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Customized Cardiac Care

After doctors discovered a blockage in her artery, a 53-year-old mother of three was told she would need open-heart surgery. While the initial diagnosis shocked her, the idea of major surgery was more alarming. She was concerned about a scar from a large incision and a long recovery. A second opinion from a Washington University cardiologist offered a larger range of options for her specific heart problem and allowed her to receive a minimally invasive treatment that minimized her downtime.

From the advanced imaging now available to help determine patients at risk for potential cardiac events to minimally invasive procedures to replace congenital valvular defects, individuals face an array of choices in heart care. Choosing the right doctor who can offer a comprehension range of advanced treatments and surgeries is key. U.S. News & World Report recently ranked Barnes-Jewish Hospital as the nation’s ninth-best hospital for heart care and heart surgery. This reputation is due to the expertise of Washington University cardiologists and cardiac surgeons and specialized nursing staff members who develop a customized treatment plan for each patient.

Balanced strengths

Washington University cardiologists from the Heart & Vascular Center see patients at both the Center for Advanced Medicine on the Barnes-Jewish Hospital campus and at Barnes-Jewish West County Hospital. Depending on the problem– whether it’s a heart rhythm disorder, valvular heart disease, congenital heart disease, heart failure or some other complicated issue – cardiologists and cardiac surgeons work closely together to find the best treatment option, often using breakthrough procedures, such as the Cox-Maze procedure for atrial fibrillation, pioneered at Barnes-Jewish and Washington University.

Washington University cardiologists from the Heart & Vascular Center see patients at both the Center for Advanced Medicine on the Barnes-Jewish Hospital campus and at Barnes-Jewish West County Hospital. Depending on the problem– whether it’s a heart rhythm disorder, valvular heart disease, congenital heart disease, heart failure or some other complicated issue – cardiologists and cardiac surgeons work closely together to find the best treatment option, often using breakthrough procedures, such as the Cox-Maze procedure for atrial fibrillation, pioneered at Barnes-Jewish and Washington University.

“Our heart program’s effectiveness comes from the balance between the strength of interventional cardiology and surgery available on this campus,” says John Lasala, MD, PhD, Washington University cardiologist and director of the cardiac catheterization lab at Barnes-Jewish. “Whether treatment is through the cath lab or with surgery, patients receive the best and most sophisticated care available. An important element in the evaluation process is listening to our patients’ wishes.” e continued

Lasala leads an interventional cardiology team with a 99.6 percent success rate for opening blocked coronary arteries – among the highest in the country. In addition, 92 percent of patients with heart attack symptoms who arrive at Barnes-Jewish’s emergency room undergo balloon angioplasty within 90 minutes, considered the gold standard for treatment.

Collectively, the team’s full-time inter-ventional cardiologists have 70 years of experience and perform more than 7,000 procedures annually. Their often seriously ill patients benefit from the cardiologists’ access to new and developing treatments.

“An example was our involvement in the testing of the first drug-eluting stent,” Lasala says. “Stents are wire mesh tubes used to prop open an artery cleared through angioplasty. In 2001, we participated in the first clinical trial of a stent coated with a drug designed to prevent re-narrowing of the artery. When the FDA approved the stent for use in 2003, we already had two years of experience with it. Our patients already were benefiting from a new technology that reduced the chance of re-narrowing to 5 percent or less.”

Currently, Lasala and his colleagues are participating in clinical studies for replacing aortic valves and repairing severe mitral valve regurgitation through devices implanted via catheters inserted through a small incision in a leg blood vessel. “If these devices are approved by the FDA, we once again will have already developed expertise using them,” he says.

Fact: 99.6% success rate for opening blocked coronary arteries through interventional cardiology among the highest rates in the country

Another option: minimally invasive surgery

Edwin Wolfgram, MD, 75, a St. Louis-based psychiatrist, underwent a minimally invasive aortic valve replacement last January. Prior to treatment, he appeared to be the picture of health. “At age 70, I placed first in my age group at the Hawaiian Ironman World Championship Triathlon, so I knew I was in top physical condition,” says Wolfgram. “But I felt myself slowing down in my athletic activities.” Diagnosed with a heart murmur, Wolfgram was monitored by his physicians until Ralph Damiano, MD, chief of cardiac surgery at Barnes-Jewish and Washington University, determined he needed valve replacement surgery.

It was a difficult situation to face, but I had a lot of confidence in all the doctors,” Wolfgram says. “Everyone knew what they were doing.”

Within weeks of the minimally invasive procedure, Wolfgram began to exercise, gradually increasing his routine. “Since the valve replacement, I seem to be maintaining my fitness better,” he says. “It’s like getting a second chance.”

Nothing slows him down now. In October this year, he competed in the 2008 Hawaiian Ironman triathlon – his 10th triathlon – placing fourth in his age group and already planning for the next one. When surgery is the best treatment option, many heart patients at Barnes-Jewish Hospital are candidates for minimally invasive surgery. The sophisticated level of these surgical techniques means they can benefit even high-risk patients. Damiano has performed minimally invasive heart surgery since 1998. “Many patients needing just one bypass procedure may undergo a minimally invasive procedure requiring an incision of only 4 to 5 inches, compared to one of about 18 inches for traditional open heart surgery,” Damiano explains. “The same is true for patients needing aortic and mitral valve repair or replacement. Except in rare instances, we can perform a mini-thoracotomy with important advantages to patients – reduced hospital stays, fewer complications following surgery, less pain and a better cosmetic result.”

Heart surgery also has improved with the option of off-pump surgery, which makes it less invasive because the patient isn’t placed on cardiopulmonary bypass. With cardiopulmonary bypass, the blood is rerouted outside the body so the heart is motionless during surgery. However, this approach can increase risks of stroke and other complications and lengthen hospital stays.

With off-pump surgery, these risks are reduced with fewer complications, less need for blood transfusions and faster discharge from the hospital. Damiano, one of the pioneers in off-pump surgery, performs the majority of bypass surgeries using the off-pump method.

Another option for certain patients with heart disease is an endoscopic approach developed by Damiano using a surgical robotic system. Damiano’s team performed the first robotically assisted coronary artery surgery in North America in 1998. Since then, they have continued to develop the minimally invasive techniques, which can significantly reduce patient discomfort, shorten the length of stay and speed
recovery in selected patients.

Lasala and Damiano are confident in the full range of care the cardiology and cardiac surgery team offers. “We treat challenging patients with serious complications every day so we can address a wide array of heart problems,” Lasala says.

To learn more about the Heart & Vascular Center physicians and their areas of expertise, watch exclusive online interviews at http://news.BarnesJewish.org.

Reducing AFIB Stroke Risk

Atrial fibrillation or AFIB is one of the most common heart arrhythmias. It comes with an increased stroke risk and a new procedure at the Washington University and Barnes-Jewish Hospital Heart & Vascular Center is targeted to reduce the need for many to be on blood thinning medications. Find out more in this podcast with John Lasala, MD, PhD, director of the cardiac catheterization lab at Barnes-Jewish.

 
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