Cardiac Innovation in Nashville, continued from page 1
without spending a month healing after rates, streamline TAVR procedures and surgery. It’s been an amazing transition.” expand access to treat patients even with While the MitraClip became comchallenging anatomies. Now the team is mercially available in 2013, Saint Thomas looking at treatment options for tricuspid Heart had already played a pivotal role in valves. “The tricuspid valve is often forgotthe MitraClip COAPT clinical research ten, but clinically it’s very important and trial. Nearly seven years later, treated has never had a good catheter-based therpatients are still going strong and the apy,” said Morse, who’s involved in a TriMitraClip has proven to be a sustainable luminate clinical study involving an Abbott therapy long term. “That was an increddevice similar to the MitraClip. ibly powerful trial for patients, and we were “Today’s therapies and screening tools fortunate to be the first to use the MitraClip are better, so we can identify valve probin the trial and then again once it became lems earlier and send patients to a valve commercially available,” said Morse. center of excellence,” Morse continued. Saint Thomas Heart recently became “We have numerous transcatheter valve the 17th heart center in the U.S. to exceed 300 options to keep us robust and innovative in MitraClip procedures. “Mitral valve therapy our approach, so we can continue to offer is quickly evolving, and there are now hunnew technology to our patients. Unless you dreds of companies working on different stay at the forefront you don’t have every technologies in that space,” Morse said. option to serve the community.” “The clip is wonderful but can’t treat every anatomy, so it’s a disease that still Robotics at TriStar needs more innovation.” Centennial To that end, Saint Robotic technology has Thomas Heart is involved in a been a game changer for mininumber of minimally invasive mally invasive procedures, and valve trials, including the SUMcardiac surgery is no excepMIT Trial for Abbott Tendyne tion. “Robotic systems have Transcatheter Mitral Valve evolved a lot in recent years, Replacement. Saint Thomas with refinements in endoHeart was also the first in scopic technology that allow Tennessee to implant the better visualization of the ACURATE neo2Aortic Valve operative field and minimizaSystem, a new generation tion of tissue trauma enabling of transcatheter aortic valve faster recovery,” said Sreekureplacement (TAVR) designed mar “Kumar” Subramanian, ACURATE neo2 Aortic Valve System to further reduce complication MD, cardiac surgeon at TriS-
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tar Centennial Medical Center. In December 2019, Subramanian became the first TriStar heart surgeon to use the da Vinci Xi robotic surgery system to operate on an uncontrolled diabetic patient with severe coronary artery disease. Using the robot, Subramanian is able to harvest internal mammary arteries from the chest wall without having to use a specific Dr. Kumar Subramanian open surgical retractor. “Being able to harvest an artery without lifting the chest wall reduces tissue trauma, as well as the risk of sternal fractures, especially in patients with diseased bone,” said Subramanian, who also plans to use the robotic system for valve surgery, removal of intracardiac tumors, atrial fibrillation ablation surgery and other procedures. While the system has notable advantages, Subramanian said the department is being intentionally conservative in rolling out the new technology. We have a very cohesive team in place and are trying to use this discriminately, as technology can sometimes increase healthcare costs, decrease efficiency and be no better for the patient in the long-run.” Subramanian said patient satisfaction has been very high among those who have undergone robotic-assisted heart surgery. “We are patient-centric, and the high patient satisfaction is ultimately the reason that we will continue to expand our program.” Subramanian anticipates the hospital will perform 100 robotic-assisted heart surgeries in the next year, with an increased focus on low risk patients with three-vessel coronary artery disease. Traditionally, patients with the diagnosis receive stenting on all three vessels. More recently, hybrid procedures, which involve minimally invasive surgical bypass using the left internal mammary artery (LIMA) to the left anterior descending (LAD) and stenting of the other vessels, have become more popular. “Robotics facilitates the minimally invasive LIMA-LAD bypass by avoiding rib spreading and may also be beneficial in some patients where a sternotomy approach is best avoided,” he explained. “I am committed to the safe and effective implementation of new technology as our program continues to grow.”
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Vanderbilt University Medical Center is breaking records for innovation in heart care. “One of our biggest priorities as an academic center is to be on the leading edge of discovery and innovation in cardiovascular care, whether in delivering life-saving therapies to patients with advanced heart disease or in delivering innovative preventive care to help keep patients free of heart disease,” said Daniel Muñoz, MD, MPA, Dr. Daniel Muñoz
associate executive medical director of the Vanderbilt Heart & Vascular Institute and medical director for the Cardiovascular ICU at VUMC.
In 2019, VUMC tied for first place as the busiest heart transplant program by volume in the United States, performing a record 118 heart transplants — 96 adult and 22 pediatric patients — topping the previous year’s record of 109. It tied with Cedars-Sinai Medical Center in Los Angeles for the busiest heart transplant center in the country. “Beyond the numbers is a remarkable story of quality outcomes and of missioncritical collaboration between a world-class team of cardiac surgeons, cardiologists, nurse professionals, and others,” Muñoz said. The Medical Center was ranked as the No. 2 heart transplant center by volume for the previous three consecutive years. The center’s adult heart transplant program began in 1985, followed by the opening of the pediatric program in 1987. “Our remarkable year also reflects how much heart transplantation has changed and the advantages of our size,” said VUMC cardiac surgeon Ashish S. Shah MD. “Frankly, modern heart transplantation demands high performing, experienced teams. Our high volume has opened opportunities to use new organ preservation technology and to help the most complex patients. It has been immensely satisfying to help patients in our region and to also have a world-wide impact with our research and clinical innovation.”
“For several decades, the number of heart transplants performed annually in the United States has been relatively stagnant,” said Kelly Schlendorf, MD, MHS, medical director of VUMC’s Adult Heart Transplant Program. “Over the past few years, however, heart transplant volumes are on the rise, due in part to transplantation using hepatitis C-positive donors. These donors offer a stratDr. Kelly Schlendorf egy to safely expand the donor pool and allow more patients to undergo transplant. When you consider the alternative, that’s a big deal.” Between 2016 and 2018, 37 percent of Vanderbilt’s heart transplants were from hepatitis C-positive donors, a factor that allowed Vanderbilt to double the number of heart transplants, from 130 between 2013 and 2015 to 260 between 2016 and 2018. Vanderbilt is now the largest heart transplant program by volume in the country. According to VUMC study results published recently in JAMA Cardiology, heart recipients from hepatitis C-positive
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