February 20, 2013
Host: Ted Simons
The Latest Procedure: 30th Anniversary
- In 1983, Channel 8 broke broadcasting ground by airing an open-heart surgery performed by local surgeon Dr. Ted Diethrich of the Arizona Heart Center. Join Dr. Diethrich; former Producer Dr. Richard D’Alli; and director Jeff Hallberg as they look back at the surgery production and talk about its 30th anniversary.
- Join Dr. Diethrich
- Dr. Richard D’Alli - Former Producer
- Jeff Hallberg - Director
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Ted Simons: Good evening. Welcome to "Arizona Horizon." I'm Ted Simons. The year was 1983. Ronald Reagan was president, the big chill was the big hit movie, and a swatch the latest fashion accessory. It was also the year channel 8 broke ground with the airing of the first open heart surgery. Dr. Diethrich performed the procedure. Science editor Richard Dalli, now a medical doctor himself, co-hosted the show and Jeff Halberg now the production services manager at channel 8 directed the live broadcast. We should note that there are graphic surgery scenes we will show during the interview. How did this get started?
Dr. Diethrich: Well, I think we were approached from somebody from ASU because that was the source of this at the beginning, and the idea was very small. It was just to maybe show an operation, show part of an operation, and the purpose was to in my mind was to educate the public because I always had this idea that if a patient or potential patient had knowledge about the procedure and if they could see the procedure and be assured that it was something that was correct and easy and so that's how we went about this. The thing is, though, it exploded beyond my ever thinking it would be so great. I was flying back from Chicago and I had this idea with Dick Williams, who was our DAS producer then. I said to Dick, you know, we're putting a lot of effort into this. Folks put a lot of effort into this, and where are we going to show this? The idea was local, whatever the local audience was. It turned out at the time of the operation people in London could have been having their afternoon tea and see this operation live. And afterwards, I always travel a lot around the world, and every place I went people said, hey, I saw it on TV. However you guys' range is, it certainly went way beyond the valley of the sun.
Ted Simons: was that the idea? Dr. Diethrich mentions education. Was that the idea and how did that turned out?
Richard D’Alli: That's exactly right. The genius behind this was a fellow general manager of Kaet at the time, Chuck Allen. He has been called I believe a Maverick of sorts. He was an absolute genius. It was his desire, his goal, motivation that this be a true educational experience that people who were facing this operation and it was, you know, proliferating widely across the states, could get a sense of what it was going to be like, what it entailed, what it meant that the out comes were often fantastic, as Dr. Diethrich's patient was. I think it turned out exactly that way. I believe the reason people in London and everyone else saw it, Jeff can speak to this, it was sent up to the PBS satellite and I believe repeated several times. I had a friend in Israel who said, I saw you on TV. I thought, how did you do that?
Jeff Hallberg: It just evolved. We were going to do this show and it was going to be local. Then we started thinking about it and made the decision to put it up to the network and see if they would go for it. Many cities decided that they would run it and a number of them decided, no, that's too weird for us. We're not interested in that. But it ran in I forget the exact number, but like 90 cities or something. A big number of the PBS affiliates took it.
Ted Simons: In preparing for the broadcast, obviously television shows are blocked and there's scheduling. Pre-planning production. We're talking heart surgery. What kind of planning was done here?
Jeff Hallberg: A lot. A whole lot. From my side of the street hi to figure out how we were going to shoot this and what needs to be covered. I talked to the doctor and the hospital, and I made arrangements to sit in on several open heart procedures. Stand in there by the table and watch what they do and learned the movements and talked to everyone, figured out what's important, what can we show, what shouldn't we show. Kind of a thing. Where can the cameras go, just the whole thing. The whole flow of what's going to tell this story. What's going to make sense to your audience. What is the flow in the operating room. Try to make sense of this. we had to make those decisions. There's a lot that had to be done.
Ted Simons: Okay. I want to show a quick excerpt from shot. This is the first view of the heart. This is from 1983. This is live television. The first view of a heart being operated on.
Dr. Diethrich: This is the first view you have of the heart. We'll open it a little more. You can splays a silk suture along the pericardial sac and it will give us a good view here of the ascending aorta. This comes from the left side of the heart and supplies the blood through the entire body.
Ted Simons: Doctor, when you're doing that -- it's amazing. You're speaking, you're performing. You know you're on television. Did the fact that you knew this was going out on live television, did that ever enter into your minds or was this just another procedure?
Dr. Diethrich: Well, I guess had entered my minds somewhat, but I grew up in my early training years with Dr. Debakey and Dr. Cooley, in Houston, Texas. They were excellent in terms of producing movies that were teaching movies. So what you saw there, I was doing the procedure, I was talking about it, but I didn't hesitate anything because it was just part of the maneuvers that you were doing. When I came from college ever medicine started the heart institute in '71 I had a lot of experience in these kinds of productions.
Ted Simons: As far as being one of the co-hosts of the program your job was to help explain what was going on along with the doctor in the surgery room.
Richard D’Alli: I jokingly refer to as the color commentator. I was the John Madden back then. We had two folks on society, myself as the science editor, we also had Sam KEINERT, a wonderful cardiologist, part of the team. The two of us held as best we could in times when Dr. Diethrich was doing something particularly difficult and was talking. You asked Jeff what went into the preparation, and one of the other I think absolutely terrific educational things that Chuck Allen had me do was to prepare the audience ahead of time. We went out and did a number of stories that we showed on "Horizon," science segments on cardiology. Everything from Barry Goldwater's operation, he had a bypass graft.
Jeff Hallberg: keeping in touch with your heart month. We did that whole special. February was keeping in touch with your heart. We did stories about heart stuff all month long. This was the culmination.
Richard D’Alli: We led up to it with a number of stories.
Ted Simons: Well, you mentioned that leading up to it in that respect, yet we just saw a beating heart on our screen. You saw it 30 years ago. Some folks this is a little squeamish, tough to take. Was it difficult for you as a director? How about the crew? Did anyone get squeamish?
Jeff Hallberg: We had some -- it didn't bother me at all. I'm totally into this stuff. It's very fascinating to me. I don't have a problem with it. I went into the operating room a lot and stood there, tell me about that. What's that? Fascinating stuff. We had some crew members that they did okay but they struggled with parts of the show.
Ted Simons: Let's go ahead and take another quick look. This is now when you found the blocked artery and told the audience, this is basically what you were here for.
Dr. Diethrich: What we're doing now, we have found a main artery that was blocked. We have also found a posterior descending coming off the circoflex. We'll bypass those two, do a jump graph from one to the other.
Ted Simons: Doctor, when you first watched the completed program on tape afterwards, what were your thoughts?
Dr. Diethrich: Well, first of all I had to compliment the team. There's no blood. Did you notice there's the blue towels, draping and everything. That doesn't just happen. We had a wonderful operating support team, the scrub nurses, circulating people, so forth. They helped make this a smooth -- I used to say that let's make the operation like a symphony. Like a symphony orchestra. That's what we tried to do. When I saw this I was very proud this number of years ago that team could perform that way.
Ted Simons: when you see this now, Rick, the first time you sat down and watched the tape, they used tape in those days, what were your thoughts?
Richard D’Alli: Again, you see a human heart beating. You say to yourself, it's a miracle. It's a miracle. All the technology, all of what we do in medicine. Yet it's still -- it still haunts us. This is what we are really all about. This is humanity. This is a beating, living organism.
Ted Simons: Jeff, when you look at it now, think about it back then, first were there any surprises during the broadcast?
Jeff Hallberg: One surprise for me in the production truck. I don't think there are any surprises in the surgery. Everything went very smooth. But one surprise for me that happened was we're right in the middle of the program, and I'm in the production truck in the parking lot of St. Joe's hospital calling the shots. We're doing our work and I'm right by the door of the truck. It opens up and I look out and it's the newspaper photographer a flash cube goes off in my face. I said, thank you and closed the door. Now I have a big purple spot in my field of vision for the next two minutes. It was very hard to see the monitors. That was a surprise.
Ted Simons: That is a surprise.
Jeff Hallberg: there could have been many but everything else went very smooth.
Ted Simons: let's take another quick excerpt from the show. This is a final shot of the finished bypass.
Dr. Diethrich: We might want to show one good final shot. Dick Williams is our overhead photographer on the boom. Dick, you might want to come down on the heart one time so our viewers can see how beautiful the heart is, the beautiful color, the function as these bypass graphs are working very satisfactorily bringing new blood Bo the heart muscle.
Ted Simons: just amazing stuff. Doctor, last question for you, what kind of reaction did you get from this?
Dr. Diethrich: Not so good. It was the first time that this had ever been done in the world, and you could imagine that physicians, cardiacs surgeons, wrote editorials. They thought it was a totally inappropriate thing to do. It was risky. It didn't -- it didn't do anything positive for our profession, for cardiac surgery. So wherever I went, for some period of time, I was sort of challenged that why would you do this. I kept coming back with the same response. I did this because unless we physicians take the responsibility of educating the public about what we're doing and how we can prevent these kinds of disease which we have worked on for so many years then we're being irresponsible. I didn't think doing the procedure was irresponsible at all.
Ted Simons: That's a surprising reaction.
Richard D’Alli: surprising but consider the source. These were colleagues or other physicians who for some reason I don't know whether they were threatened by what Dr. Diethrich did or what the motivation was but I can tell you anecdotally what about the response from viewers? It was sensational. Letter after letter that came in, for example, to me saying how wonderful, how courageous. How fascinating. How absolutely important it was that we did this.
Ted Simons: Jeff, when you look back, memories of this particular production, what do you got?
Jeff Hallberg: Very proud. Just an amazing, amazing process. Learned a lot. You know, again, the whole reason we did this was to educate people and our audience and to just quash any fears. People -- this is such a common procedure. It even was back then. If you're thinking about having it, they show it on TV. You know, don't be afraid. It's okay. Go ahead and talk to your doctor and see if this is going to work for you. Very proud.
Ted Simons: gentlemen, congratulations on the 30th anniversary. It's a tremendous achievement and tremendous milestone at channel 8. Thank you for joining us.
Richard D’Alli: Our pleasure.
Dr. Diethrich: Thank you.
The Latest Procedure: TAVR
- Dr. David Rizik will discuss Transcatheter Aortic Valve Replacement, a non-surgical approach to treating aortic valve stenosis, a narrowing of the aortic valve.
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Ted Simons: After the 1983 heart operation broadcast channel 88 continued to feature medical procedures with special programs on hip and knee replacement surgery. That tradition continues with a new medical series titled the latest procedure co-produced by Kaet with Chris Wooley of VAS communications and Wayne Dickmann of even keel productions. It showcases a nonsurgical procedure to fix narrowing of the aortic heart valve. Dr. Rizik is medical director for Scottsdale health care. Thanks for being here. 30 years ago that was quite an event.
Dr. Rizik: I'm humbled to be sharing the studio with the doctor. You're talking about one of the pioneers of the last 30 years. My first live case I did as part of his meeting. He gave me a chance to do a live case when I was right out of training and two things happened that day. First I got bit by the bug, that teaching education bug that he instills in everyone, but I got to do that live case with Denton Cooley, a world famous heart surgeon, standing over me. I got to say I think I was sweating a little bit that day.
Ted Simons: you're not sweating during this production. Let's get to T. trance catheter aortic valve catheter. What is this?
Dr. Rizik: Historically a blocking of the valve that leads out of the heart, think of the aortic valve as a one-way door out of the heart. Traditional way, the time honored way of treating this is with open heart surgery. Open heart surgery not dissimilar to what you just saw, but a lot of patients who are elderly, frail, have a number of other comorbid diagnoses, may not ab Anderson indicate for such an invasive procedure. Now we have a trance catheter aortic valve replacement which is geared toward elderly, frail patients. Patients who may not be candidates for surgical valve replacement. They too can have their valve replaced. It's a minimally invasive way of accomplishing the same thing.
Ted Simons: take us through this, the idea that a new valve was carried inside a catheter? A small incision is made and we go from there?
Dr. Rizik: That's right. It's mounted on a balloon similar to stents for coronary arteries although it's larger in profile. It's mounted on a balloon. We go in much the same way as we perform angioplasty through a minimally invasive incision in the femoral artery in the grown or thigh area, thin this is passed up to the heart and is implanted. The balloon is inflated, deflated, retreated and the valve is in place.
Ted Simons: No saw, no scalpel.
Dr. Rizik: no saw, minimal scalpel.
Ted Simons: no chest spreaders, though.
Dr. Rizik: no chest spreaders.
Ted Simons: Where did this technology come from?
Dr. Rizik: About ten years ago, some very forward thinking interventional cardiologists, scientists, researchers began to develop the concept of a catheter based valve replacement. At that time, not dissimilar to what Dr. Diethrich just said, there were a lot of naysayers. You're cowboys, showoffs. This will never work. Somewhere around five or six years ago, they began these researchers to show proof of concept. Now this is approved in over 50 countries around the world including the United States.
Ted Simons: What kind of recovery time are we talking about now as opposed to recovery time ten, 10, 30 years ago?
Dr. Rizik: When you think about traditional surgical valve replacement you're talking from five to ten days in the hospital. We generally send these patients home within 48, maybe 72 hours of the procedure. You're talking about okay to Jen aryans. These are not young, healthy patients, necessarily, these are older patients to. Get them home in 48 or 72 hours is an amazing achievement.
Ted Simons: the heart valve, what is it made of?
Dr. Rizik: It's a stainless steel cage now a cobalt chromium cage so it's attached to this stainless steel or cobalt chromium framework and it's crimped on a balloon and then taken up to the old valve, the diseased valve, and implanted there.
Ted Simons: What follow-up is required?
Dr. Rizik: Generally we see them the next morning and for several days after, but then they go home and routine follow-up in the office, we usually see patients a week or two later. We get an ultrasound of their heart a sound wave test to make sure it's functioning, but we have had tremendous success with this new technology.
Ted Simons: as far as the program is concerned, I asked Dr. Diethrich, he was prepared, he was, obviously, everyone seemed well prepared foregoing on live television for the first time with open heart surgery, but knowing that you're on television, knowing you're being taped and you have a relatively complicated procedure here, do you get nervous?
Dr. Rizik: Not at all. One of the keys is teamwork. We have a team. While I was flattered to be the voice of this procedure, we do have a team of multiple doctors who work on this. But we are used to having the camera on us. We do a lot of teaching cases. And we do a lot of live telecasts mostly for physicians. This was really just another day at work with cameras in the room. Our first focus we concentrate mainly on the patient, but we have cameras and we're used to talking and teaching during our cases, so it want that much different.
Ted Simons: education the primary focus 30 years ago. Still today?
Dr. Rizik: Absolutely. The key to what we do is education. None of us learned these procedures by reading them out of a book. Somewhere along the line we had to see these cases being performed live. Dr. Diethrich talked about educating the public. I believe he's right on the money with that. This really demystify was we do and educate the public. It's a perfect forum for education.
Ted Simons: with all this in mind, we just saw what happened 30 years ago, we're going to see what happens today. Where does heart surgery, where -- treating conditions of the heart, where do we go from here?
Dr. Rizik: There are no limits. If you think that in ten years we took a concept, drawings, all the way through FDA approval and approval through agencies all over the world, over 50 countries, to think in ten years that's what we have achieved and we're learning this and advancing the technology on the oldest, sickest, most frail patients, there's no limit to what we can do in heart and vascular medicine.
Ted Simons: no limit apparently for the technology as well.
Dr. Rizik: absolutely true.
Ted Simons: you think something big will happen soon or is this something that develops over time?
Dr. Rizik: I think that we see these things develop over time. Ten years ago is an awfully short period of time to have developed this, but I think we'll see more and more cardiovascular miracles occurring every year. It's really a fantastic time to be in heart and vascular medicine.
Ted Simons: what do you want viewers to take from the broadcast of the latest procedure?
Dr. Rizik: I think the main thing is that we are pushing the envelope in terms of our ability to treat sick patients with heart and vascular medicine. I think the important thing is that they see their physicians if they are not feeling right, if they are having symptoms. We're treat ago lot more of these untreatable diagnosis today than a decade ago.
Ted Simons: doctor, thank you for joining us. We appreciate it.
Dr. Rizik: great to be here.
Ted Simons: And that is it for now. I'm Ted Simons. Thank you so much for joining us. You have a great evening.