At 68, Elliott Landman was accustomed to creating transformations for other people.

An architectural designer who has spent decades helping clients reimagine their homes, the longtime Boca Raton resident describes himself as energetic, optimistic and passionate about his work and family. He was undergoing his own personal transformation, too—losing 50 pounds and eating healthier—and says he generally felt well.

So when a cardiac evaluation revealed severe coronary artery disease—including arteries that were 97 percent and 100 percent blocked—the findings were startling.

“The silly part is, I never felt bad before,” Mr. Landman says. “I didn’t have any symptoms.”

He had occasionally noticed some chest tightness but attributed it to the stress of running his business. Heart disease, however, was already familiar territory. Mr. Landman had previously undergone coronary stenting and had a strong family history of cardiovascular disease.

This time, another stent wasn’t going to solve his problems.

His evaluation showed critical disease in three major coronary arteries, including a 100 percent blockage in the vessel supplying the back of his heart. For a durable solution, Mr. Landman would need triple coronary artery bypass surgery.

He was referred to Bradley Taylor, M.D., chief medical executive at Christine E. Lynn Heart & Vascular Institute and chief of cardiac surgery for the Palm Beach Region with Baptist Health Heart & Vascular Care.

Mr. Landman had initially scheduled consultations with six surgeons. After meeting Dr. Taylor, he canceled the other five.

“He dug into my heart in a different way. He got into my soul and I just immediately felt super comfortable with him,” Mr. Landman says. “It was probably the best decision that I ever made because when you’re in the hands of somebody, they have to have more than the skills. They have to have kindness and they have to be humble.”

Three Blocked Arteries—and a Complex Solution

Coronary artery disease develops when plaque accumulates within the arteries that supply blood to the heart muscle. Genetics can play an important role, while smoking, diabetes, uncontrolled high blood pressure, inactivity, poor diet and other factors can accelerate the process, Dr. Taylor explains.

In Mr. Landman’s case, the disease had become extensive.

“He had tight blockages to three of the main arteries that go to the left side of his heart, and we planned to do a three-vessel bypass operation,” Dr. Taylor says.

The stakes were considerable. Critical blockages in the heart’s major arteries can lead to weakened heart function, a major heart attack, dangerous heart rhythms or sudden death.

Mr. Landman had been treated without surgery for years, Dr. Taylor says, but his anatomy had reached the point where cardiac stents would no longer be an effective long-term option.

“In his case, the only way to provide a good, durable and safe option was through coronary artery bypass grafting,” Dr. Taylor says.

A bypass does not remove an existing blockage. Instead, surgeons create a new pathway for blood to flow around it.

For Mr. Landman, Dr. Taylor performed three bypass grafts. Dr. Taylor used both internal mammary arteries from the chest for two bypasses and a vein taken from Mr. Landman’s leg for the third, which needed to reach a vessel farther around the heart.

Whenever possible, Dr. Taylor says, his team favors arterial grafts because of their long-term durability.

“We want to design durable, long-term operations that give patients the best advantage of having a one-time bypass operation that should last decades,” he says.

Mr. Landman’s anatomy also meant that a less-invasive robotic approach was not appropriate. He required grafts to areas on the back of the heart that could not be safely reached through a small incision. This meant he would need traditional open-heart surgery via a sternotomy, in which the breastbone is cut open to give the surgeon unobstructed access to the heart.

Yet even with a complex three-vessel reconstruction, Dr. Taylor kept the time Mr. Landman spent on the heart-lung bypass machine to less than an hour, with the aorta cross-clamped for less than 45 minutes.

Minimizing operative time when possible reduces the potential for temporary anesthesia-related side effects and can help patients begin recovering sooner, Dr. Taylor says.

More Than an Operation

For Mr. Landman, however, what stands out about his experience is not simply what happened in the operating room. It’s what happened before and after it.

From preoperative care and surgery through both inpatient and outpatient cardiac rehabilitation, he remembers a well-coordinated team of physicians, nurses, anesthesiologists, therapists and other staff, “each of whom seemed connected to the same plan.”

“It was just seamless,” Mr. Landman says.

He was so impressed that he began writing down the names of the people who cared for him, ultimately compiling dozens.

“The culture there understands it—they treat their patients like real people,” he says.

That team approach is intentional, Dr. Taylor says. Complex cardiac surgery requires much more than a surgeon. Nurses, advanced practice providers, respiratory therapists, physical therapists and other specialists each have a role in helping patients safely move from surgery toward independence.

What makes Baptist Health Heart & Vascular Care specially equipped to take care of advanced problems like Mr. Landman’s, according to Dr. Taylor, is that it uses multidisciplinary teams of physicians and advanced care providers.

“You’re not just seeing one individual or one provider. You’re seeing a team that can look at a complex problem from different angles and find solutions specific to that patient,” he says.

Bridging the Gap Between Hospital and Home

For many bypass patients, leaving the acute-care hospital does not mean they are ready to resume everyday life immediately.

An operation can temporarily reduce strength and mobility even in someone who was highly independent beforehand. Dr. Taylor estimates that about one-third of cardiac surgery patients require some type of formal rehabilitation.

“We want our patients to be independent by the time they go home so they can manage themselves,” he says. “Bridging them with cardiac rehab is a constructive way of helping them get back on their feet and become independent.”

For Mr. Landman, that bridge was the Cornell Institute for Rehabilitation Medicine at Bethesda Hospital East, part of Baptist Health.

Inpatient rehabilitation hospitals such as Cornell provide patients with expertly administered programs and strategies to help transition them back to their daily lives, says Ronald Tolchin, D.O., chief of nonsurgical spine care and rehabilitation for Baptist Health Brain & Spine Care, the Kalman Bass Endowed Chair in Pain and Rehabilitative Medicine at Baptist Health Miami Neuroscience Institute and chief medical officer of Baptist Health Rehabilitation Hospital. 

“We treat the entire person rather than focusing solely on a single injury or condition,” he says. 

Dr. Tolchin notes that in addition to Cornell Institute for Rehabilitation Institute, Baptist Health also has inpatient physical rehabilitation hospitals at Baptist Health Homestead Hospital, and a new 62-bed facility that opened recently next to South Miami Hospital.

Addressing a Patient’s Physical and Emotional Needs

After several days recovering in the hospital, Mr. Landman was transferred to Cornell Institute for 10 days of inpatient rehabilitation.

There, the focus shifted from simply recovering medically to relearning how to safely navigate daily life while his breastbone and body healed. Occupational therapists observed how he dressed, showered and performed other everyday tasks. Physical therapists worked with him on walking, climbing steps and rebuilding his strength.

“They were spot on,” Mr. Landman says. “It wasn’t just, ‘Okay, go get dressed.’ They watched me put my shirt on. They watched me put my socks on. They showed me what I shouldn’t do.”

He credits his wife and daughter for helping with his recovery, and Jake, a physical therapist at Cornell Institute, for pushing him and motivating him.

“He was relentless in the best way,” Mr. Landman says of Jake, “and he helped me recover successfully.”

The rehabilitation team taught him how to move without putting excessive strain on his healing chest, what he could safely lift and how to protect himself while coughing or sneezing. Physicians continued monitoring his incision and adjusting his medications.

His care team also addressed something less visible: the emotional impact of major surgery.

Seeing his surgical wound bothered Mr. Landman more than he expected. And when his team initially thought he might be ready to leave rehabilitation early, Mr. Landman told them that physically he may have been ready, but mentally he wasn’t.

A psychologist at Cornell—someone he continues to speak with occasionally today—helped him process those feelings, which are not uncommon for patients who’ve undergone major surgery. By the time he did return home, Mr. Landman felt prepared.

“So I listened, I learned and I did. I actually followed the directions, and that’s not a typical ‘Elliott thing,’” he says with a laugh.

From Recovery to Cardiac Rehabilitation

The next step was not simply healing from his surgery. It was rebuilding the cardiovascular fitness and confidence necessary to return to his life.

That happened through outpatient cardiac rehabilitation at Gloria Drummond Physical Rehabilitation Institute at Boca Raton Regional Hospital, also part of Baptist Health.

There, Mr. Landman began exercising under careful supervision. Staff checked his blood pressure and attached monitoring leads so his heart rhythm and response to exercise could be observed as he moved through different machines and activities.

“Now it was time for me to get well in a physical sense—not just recover from the operation, but start getting through every single day,” he says.

He began attending hour-long sessions twice a week.

Just as valuable as the physical conditioning, he says, was seeing other cardiac patients working toward the same goal.

“The encouragement of seeing that is really good for your mindset—seeing people who want to get better,” he says. “That’s what it was about.”

The progression—surgery, inpatient rehabilitation, home recovery and monitored outpatient cardiac rehabilitation—illustrates the continuum of care Dr. Taylor believes can make an important difference for patients.

“At Baptist Health, we have the advantage of having two rehab institutes that can help patients get back on their feet and build their confidence and strength—the Cornell Institute for Rehabilitation Medicine and the Gloria Drummond Physical Rehabilitation Institute,” he says.