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Weekly UpdatesNO MATTER WHAT REGION of Indiana you live m, there are qualified heart centers and heart hospitals performing the latest procedures and conducting research to continue to improve outcomes. Here is an update on the latest cardiovascular technology being used and the newest procedures being performed in each region.
Central Indiana. On January 1, Community Health Network, The Indiana Heart Hospital and cardiovascular physician practices formed one cohesive entity to deliver the first integrated model for heart and vascular care in central Indiana, Community Heart and Vascular. "All aspects of the program are co-managed with physicians," says Dr. Ramu Yeleti, president of Community Heart and Vascular. "Patients will benefit from having access to a full continuum of integrated cardiovascular services." Advantages include the ability to better harmonize and leverage related clinical services, the expansion of clinical research and teaching opportunities and alignment of economic and operating efficiencies.
"These new integrated relationships set the highest standards for heart and vascular care and will allow us to meet a growing demand for cardiovascular services in the area," adds Tom Malasto, CEO of Community Heart and Vascular and The Indiana Heart Hospital. The hospital operates the state's only cardiac emergency room with a cardiologist on-site 24/7/365. Its door-to-balloon rime is around 30 minutes, well ahead of the national standard of 90 minutes. It offers some of the latest procedures including a standalone, minimally invasive surgical procedure for atrial fibrillation with a 90 percent success rate for patients with intermittent atrial fibrillation; valve repair/replacement and ventricular remodeling for patients with severe congestive heart failure; a new laser treatment to remove defective or non-functional implantable cardiac defibrillator leads (wires); and hypothermic therapy, cooling the patient's core body temperature, for resuscitated cardiac arrest patients.
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The St. Vincent Heart Center of Indiana is the largest cardiovascular center in the state. "Being such a high-volume center, we have multiple research projects with several vendors going on all the rime in every division," says John Stewart, president and CEO of the St. Vincent Heart Center of Indiana. "We cover the full spectrum, all the way from pediatrics in our Peyton Manning Children's Hospital to acute care at our Seton Center."
For example, the hospital is working with several ventricular assist device vendors to test the latest versions of those devices, as well as new implantable defibrillators. "With the aging of the Baby Boomers, we are starting to see a significant growth in the heart failure and the electrophysiology arenas," Stewart says.
This March the hospital will televise and deliver several complex interventional cath procedures, via real-time, to the national conference of the American College of Cardiology.
The Center did more than 16 heart transplants last year, exceeding the volume requirements (10) for Medicate. "With our growth in, and focus on, heart failure, our volumes are now the highest in the state," Stewart says.
St. Francis Heart Center is the only 24/7 comprehensive heart center in south central Indiana and The Midwest Heart Valve Center, a collaborative venture of St. Francis Heart Center, Indiana Heart Physicians and Cardiac Surgery Associates, is the only center focused on heart valve disease. St. Francis Heart Center is taking part in an FDA-approved clinical trial to test the safety and effectiveness of using lower dosages of blood-thinning drugs in conjunction with the On-X artificial heart valve. "The On-X valve could become the first mechanical heart valve approved for use with lower doses of anticoagulants such as Coumadin or even antiplatelet therapy (aspirin and Plavix) alone," says Dr. Marc W. Gerdisch, investigator and director of cardiothoracic surgery at St. Francis Heart Center. "Ultimately, this means a better quality of life for our patients."
St. Francis Heart Center has a new state-of-the-art electrophysiology lab for the care of patients with abnormal heart rhythms. "Our new lab will expand our capabilities of treating these conditions, as well as implantation of devices that correct arrhythmias and help treat heart failure," Gerdisch says. "St. Francis was the first in Indiana to perform an advanced and highly successful, minimally invasive surgical procedure, called the 'Mini-Maze,' to treat atrial fibrillation. Surgeons at St. Francis are also experienced in left ventricular restoration, a procedure in which the heart is returned to a more normal three-dimensional shape to improve its function." The facility also has new 3-D technology for advanced cardiovascular imaging with functional analysis, which assists in the evaluation of patients and the planning of their treatment.
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Northeast Indiana. In November, Goshen General Hospital became the first hospital in the state to use the TAXUXS Liberte drug-eluting stent, a technology recently approved by the FDA for use in the U.S. It has been used successfully in Europe for nearly two years.
"Early adoption of the TAXUS Liberte stent reinforces our commitment to deliver advanced treatment to patients in Goshen and the surrounding communities," says Dr. Mark Smucker, medical director of cardiology for Goshen and the surgeon who performed the surgery.
The use of stents offers qualifying patients an alternative to open-heart surgery.. This stent was designed for uniform drug delivery to help minimize scar tissue growth around the stent that can lead to renarrowing of the coronary artery and subsequent treatment. It may also reduce or eliminate chest pain so patients are more comfortable and able to lead more active lifestyles.
"Drug-eluting stents have helped reduce restenosis from occurring in 30 percent of all angioplasty cases, down to single digits," Dr. Smucker says. "This is a technology that keeps evolving. We are excited to be able to offer this latest advancement to our patients."
In 2008 Lutheran Hospital in Fort Wayne became the first hospital in the region to implant the new HeartMate II ventricular assist device (VAD) in a patient with heart failure. The American Heart Association estimates that five million Americans are affected by congestive heart failure and 550,000 new cases are diagnosed each year. Twenty percent of patients waiting on a heart transplant die before a heart becomes available. The HeartMate II gives heart failure patients better odds of survival while they are waiting. The new device is whisper quiet and has a much longer functional life than the previous generation of devices. It weighs approximately 12 ounces (compared to earlier versions that weighed up to five pounds) and is slightly larger than a pacemaker.
"The uniqueness of this particular VAD is that it can fit into small adults, particularly women," says Margaret C. Scatena, transplant administrative director for Lutheran Hospital. "Historically, women are too small for a totally implantable VAD."
Lutheran Hospital, which offers comprehensive heart services, has implanted more than 100 VADs since 1987. It is the only center in the region performing heart transplants and implanting the HeartMate II.
"Even before establishing the region's first coronary care unit in 1967, Lutheran Hospital had become keenly aware of the special needs of heart patients and their families," Scatena says.
Fort Wayne's Parkview Heart Institute is in the process of transitioning to a non-fluoroscopic mapping system, so heart rhythm problems can be found using a magnetic field instead of by x-ray, thus eliminating the risk of radiation exposure to patients, physicians and staff. Another new technology at Parkview is the intercardiac echo or ultrasound.
"We can actually take ultrasound from inside the heart which can give us a better picture of abnormalities that may be the cause of heart rhythm abnormalities or symptoms," says Dr. David Scheinkofer, cardiologist with Fort Wayne Cardiology which partners with Parkview Heart Institute. "Echo or ultrasound has primarily been transesophageal. Patients would swallow an echo probe and we would look into the heart from the stomach. Now we can actually look from inside the heart itself, which gives us a much better resolution picture. This allows us to treat more complex heart rhythm problems."
Ablations have been performed on basic heart rhythm problems for years, bur the new technology makes them possible for atrial fibrillation and ventricular tachycardia, which affect a broad area of the population. Atrial fibrillation affects millions of people nationwide, and is second only to coronary artery disease with patients that present themselves to Parkview Heart Institute.
Electrophysiology is one of Parkview's areas of specialization. Much of the hospital's research focuses on devises such as pacemakers and defibrillators and the wires connected to them.
Northern Indiana. St. Joseph Regional Medical Center, with campuses in South Bend, Mishawaka and Plymouth, is a certified Primary Stroke Center with the Joint Commission. It specializes in open-heart surgery, balloon angioplasty, stent placement and electrophysiology procedures. It is also a pioneer in offering directional orbital athrectomy featuring the Diamondback system, which allows physicians to remove hardened plaque from the walls of the arteries of the legs and/or arms of patients more safely and efficiently.
The center employs its activation system for heart attack emergencies. The system is a collaboration between Saint Joseph's Emergency Department and Catheterization Laboratory and the local EMS communities. Studies have shown that reopening clogged arteries with percutaneous coronary intervention (PCI) and inflating a tiny balloon at the site of the blockage, can increase a patient's chance of surviving a heart attack by 60 percent, but only if it is done within 90 minutes of the patient's arrival at the hospital. Since implementing the new system, the hospital has improved its door-to-balloon time.
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