STATE-OF-THE-ART CARDIAC CARE is making a difference for hundreds of thousands of patients each year—there are five million people in the United States suffering from chronic heart failure, with about 550,000 diagnosed each year. Here are the latest treatments that are saving lives and improving the quality of life for survivors and their families. In addition, through early intervention, many 911 calls and emergency room visits are being avoided altogether.
Atlantic Health System By Kevin McGovern, Director, Cardiovascular Service Line
Morristown Medical Center (MMC) offers high-quality, minimally invasive heart interventions. MMC, home to the largest cardiac surgery program in the state, performs more transaortic valve replacement (TAVR) procedures than any hospital in the state. MMC offers transcatheter mitral valve repair (TMVr) through clinical trials. Due to the complexity of the mitral valve’s structure and medical needs of patients with mitral valve regurgitation, only the most technically skilled cardiac teams can perform repair with a catheter-based approach. MMC has significantly expanded the use of the transradial (wrist) approach for complex cardiac procedures from angioplasty to branch stenting procedures and offers imaging such as nuclear cardiology and echocardiography. MMC is a destination for cardiac clinical trials—including two first-in-world trials—providing patients with access to the latest technology and therapies sooner than available to the general public. A 72-private patient room expansion and new imaging technology are planned in 2019. We focus on preventative screenings like calcium scoring, lipid panel, and blood pressure for all patients, and educate our colleagues in other areas like ob/gyn on the importance of heart health and screening. We offer a number of free clinics and facilitate them at community events and soup kitchens.
Englewood Health By Aron Schwarcz, M.D., Interventional Cardiologist
To treat a Chronic Total Occlusion CTO in the cardiac catheterization lab, a catheter is placed in the artery of the leg or arm and advanced to the heart. With new technology we can either go through the blockage, around it, using the vessel wall, or go through the nearby collateral vessels in the heart and backward through the blockage. Then we open the artery with a balloon angioplasty and place a stent. We can now perform interventional cardiology procedures for patients who, in the past, would have been assessed as poor or high-risk candidates, especially those with very poor heart muscle function. We can place an Impella® heart pump, a device that supports the heart’s function during procedures, allowing our interventional cardiology team to perform more complex procedures in a safe and efficient manner. This gives us another alternative to surgery. Also, for those who come to the hospital with heart attacks and very low blood pressure, placing an Impella® device can help us improve survival. Today, patients in cardiogenic shock can be treated successfully, where in the past they might have had a lower chance of survival.
Hackensack Meridian Health, Hackensack University Medical Center By Joseph E. Parrillo, M.D., Chair, Heart and Vascular Hospital
One major challenge is the treatment of patients with heart failure who are no longer responding to conventional medications. Ventricular Assist Devices (VADs), mechanical heart support devices, are highly effective in the short and long term as heart assists for patients with severe heart failure. VADs can be implanted to improve quality of life and long-term survival. These devices are lifesaving in appropriate heart failure and shock patients.
Another recent revolutionary technique allows replacement or repair of heart valves using catheter techniques rather than surgery. The aortic valve can be replaced by Transcatheter Aortic Valve Replacement (TAVR), and the mitral valve can be repaired using a clip technology. The Hackensack Structural Heart Disease program also performs trans-catheter closure of para-valvular leaks (PVLs) in previously placed artificial valves. Our team has one of the largest experiences in the world in successfully closing PVLs. A groundbreaking technology is the Left Atrial Appendage Occluder Device (LAAOD) for patients who suffer from atrial fibrillation and are likely to develop small blood clots in their atrial heart chamber which can travel to the brain causing a stroke. Using a catheter-based approach, a device can be permanently implanted into the left atrium, preventing clots and strokes. These patients no longer require anticoagulants.
Hackensack Meridian Health, Jersey Shore University Medical Center By Richard Neibart, M.D., Chief of Cardiac Surgery
We are extremely proud of the cutting-edge advancements that our team continuously introduces to the community, such as the new Advanced Heart Failure Center at Jersey Shore University Medical Center. The program provides specialized treatment options such as Left Ventricular Assist Device (LVAD) surgery, as well as services for patients with new onset heart failure, cardiomyopathy and valvular heart disease. The center’s robust expertise and capabilities expand services at the region’s leading cardiovascular center and serves a critical need for many patients. We are making this specialized service even more convenient and accessible to residents in central and southern New Jersey. Our team is committed to transforming treatment options and improving the quality of life for patients. We consistently remain on the forefront of cardiovascular care, offering advanced procedures, such as TransCarotid Artery Revascularization (TCAR), robotic-assisted Coronary Artery Bypass Graft (CABG), Transcatheter Aortic Valve Replacement (TAVR) and HeartMate 3™ technology. Paired with the Advanced Heart Failure Center, the state’s newest Cardiac Fellowship program and a phenomenal continuum of services—from diagnostics and medical treatment, through surgery and rehabilitation— our team has the experience, skill and technology to mend virtually any heart.
Holy Name Medical Center By Zankhana Raval, M.D., Board-Certified Interventional Cardiologist
At Holy Name Medical Center, our cardiac team focuses on providing comprehensive and compassionate, patient-centered heart care utilizing state-of-the-art technology and advanced techniques. Our world-class, technically skilled cardiologists have expertise in interventional cardiology, electrophysiology and endovascular interventions for peripheral arterial disease. We have access to state-of-the-art diagnostic technology for both non-invasive and invasive testing. We investigate the structure, blood supply, and electrical system of each patient’s heart, with a focus on diagnosing diseases early to improve outcomes. We always strive for the best and safest management strategies. Our philosophy involves empowering patients with knowledge, educating them so they can be proactive in helping prevent serious heart disease and illnesses. In our offices and on a population health level, we offer screening and management of risk factors for heart disease, such as hypertension, high cholesterol, diabetes, smoking and family history. We are also quite comfortable identifying and managing lesser-known risk factors, such as advanced liver or kidney disease, a history of chest radiation or certain types of chemotherapy (often life-saving), sleep apnea, significant alcohol or drug abuse and even certain infections.
RWJBarnabas Health, Saint Barnabas Medical Center By Gary J. Rogal, M.D., Director, Cardiac Services; Chief of Cardiology; Member, Barnabas Health Medical Group
RWJBarnabas Health (RWJBH) offers access to the latest advances in cardiac care for patients with aortic stenosis, atrial fibrillation (AFib) and those who are being screened for a recent heart attack. RWJBH performs more Trans-catheter Aortic Valve Replacements (TAVR) to treat aortic stenosis than any other healthcare system in the state. During the procedure, a valve is collapsed and threaded through a blood vessel to the heart. Advanced technology is used to visualize the placement and expand the valve. TAVR is a percutaneous procedure—no chest incision is required, resulting in quicker recovery, less pain and fewer complications. We also offer the Watchman device for patients with AFib. These patients are typically put on a blood thinner to prevent blood clots; however, certain patients cannot take long-term coagulation medication. Surgeons can now place the Watchman device onto the left atrial chamber to plug the part of the heart where clots form. Also, we will be introducing a more sensitive marker to detect a heart attack in patients with more precision. While in the past tests took up to six hours to rule out a heart attack, with the new high sensitivity marker, it will take a fraction of the time.
Saint Peter’s University Hospital By Pratik Patel, M.D., Peripheral Vascular Interventionalist
Peripheral vascular disease (PVD) is a circulatory problem caused by the build-up of plaque in the arteries of the legs. It obstructs blood flow to the limbs and feet, resulting in leg pain, poor wound healing, loss of leg hair and thickening of the toenails. The long-term risks associated with PVD include amputation, heart disease and stroke, so early intervention is critical. At the Cardiac Catheterization Lab at the Center for Ambulatory Resources (CARES), part of Saint Peter’s University Hospital, technology is helping patients mitigate the serious risks associated with PVD. Doctors at Saint Peter’s use Intravascular Ultra Sound (IVUS) in combination with angiography to precisely locate the obstructed area, allowing them to unblock the artery and insert stents for improved blood flow, with precision. Peripheral Laser Atherectomy is also a treatment. This process inserts a catheter with a light-emitting laser that virtually vaporizes the blockage. A benefit of atherectomy is the ability to reach small vessels in the feet, an area with limited access and not usually amenable to the use of stents. This is especially important for diabetics who have circulation issues. In addition, atherectomy has become the new standard for treating blocked stents. These new technologies have increased patient mobility, but more importantly prolonged lives.
The Valley Hospital By John Goncalves, M.D., Director, Cardiac Surgery; Surgical Director, Transcatheter Aortic Valve Program
Valley is home to northern New Jersey’s most experienced transcatheter aortic valve replacement (TAVR) team. TAVR is a minimally-invasive procedure that repairs heart valves for the millions of Americans who are diagnosed with aortic stenosis, a serious heart valve disease. In a TAVR procedure, an expandable heart valve is placed into the body with a tube-based delivery system (catheter). This allows the valve to be inserted through a small cut into an artery in the groin or through the ribs or top of the sternum. TAVR patients have a shorter hospital stay and are able to get up and walk around faster than with those who undergo conventional surgery. The number of TAVR treatments we perform at Valley keeps growing. For patients at high or intermediate risk for conventional open-heart surgery, excellent outcomes are consistently realized. And now we’re especially excited to be participating in a first-of-its-kind clinical trial to evaluate the use of TAVR in low-risk patients. For more information about the TAVR clinical trial, please call Sarah Polites, BSN, RN, CCRN-K, Clinical Trials Coordinator, at (201) 447-8453.
Trinitas Regional Medical Center By Fayez Shamoon, M.D., Medical Director of Cardiovascular Services
Trinitas has a fully equipped Cardiovascular Diagnostic Center to diagnose and treat all areas of heart disease. For instance, we use a Coronary CT Angiography on a state-of-the-art 128-slice CT scanner, and have two fully functional Cardiac Catheterization Labs that treat more than 1,000 patients every year. We have the ability to treat both elective and emergency coronary blockages with Angioplasty (PCI) and have a 24/7 STEMI receiving center for patients having heart attacks. We also have Loop Recorder Insertions for arrhythmia management, Syncope, CVA treatment and a Cardiac Rehab. I am very pleased with how many lives we’ve been able to save.
St. Joseph’s University Medical Center Offers the World’s Smallest Pacemaker
St. Joseph’s University Medical Center, part of St. Joseph’s Health, announced that it is among the first hospitals in New Jersey to offer the world’s smallest pacemaker for patients with bradycardia, a slow or irregular heart rhythm. The Micra® Transcatheter Pacing System (TPS) is a new type of heart device that provides patients with the most advanced pacing technology at one-tenth the size of a traditional pacemaker.
Bradycardia is a condition characterized by a slow or irregular heart rhythm, usually fewer than 60 beats per minute. At this rate, the heart is unable to pump enough oxygen-rich blood to the body during normal activity or exercise, causing dizziness, fatigue, shortness of breath or fainting spells. Pacemakers are the most common way to treat bradycardia to help restore the heart’s normal rhythm and relieve symptoms by sending electrical impulses to the heart to increase the heart rate.
Comparable in size to a large vitamin, the Micra TPS does not require cardiac wires or leads or a surgical “pocket” created under the skin to deliver a pacing therapy. Instead, the device is delivered through a catheter and implanted directly into the heart with small tines, providing a safe alternative to conventional pacemakers without the complications associated with leads, all while being cosmetically invisible. The Micra TPS is designed to automatically adjust pacing therapy based on a patient’s activity levels.
The Micra TPS also incorporates a retrieval feature to enable retrieval of the device when possible; however, the device is designed to be left in the body. For patients who need more than one heart device, the Micra TPS was designed with a unique feature that enables it to be permanently turned off, so it can remain in the body and a new device can be implanted without risk of electrical interaction.