose to first perform an endarterectomy to the patient’s dominant side and then stage the patient with coronary bypass +/- valve surgery during the same admission. On the other hand, if the patient’s ischemic condition warrants proceeding with revascularization, first our team is cognizant of the need for higher perfusion pressures while on the heart lung machine to provide as much cerebral protection as possible. We also utilize cerebral oximetry to evaluate oxygen saturation levels in the brain. This allows us to monitor and adjust measures to secure adequate perfusion throughout either case.



what if he was your patient?

The Venice-Ocala Heart Institute Difference:Since we perform both cardiac and vascular procedures on patients who are older and more complex than the average patient, we hope to provide you with a resource to obtain the best surgical care possible for your patients.

Patient follow-up and recoveryAfter undergoing a carotid endarterectomy, the patient then underwent aortic valve replacement and another operation on the opposite carotid over an eight-week period. After a four-week recovery, the patient is doing well.

HOT TOPIC

The doctors at the Venice Ocala Heart Institute are welcoming the da Vinci® “robot” through

their doors as a new way to reach their patients’ hearts.

The da Vinci® Surgical System has been hailed as a cutting-edge new tool to perform surgery. Its sophisticated robotic platform is designed to expand a surgeon’s capabilities – and for the first time – offer a minimally-invasive option for major surgery.

With the introduction of the da Vinci®, and rigorous hands-on training, doctors at the Venice Ocala Heart Institute can now perform some of the same intricate heart surgeries for certain surgical candidates while reducing patient morbidity.

The da Vinci® provides surgeons and patients with what may be the most effective, least invasive treatment option for even the most intricate cardiothoracic procedures. The da Vinci® allows for open heart surgery without opening the sternum. In many cases da Vinci® leaves patients with only three small dime-size scars.

How does it work?With da Vinci®, small incisions are

used to introduce miniaturized wristed instruments called EndoWrists. The surgeon directs the “robotic” surgical instruments at all times while watching a 3D image of the surgical area and manipulating the da Vinci’s® robot arms from a console.

The state-of-the-art robotic and computer technologies scale, filter and seamlessly translate the surgeon’s hand movements into precise micro-movements of the da Vinci® instruments.

The da Vinci® System requires that every surgical maneuver be performed with direct input from the surgeon. It enables the surgeon to perform even the most intricate procedures with unmatched precision through very small incisions. Even the smallest or most precise movements of the hand controls on the console are transmitted to the instruments inside the patient’s heart in real time.

da Vinci® and tHe HeartPatients suffering from a variety of heart conditions may benefit from a da Vinci® assisted surgery at the Venice Ocala Heart Institute. da Vinci® Surgery is used in common cardiothoracic conditions such as: • Coronary Artery Disease • Mitral Valve Prolapse • Lung Cancer

surgical robotics and responsibilitySurgeons at the Venice Ocala Heart Institute are committed to the responsible introduction of the da Vinci® Surgical System and have completed a comprehensive training program to support the successful use of the system. They are looking forward to extending the benefits of a da Vinci surgery to your patients.

da Vinci® Surgical SyStem

benefits The potential benefits of da Vinci® cardiothoracic surgery are: • Reduced risk of infection • Less blood loss and need for blood transfusions • Shorter hospital stay • Less pain and scarring • Faster recovery and return to normal activities




YOUR TRUSTED ANESTHESIOLOGIST, DR. JONATHAN DREIER


Why Dr. Dreier?Dr. Dreier is Board-Certified in Anesthesia, Critical Care Medicine and Echocardiography. As a part of the well-rounded team of cardiothoracic surgeons at theVenice-Ocala Heart Institute, Dr. Dreier is exclusively dedicated to the care of cardiovascular and thoracic patients. Dr. Dreier makes it a priority to include a patient’s physician in the surgical process before, during and after an operation. High-risk cardiovascular and thoracic patients have special needs when it comes to administering anesthesia and Dr. Dreier is specifically trained to care for these types of patients.Whether a patient is scheduled for a pacemaker insertion or the most complex cardiovascular surgery, we ensure he or she will receive the most thorough care possible. You can enjoy being involved in your patient’s care with our true team approach. Dr. Dreier has the ability to call you and discuss perioperative echo findings. We feel you are not just sending a patient to us – you are entrusting us with their care and we welcome your involvement every step of the way.



The Venice-Ocala Heart Institute began its work in thoracic and vascular surgery in 2003. Working in complete cooperation with Venice Regional Medical Center, the physicians continue to build a program that provides the highest quality care using the most appropriate and latest technologies.This approach to delivering care was affirmed as Venice Regional Medical Center has been continually recognized as a ‘Top 50’ Cardiovascular program nationally. Additionally, the hospital itself has been designated one of the nation’s ‘Top 50’ Hospitals by Thomson Reuters, a nationally recognized objective business rating organization.

The goal of the Venice-Ocala Heart Institute is to draw upon the expertise of two specialties – cardiovascular surgery and anesthesia, and to deliver the best quality of cardiothoracic and

vascular care to the heart, lungs and vascular needs of the patient.

Jonathan Dreier,M.D., M.B.A. AnesthesiologistDr. Dreier earned his Bachelor of Science in molecular biology

and microbiology and a Master of Business Administration from the University of Central Florida. He received his Doctor of Medicine degree from the University of South Florida College of Medicine. He completed his residency in Anesthesia with subspecialty training in Cardiovascular Anesthesia at the University of South Florida. He also completed a fellowship in Critical Care Medicine. He is a Fellow of the American College of Chest Physicians and has written multiple journal articles and book chapters in the areas of Anesthesia, Critical Care and Trauma.

Documents

Venice-Ocala Heart Institute