Dr. Lawrence Kanner, the chief of cardiology at Mount Sinai South Nassau in Oceanside, is leading the hospital’s cardiac unit into a new era as it embarks on a journey to perform open-heart surgery for the first time.
In a partnership with Mount Sinai Heart, which was ranked No. 6 nationally for cardiology and heart surgery by U.S. News & World Report, work is slated to begin in the spring on a new four-story addition that will include nine new operating suites specifically designed for open-heart surgery, pending health department approval.
This conversation has been edited for length and clarity.
What inspired you to focus your medical practice on the heart? The thing about cardiology is — especially procedural cardiology — is that not only can you get the immediate gratification of fixing something but you also frequently have long-term relationships. I don’t know why anyone would do anything else. I get the best of both worlds. I get to fix things and make people feel better right away.
Can you tell me about the advancements in preventing, detecting, and treating heart disease that you’ve seen? In the last 15 to 20 years, statins, the anticholesterol drugs, have had a huge effect on how we manage coronary disease. They have been demonstrated to show plaque regression so you can actually have blockages and then go on high doses of statin therapy, like Lipitor or Crestor, so that you can actually reverse coronary disease with medicines. In terms of intervention, much of the research has gone toward stents. They came out with drugs that were coated with a drug that inhibited the progression of scar tissue. The number of open-heart surgeries for bypass that are being done really tanked after that because many patients can be managed in the cath lab. In my area, defibrillators have made a huge difference. Twenty-five years ago patients died when they were outside of a heart attack. Many of those patients went on to have a sudden death afterwards. Now we have very well-established guidelines on how to approach a patient who has a weak heart muscle after a heart attack, and many of these patients get seen years after their defibrillator is put in.
What issues have you faced in ushering some of these advancements into practice? Sometimes there’s intolerance toward medications or patients’ ability to afford medications sometimes comes into play. In terms of device implantation for defibrillators, there are patients who are not good candidates based on the fact they have not been optimized on their medication. And there are still many people in the community who aren’t seeing doctors regularly.
What can the public do to mitigate their risk? The only thing that a person can’t do is change their genes. If you have early disease in your family, that’s one thing that can’t be changed. Smoking is No. 1. There’s nothing good that smoking does. Good control of diabetes is another one. Very aggressive control of sugar. Weight reduction, when appropriate. And making sure when you hit those adult years, 40 years-plus, that you’re seeing your primary care physician regularly.
How has the coronavirus pandemic impacted your work? We have a general feeling for how many heart attacks we see on a monthly basis and it kind of dropped off somewhat during Covid. And it’s not because Covid was protecting against getting a heart attack. Those people did not seek care.
Is there anything on the horizon that has you excited about how we treat patients next? The main thrust in our area now has been the management of atrial fibrillation. AFib is the most common heart rhythm disorder in the country and has certain morbidities associated with it. And one of the main growth areas has been ablation of aFib where we electrically isolate the areas of the heart that are causing atrial fibrillation.
Anything else you want to add? We’re going to be developing an open-heart program here at Mount Sinai South Nassau. In 2006 we were the first hospitals to do an angioplasty in a hospital that didn’t have cardiac surgery on-site. We were the first hospital in New York State to do that. The program then grew and we developed a very successful cardiology program. We don’t do open-heart surgery here yet. That is one of the technologies we’re going to be growing over the next several years under Mount Sinai Heart.