HeartBeats Episode 11: SW Florida’s Best Kept Secret

Host:

Welcome. I'm Cathy Murtagh-Schaffer and I'm your host for this episode of HeartBeats. This podcast is brought to you by Shipley Cardiothoracic Center, an educational series dedicated to providing our patients and the community with information and education about our cardiothoracic surgery program, Lee Health, and matters affecting your health. Today I have the great pleasure of talking with Armando Llechu, Chief Officer for Lee Health, Hospital Operations and Women and Children's Services, and Dr. Paul DiGiorgi, a leading cardiothoracic surgeon from Shipley Cardiothoracic Center. Today we're going to discuss the future of cardiothoracic surgery. Thank you gentlemen, for being here. Perhaps we can begin with you Armando, please tell our listeners a little bit about yourself and your responsibilities here at Lee Health.

Armando Llechu:

Hello everyone. So my name is Armonia Llechu and I serve as the Chief Officer of Hospital Operations and Women and Children's Services. I'm about to celebrate my fourth year here with Lee Health, and I have the responsibility for all the acute care services across our health system, which is 1,652 licensed beds. So we serve, Lee Health citizens, and we serve pediatrics for the region here in Southwest Florida. And so I've got the privilege of working with the cardiothoracic surgeons here at the Shipley Center. And my role with them is really as an enabler, I remove obstacles from their path so that they can take good care of our patients.

Host:

I bet you that makes them happy.

Armando Llechu:

some days.

Host:

Dr. DiGiorgi, can you share a little bit about yourself and your career as a surgeon?

Dr.DiGiorgi:

Well, my name is Paul DiGiorgi and I have been in Fort Myers since 2007, originally from New York, where I grew up, did my schooling and training that and in Connecticut and we, my wife and I moved down in 2007. And I've been here with this group ever since, right out of training. And we do a combination of heart and lung surgery, and really focus on optimizing patient care and kind of the overall patient experience. And then surgically on minimally invasive surgeries of the heart and lung, specifically lung cancer type surgeries, and heart surgeries, all types of adult heart surgeries really, atrial fibrillation, mitral valve disease, coronary bypass grafting, aneurysms and that includes a right chest minimally invasive cases. So avoiding sternotomy and also robotics.

Host:

Shipley has five outstanding cardiothoracic surgeons here at HealthPark and our Shipley surgeons offer our community some unique surgical approaches that aren't offered in too many other sites in the country. Dr. DiGiorgi, can you describe some of the innovative surgical approaches that Shipley has perfected? And is this why Cleveland Clinic is proposing to collaborate with our CT surgery team?

Dr.DiGiorgi:

Well, we have really focused on minimally invasive surgery, really since I got here, it's one of the reasons I was recruited. And so we have been able to develop our team and take minimally invasive surgery to places where most hospitals are not able to go. In fact, we do some minimal invasive surgeries, I know, they are not comfortable doing in Cleveland Clinic. So when we talk about minimally invasive surgery, we're talking about being able to do the same open-heart surgery you would have with a full open chest, but do it minimally invasive. We are not through a sternotomy, usually, going in between the ribs on the right side. That is really been our mainstay approach to probably half our hearts surgeries ,and complicated surgeries as well, high-risk surgeries, which is something we have in common clinic, for sure. So we serve as kind of a safety net hospital for our community, and we have the unique experience of doing that as the only hospital system in the county. Which is a little bit different than Cleveland Clinic, where they're a tertiary referral center where most patients are coming in off an airplane. We have to deal with the sickest of the sick who come in through the emergency room doors, it's is a distinct difference in how the hospitals run. But, one thing that I think we can learn from each other are some of the surgical techniques that we've each really kind of perfected over the years and also organizationally how our service line functions as opposed to how their service line functions. And what can we learn from each other for the service line developments.

Host:

Armando, what opportunities do you see arising from this type of expertise?

Armando Llechu:

The reality is that as healthcare continues to evolve, technology continues to evolve, technique, continues to evolve. It is specialization and outcomes that differentiates one program from another, and being blessed to have the team of surgeons that we have here at Shipley and the techniques that they have not only mastered, but demonstrated year over year, to have great outcomes, really helps us stand apart from the sea of cardiothoracic programs that exist not only in our region, but throughout the state. You know, as Dr. DiGiorgi mentioned patients travel for quality care, and it's important that the Florida community, the community in the Southeastern United States recognizes that we have quality care available here at the Shipley Cardiothoracic Center. And so I think that level of expertise really is something that we build on to attract patients, but also to attract talent, additional surgeons in the future, folks who want to work as part of a program like ours, whether it's scrubbing in in the, or serving as a Physician Assistant, people want to be associated with champions. And I feel like we have a team of champions here.

Host:

Yeah, I would agree with that.

Host:

There've been some recent changes in screening recommendations for lung cancer by the United States preventative task force, which has lowered the age of annual screening for lung cancer to adults with a smoking history to age 50, the 2013 recommendation was age 55, Dr. DiGiorgi, the lung cancer screening changes will ultimately identify more patients with early disease. Can you talk about Shipley's lung cancer treatment protocol and the close collaboration Shipley has with patients oncologist?

Dr.DiGiorgi:

So since the 1970s, when we started at, in Lee County as a CT surgery program, we've always had a grim relationship with the community physicians and even physicians outside of our community. And what has changed a lot for the medical physicians is the screening programs, especially in lung cancer. And so we work very closely with them, there are tumor boards, there are lung nodule conferences that we host, and it is important to work together because it's becoming more multidisciplinary all the time. Lung cancer screening really was a breakthrough to find these very deadly cancers at an early stage,with lung cancer kills more people from cancer than all the other cancers combined. So it's really a bad one and that's why there's been so much work on trying to find an effective protocol for screening. Now that we seem to have it, we're seeing more and more patients who are caught this way. Now we're still seeing the numerator, our office. These are suspicious nodules, but there are many patients getting screenings done now that the radiologists and the pulmonologist and oncologist are working together on. And we work with them when we reviews the cases as well, so it is the next big step towards reducing the mortality of lung cancer. There've been other breakthroughs as well in the medical arm treatment of lung cancer. But for advanced cases, the goal with any cancer is to catch it before it becomes advanced. And unfortunately, historically the average person was caught very late, which is why the global outcomes of all patients lung cancer is so horrible because the vast majority of those patients are found too late to be able to offer what is curative surgery. Surgery is the first line, if it is not too advanced. So we'll be able to impact a lot more lives, a lot more effectively with a good screening program, which now we've had for at least a few years.

Host:

Armando, from a system perspective, do the changes in screening protocols open up new opportunities?

Armando Llechu:

Absolutely, and if you consider that some individuals might say that screening patients earlier increases the cost of healthcare. When you think of what we're able to avoid an advanced disease and to Dr. DiGiorgi's point, what curative surgery can do for these patients and extending their lifespan, it's absolutely the right decision to make. And so if we can get patients identified early through, and we have a large network of physicians across all health. And so using these protocols, working with Dr. DiGiorgi, educating the community, helping individuals live the best lives that they can. That's a definitive game changer for our community here in Southwest Florida,

Host:

Shipley has built a great reputation around it's minimally invasive techniques, which include robotic mid cabs, right chest approach to valve replacement, transcatheter approaches to aortic dissection and valve replacement to name just a few. And as a cardiac center, Shipley also offers access to ECMO, Extra Corporeal Membrane Oxygenation, which is used to treat catastrophic shock after a heart attack. Impellas, which act as a miniature heart pump that are meant to provide pumping support to the heart as it recovers and even a vacuum that can suck off infectious growths on valves, Armando with all the advanced techniques and equipment.,what role do you see Shipley playing in the advancement of Lee Health?

Armando Llechu:

Well, we often talk about the cutting edge and the bleeding edge, right? And as early adopters, our surgeons have shown that we can bring this new technology here and have positive outcomes. We're not practicing on lives, we're saving them. And that's a real testament to the commitment of our surgeons to continue to master their trade, to continue to learn and advance, to not be stuck with what they trained with at some point in the past, but to stay on that leading edge. And so it creates a great opportunity for us to showcase and highlight number one, Lee Health's commitment to investing in our surgeons and in our community. And number two, the fact that we have surgeons here who are truly committed to being at the top of their profession. You'd say that you can't have a championship team without championship players, and so to stay on that theme, we've got championship players who continue to evolve their game to meet the needs of our community.

Host:

And I think what's really important in that concept is that that championship team pulls everyone all along with them that is associated with them. So our nursing staff, our perfusion staff, our OR staff, the championship team demands and requires that they come up to that level as well.

Armando Llechu:

Absolutely. And I often describe the healthcare setting to be similar to a finely tuned sports car. Every part matters and so if you said that our CT surgeons are the engines, our nurses are the transmission, we've got support service personnel that are working in the lab, in the pharmacy, in radiology, helping with diagnostics, procedural folks, tech folks, folks that are answering the phone, every single piece in part of that sports car matters because you wouldn't drive a car without brakes, or you wouldn't drive a car without wheels or without an ax or without a windshield, and so every piece important matters and so excellence begets excellence. And that's what you see in our team here at the Shipley Center. It is a team of excellent providers surrounded by excellent personnel, excellent caregivers, creating excellent outcomes.

Host:

Dr. DiGiorgi, tell us a little bit about the development of these programs that are unique and sets Shipley apart. What is the future for the expansion of CT? Surgery

Dr.DiGiorgi:

CT surgery is always expanding and we're constantly changing. And whenever you think you figured it out, it'll be different than next day, guaranteed. We do things now that I wouldn't have thought we would have been doing when I started here. So sometimes it's hard to say exactly what's going to become around the corner only to say that you're going to adapt to whatever the needs of the patient and the community are. Some of the bigger things that we've done recently is expanding our clinical research department. So we've really been running some pretty pivotal clinical trials, not just around surgery, but also around COVID-19 some other things. So because of our expertise with our research nurses, we've been helping out with the health system with that. Our transcatheter program continues to expand, with clinical trials and, the kinds of cases that we do to really offer a great adjunct to care some of the sickest patients who are really at the highest risk. Additionally, our atrial fibrillation program continues to expand with our coordination with the cardiologist. And that's a good example of the critical value of coordinating with your colleagues because that kind of disease process really demands looking at everything that's available to each patient, because they are also different, whether it's medicine and catheter based therapies or surgical based therapies, and they all compliment each other too. So we recognize that the best care of the patient is by collaboration. That's what we've been able to do. So we look to expand that. We're expanding philanthropically with the foundation. We just started The Shipley Scholars Program with FGCU's Biomedical Engineering Department, where we will sponsor our students to learn more about what's happening in the hospital and how we integrate a biomedical engineering department and university with our hospital. So we really try to hit everything that we can. We're expanding with personnel, we're expanding with operating rooms, we're expanding technology within those operating rooms. It parallels the expansion within the community. So we're never stopping, and we're constantly evolving

Host:

Shipley places, a lot of importance in its collaboration with their cardiology colleagues and atrial fibrillation, as you mentioned, is a great example of that. Atrial fibrillation affects two to 6 million people in the United States and has seen that. And we've seen that collaboration here at Lee Health grow, Shipley's very invested in the surgical treatment of atrial fib, which could ultimately prevent strokes, which are serious life-threatening consequences of untreated, afib Dr.DiGiorgi, can you tell us about the treatment of afib, how surgery fits in and how collaboration improves care? You briefly mentioned it just now, and I'd like you to elaborate a little bit more on that and are the results of, are there results that Shipley has had in impacting this disease?

Dr.DiGiorgi:

So atrial fibrillation is very common. It's an arrhythmia of the heart that causes congestive heart failure and stroke. And the older you get, the more likely it's going to happen to you. And the more likely you are to get a stroke from it, it accounts for the majority of strokes in patients over 80. It is relatively under-recognized because half the patients don't even know they have it as relatively undertreated because many of the newest technologies available for are not well known. Nor disseminated, except here we have basically all the new technologies you can use for atrial fibrillation. So we put together a program, we've run educational programs for patients and physicians in the community to go over these two programs in conjunction with the cardiologists and the surgeons, and really what it means to take care of those patients. In caring for a patient with atrial fibrillation really it's about getting a diagnosis first. It's about changing lifestyle from patients who are subject to being overweight or alcohol induced atrial fibrillation, or COPD or sleep apnea. So really we work on the lifestyle things first, and I've seen several patients where we actually send them for weight loss programs first, before we consider operating. Partly because I know that if they get their weight down, they may not have atrial fibrillation at all. But even if that doesn't happen, it still makes them lower risk for a surgical procedure. Really the treatment start with lifestyle changes in medicines. That's the main state, and that's what the vast majority of patients get. But beyond that, and patients have been tried on these kinds of therapies and they're not working and they're still symptomatic, then you start getting into the ablative therapies where actually the physician, whether it's a cardiologist or surgeon, creates an ablation line within the heart, which is basically just creating a scar line that effectively blocks the electrical impulses of this arrhythmia. Oftentimes patients start with a catheter based approach if they're caught early enough. But if they're caught late or it's more advanced or they've tried catheter ablations, and they still have symptoms after the catheter ablations, where they have structural heart disease with mitral valve regurgitation, which is a very common a valve problem with atrial fibrillation, then we need to go to the next level and the surgical ablation and treatment for it really is the most extensive comprehensive ablation available. And mainly because we're inside the heart and we can do a lot more with larger instruments than just a catheter, but that's called the MAZE procedure. And it is just another ablation, just like the cardiologists do with the catheters, but we're able to do more faster, and we can address any, any valve problems or any other problems with the heart at the same time. Additionally, we get rid of what's called left atrial appendage. That is a critical structure inside the heart that is the source of stroke in afib and in surgery, we can within a matter of seconds, essentially remove that from the circulation and patients risk for stroke is dramatically reduced, less than 1% in patients who over the course of the lifetime might have a 30% risk of stroke if they have atrial fibrillation. So it's dramatic and we've presented these results of our own patient cohorts at meetings. But it's been shown since the nineties really that there's surgical removal of left atrial appendage, however you do it has a dramatic impact on stroke. There are other devices for patients who can't get surgery, that can be done transcatheter, and that's the Watchman device, which, which we offer here as well. That is an effective FDA approved device for excluding left atrial appendage as well. Without the need for any incisions on the chest, you do need to have a blood before and afterwards for certain period of time. So, it's not a good choice for patients who have had severe bleeding complications leading up to this such as, intracranial hemorrhage or life-threatening GI bleeds. Where really gone back on a blood thinner for any amount of time could be life thretening. So, those are the patients that we typically see as well. So what we work in conjunctions because sometimes, the anatomy doesn't fit or because of scarring one, one procedure isn't as good to do versus another. So by having that collaboration with the cardiologists, you can evaluate patients together and say, okay, this is going to be the best, I think this is the best choice for this patient. And knowing that we offer everything is very helpful. We're not just trying to use one therapy for every single patient and make the patient fit the therapy, we have the therapy fit the patient needs.

Host:

Yeah, that is the advantage of having a large group and expertise in both cardiology and the thoracic surgery, cardiothoracic surgery, to be able to offer patients a treatment that fits them versus trying to fit the patient to the treatment as you said.

Dr.DiGiorgi:

And that really is important for any patient looking for any therapy, for any problem anywhere you really need to know all the options and you need to hopefully be at a center that has all those options available. So they're not trying to pigeonhole you to just what they're expert at.

Host:

Armando, how do we maximize Shipley's impact on atrial fibrillation within the community?

Armando Llechu:

Well, I think it starts with the relationship and the partnership with the cardiologists, the primary care physicians in the community. And then it goes on to an understanding for our patient population of the role that our cardiothoracic surgeons play in the treatment of atrial fibrillation. Dr.DiGiorgi said many of the treatment options have not been well, socialized are not well known, but they're here and they're available. And so figuring out how to get that message out because as GI Joe would say, knowing is half the battle. And so part of our lift is how do we help people to know what we can do, the role that we play and what options are really available? And it really comes down to how does the team collaborate to work together to help identify what the best course of treatment is for the patient, and then how do we in turn educate that patient about the availability of that? If the patient never walks through our door, they never get to understand how we can help. And so it all starts with helping to get the patient here.

Speaker 1:

And I would submit that part of that education is reaching out to primary cares and letting them know. I mean, even though we have a huge group of primary care physicians, I would venture to say that a lot of them probably are unaware of the abilities of Shipley's care of atrial fibrillation, or even some of the cardiology techniques.

Armando Llechu:

Yeah. You know, it's interesting because most of us are fairly humble. And so we don't spend a lot of time talking about ourselves, but it's in the telling of that story that we really get information into the hands of those who need it. Yeah. And so breaking out of the, putting your head down, grinding, taking care of patients, coming in, doing what you have to do and taking a moment to stop and say, hey here are the great things that we're doing and here's how they're impacting lives. It's, we're just conditioned not to, and we have to do a better job of telling our story.

Host:

I was at a donor dinner a couple of weeks ago with Dr. DiGiorgi and Dr. Hummel. And I overheard a couple of comments that stuck with me. One comment was how impressed they were, that Shipley was a guiding light for research in the system. And they were most impressed that Shipley had participated in the COVID-19 convalescent plasma study. I think they are so impressed because they understood the immediate impact on the community, even if it was kind of outside of Shipley's normal types of routines and studies. Dr. DiGiorgi, research has been a part of Shipley for a long time. Now, could you tell our listeners about the protocols Shipley is engaged in and how some of them have actually changed the way cardiac surgery patients are cared for?

Dr.DiGiorgi:

Well, we've been involved in many different studies, and it kind of spans, kind of everything that we do and everything that affects the patients that we care for, not just surgically. So we've done studies where we looked at different labs and medications for patients, that have actually impacted how we care for the patients throughout the hospital, specifically with regard to, kidney function and renal failure. So, we'd had, we have excellent results in that realm. And it's not something about, it's not really about suturing or doing surgery, but it was about caring for the patient. And it has spill over into many other areas, within the hospital. So the trials with that, we've worked with FGCU and the biomedical engineering students looking at innovative ways ofdoing surgery, and organizing surgery, in the hospital. We have been involved in many transcatheter trials, atrial fibrillation trials, the COVID-19 stuff, which you mentioned,and we've even helped out in developing better ways to care for patients with IV drug abuse and hopefully we'll never need surgery. So, you know, when you look at it holistically, you realize you're, you're trying to do things many, many, many ways to avoid patients needing surgery at all, or if they do need it, it's, it's a simpler version of it. So, you know, constantly looking at different ways of helping to take care of the patient. It isn't always just with a stitch and that's where the research comes in. We've also been able to partner with some of the bigger entities, besides FGCU, also Arthrex trials with Arthrex. And you wouldn't think sn orthopedic company parters withCT surgery, but, but those are the kinds of relations that we built because we look for people who are really kind of moving things within the community to help build a community in general, and to advance everyone.

Host:

The other comment that I heard, and this goes back to what you were mentioning, Armando three or four people who thought Shipley was Southwest Florida's best kept secret. And that's not the first time I've heard a comment like that. Again, from a system perspective, how do we expand Shipley branding within the community and even beyond?

Armando Llechu:

So healthcare, healthcare is an interesting, interesting industry. Well, when you go to a liquor store or Publix and you're perusing bottles of wine, oftentimes you're drawn to a label. If you look at craft beer, oftentimes you're drawn to the color of the can and the decal on the can. So most of the things that you acquire as a consumer have a mechanism to draw you in Apple, Samsung, they spend millions upon millions of dollars on advertising. Doritos, put people inside of vending machines. Yeah. Healthcare is different. You're not going to see very many commercials of Dr. DiGiorgi talking about atrial fibrillation or the most innovative cardiothoracic procedure that he's brought into the Shipley Center that his partners have brought in. That's not the way we work. And so the number one mechanism for advertising and healthcare is word of mouth happy patients, grateful patients. And we have plenty of those. And so I'd say that there is an army of former patients that are out there singing the praises of this team, but we do have an opportunity to leverage social media. We do have an opportunity like this podcast to leverage the skills and talents of our team, and really put ourselves out there because more often than not a patient will be searching for information about a program like ours when they need it, right. It's not too often when you're healthy and well that you're out researching, who has a great cardiothoracic surgical program. But when your primary care physician or your cardiologist or someone else says, Hey, there might be a problem. Most of us turn to Dr. Google. And so there's a lot of work underway with Dr. DiGiorgi, his partners, myself, our team, over in the marketing department, on how we make information about our services more available and really easier to digest so that when someone is looking to learn, we have resources available in, in terms that they understand to help them better know what we can do here. But I'd say that if we continue to care for patients, the way we are and continue to have the outcomes that we have, couple that with making a better effort at telling our story and then leveraging digital avenues, I think we're not going to be the best kept secret very long.

Host:

From our listeners point of view. I would bet that many of them don't realize in caring for surgical patients, you also need to understand their diabetes, their COPD, the obesity issues, and even mental health issues and the intense collaboration that occurs with other specialties during a patient's stay in the hospital. In fact, you could say that based on the community health needs assessment of 2020 for Lee County, that Shipley has tentacles that reach from the operating room into the community on the top 10 problems noted in that assessment, Dr. DiGiorgi, how do you see Shipley's role impacting the community

Dr.DiGiorgi:

We are surgeons who do surgery. So the patients that come into us are patients that are a small group of patients compared to the community. But it's so very large program, 1500 cases a year through our, through our department. But what's unique and what is special about CT surgery is, as you alluded to, when we see a patient for surgery, we have to evaluate everything. So everything that we, every patient we take care of is a reflection of every other medical problem, social problem in the community, hence the IV drug abuse program that we developed. So, we tend then to get involved in a lot of things because it affects our patients postoperatively and preoperatively, but whether it is diabetes care or a home health care or rehab centers or care of pulmonary patient, dieticians, weight loss centers, kidney doctors, we're involved in all of it because at some point we need them to help us take care of the patient. And so it puts us in a really unique position where we don't just take care of one thing. We take care of the whole patient, and you have to, because if you miss anything with these patients, there could be a deadly complication, whether it's neurological or orthopedic and everything in between, you can have big complications in cardiothoracic surgery. If you don't evaluate the patient completely. It is the reason why we are the only, program that actually admits the patient to our service/ surgical service when they come in for surgery and keeps them on our servers the entire time. Because we know that only our team's going to be able to assess that patient completely. And we don't give up responsibility to those post-op patients ever, when they're in the hospital with the exception of very unique cases, it is because of that, that we keep our skills up, we know all the different things that affect those patients. It really is our duty as their surgeon to make sure that we look after them completely and where we are captain of the ship, and we control everything that happens to them and they look to us, you know. What really defines CT surgery is that every one of those patients is in crisis mode. Everything we take care of in CT surgery is a life-threatening disease process, which is pretty unique. Everything that they come in, whether it's lung cancer or heart disease, it's likely gonna be their demise soon if we don't do something about it. So we become automatically their focal point rightfully so, because we know how to take care of it. And we know how to coordinate the team around us, to make sure that patients are getting the best care that they can.

Host:

Armando, as operations officer, how do the community metrics help you plan for Shipley initiatives?

Armando Llechu:

So there's no secret that the Southwest Florida community is growing at a rate much higher than the rest of the country. It's been publicized in several newspapers. It's been all over the internet, that two of our cities make the top eight cities for growth in the country. And the forecasted growth here is very high over the next 10 years. And so, as we consider the growth of our population, what continues to happen with the health overall of our population, because the prevalence of disease in many cases is not changing for the better, obesity is not being reduced as a factor, while smoking cessation programs have been around for decades there's still quite a bit of tobacco use and abuse. We're not seeing a real change in prevalence of heart disease or in prevalence of lung cancer. And so we have to factor in that as the community continues to grow, and as the community ages, there will be more patients requiring the service of our surgeons. And so given that there are a limited number of surgeons available in the country, we can't hire them all. And so it forces us to be more efficient with our operations, be more effective in how we partner with cardiologists and with primary care physicians in the community. So that we're getting patients here who need to be here, and aren't bringing patients in that don't. There is a commitment across the health to getting patients the right care in the right place at the right time. And we continue to work towards that, and the Shipley Center is no exception. And so we continue to grow our team. We continue to plan for the future, we just added our fifth surgeon two days ago. And so we, we have a forward looking approach to how we want to continue to manage the Shipley Center, because today is a foregone conclusion, and we're probably not going to change very much for tomorrow, but what do we look like as a team and as an institution three years, five years, 10 years from now, that's how I earn my paycheck. And that's where the conversations between the cardiothoracic surgery team and administration really get exciting and interesting, right? Cause that's the fun work. The work today is the meaningful work and the fun work is the work of tomorrow.

Host:

This has been a really great conversation. You guys. And before we go do either of you want to add anything,

Dr.DiGiorgi:

You know, I've been here almost 15 years and I have another 15 years left and it's been a great ride and it just gets better and better all the time. It gets better because we're able to do more for our patients all the time. And it gets better because we continue to build the most important asset we have in the building our team, to bring in excellent people who's had the same vision that we do. And as I see new faces coming on into our team, and I see the light in their eyes, the spark in their eye, and that they want to be part of our team and how excited they are to be doing hearts and lung surgery. It's really the younger generation of people that have come on recently. It's a great feeling, cause I know those are gonna be the patients who are gonna take care of me for 20 or 30 years. And those that those team members are really critical to us. So I'd say, you know, kind of handing off to the next generation is one of the most fulfilling things you can do as you get into your later on into your career. And you're not the junior person anymore. So, you know, we've talked about patients and refers and the community, but actually if you ask me, what's the most important part, what happens around here and my most important asset are my personnel, my team.

Host:

Armando, any last words?

Armando Llechu:

Sure. So, you know, my father once told me if you, if you do something you love, you'll never work a day in your life. And I have been blessed over the course of my career to work with some really amazing people. And the team here at Shipley is no exception. I can say without question that some of the best conversations I've had have been with Dr. DiGiorgi, some of the funnest moments I've had have happened in this conference room. And it's, it's really truly a blessing to work with this team and to be a part of what the Shipley Center is doing for Southwest Florida. Thank you for having me.

Host:

So glad you came. Thank you. So thank you for taking time to do this to both of you, cause I know how busy you both are until next time. I'm Cathy Murtagh-Schaffer, and this has been HeartBeats, Shipley Cardiothoracic Centers podcast dedicated to bringing research innovation and education to our patients and the community.