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Robotic Interventions, continued from page 1 console to navigate the heart arteries and place stents inside the blocked arteries to fix heart blockages with the potential for incredible precision. Jackson-Madison County General Hospital, is the only hospital in Tennessee to offer the CorPath GRX System for the treatment of coronary artery disease. The vascular robotic-assisted system offers interventional cardiologists robotic precision when controlling guide catheters, guidewires, balloons and stents during CorPath Robotic Angioplasty. Currently the hospital has two units in operation. Cardiologist John Baker, MD, of the Jackson Clinic, PC was instrumental in the technology coming to Jackson. “The equipment for robotic PCI has been present for seven to eight years, but recent advances in technology caused me to develop an increased interest,” he said. “The area that was of most interest was the ability to deliver increased precision over the manual techniques we already have been using. Dr. (Tommy) Miller and I traveled to New York Presbyterian Hospital/Columbia University to learn about and evaluate the technology. We realized this was something that could be beneficial to patients in West Tennessee. Our training included instruction on the use of the equipment as well as observing live cases. We also traveled to a research facility in upstate New York, where we were able to obtain hands-on training with the device in an animal lab.” The CorPath System is the first FDAcleared robotic platform designed for interventional cardiologists. It is composed of two functional subunits: the bedside unit

The Robotics Team at Jackson General Hospital is excited to be the only hospital in Tennessee to offer CorPath GRX System for the treatment of coronary artery disease.

and the remote physician workspace. The bedside unit consists of the articulated arm, the robotic drive, and a single-use cassette in which devices including wires, balloons, and stents are loaded. The remote workspace consists of the interventional cockpit, which is surrounded by a radiation shield and houses the control console, angiographic monitors, hemodynamic monitors, and the x-ray foot pedal. In robotic PCI, a cardiologist sits at a robotic console and uses the controls to manipulate the wires to incredible degrees of precision allowing them to be passed into the chosen artery and through the area of

blockage. The system allows the operator to control and manipulate guide wires, balloons, and stents using a set of joysticks and touch screens while fluoroscopy provides image guidance. Axial and rotational motion are achieved by a mechanical transmission module. The balloon or stent can be guided both in a continuous motion using the joystick and in discrete highly sensitive small steps using the touch screen. The major benefits of robot-assisted PCI include improved operator safety and procedural precision, increased accuracy in stent selection and improved patient outcomes. “The procedure is performed in the

cath lab,” said Jeff Young, executive director of West Tennessee Heart and Vascular Center. “The system takes images at the cath table and sends them to the cardiologist who is in the cockpit. There are three screens that have real time images and still images. Tools built into the system and software allow those images to be layered to allow for more accurate marking of vessels and to set targets for advancing wires and stents.” “The procedure is possible on virtually any type of patient. Benefits to the patient are increased precision with which guidewires, balloon dilation catheters and stents may be placed with robotic control,” said Baker. “The physician however, has the benefit of being removed from the x-ray source resulting in reduced exposure to radiation. The potential for orthopedic injury to the physician is decreased because a lead apron is not required while doing the robotic procedure.” “This raises our program to a whole other level in technological advancements. To be the first and only hospital in the state to offer this shows our commitment to giving the best care possible to our patients,” said Emily Garner, RN, clinical manager for West Tennessee Heart and Vascular Center. “This is cutting edge technology that not Emily Garner only offers exact and precise treatment for the patient, but also helps prevent future negative effects to our physicians.”

Get with the Guidelines: Blood Pressure Edition, continued from page 1 above 80 but also a benefit from treatment. “Even when we can show a correlation between bad outcomes and hypertension, we still have to show that treatment is going to make a difference,” he said. With the science in place, these new numbers are the first change in blood pressure guidelines since 2003. Previously, patients with blood pressures between 120 and 139 systolic and/or a diastolic reading between 80-89 would have been classified as having ‘prehypertension.’ Now, anything greater than 120/80 is considered an elevated blood pressure. “It’s not ‘pre’ so we don’t say, ‘We’ll see you in a year,’” Clair said of the new trigger points. Instead, he continued, physicians should be intervening at that point and following up with patients more frequently to monitor improvement and sustainability. “Jumping all over it (hypertension) doesn’t mean you should necessarily start taking a drug for it,” he added in response to one concern some patients and physicians have voiced about the new guidelines. “But we begin to look more aggressively at cardiac risk factors … and you now have one, elevated blood pressure … so we should look at lifestyle, sodium intake, exercise, diet, smoking.” Realistically, Clair continued, lifestyle modification only achieves a decrease of about 11 millimeters of mercury so 4

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FEBRUARY 2018

someone with a blood pressure of 160/90 probably won’t move the needle enough with lifestyle changes alone. However, he pointed out, those defined as having elevated blood pressure and stage 1 hypertension could quite likely get numbers back in the normal range without requiring medication. He was quick to add that doesn’t mean lifestyle modifications aren’t critical for everyone at any stage of hypertension. “Many people think because they are taking these blood pressure medications and controlling their blood pressure, they don’t have to give up that frequent flyer card to McDonald’s … yes, you do,” he stated. “You still have to do all of the other cardiovascular risk modification steps to get the

full benefit. We continue to work to get that message out.” In addition to lowering the definition of high blood pressure, Clair said the new guidelines also reemphasized the correct way to take a blood pressure reading – making sure the person is seated correctly, using the proper cuff size, waiting a few minutes after the patient arrives in an exam room. “We kind of got a little lazy about checking blood pressure over the last few years,” he said. Technology, he added, can also be an important tool for getting an accurate read on blood pressure – particularly among a couple of specific groups. Mobile technology, Clair noted, eliminates ‘white coat hypertension,’ where patients experience a

jump in blood pressure simply by being in a medical setting. “We now have the capability to actually look at people’s blood pressure at home to see if they are really normal or not,” he said. “The other group is people who are suspected of having high blood pressure,” Clair continued. “Those people … believe it or not … actually have blood pressures that look pretty good, but it’s labile.” While they test normal at the physician’s office, they actually have elevated numbers at home or work. “We have these two extremes of people – those who might be over-diagnosed and those who might be missed.” The rising death rates underscore just how important it is to properly identify those at increased risk of heart disease. Additionally, Clair said, “We are worried the increase in childhood obesity is a precursor of another surge in cardiovascular disease.” He continued, “For many years in cardiology, we have been striving to be the #2 killer … it’s a credit to our colleagues in oncology that cardiac disease and stroke remain #1 killers of both men and women in the U.S.” Noting that being the leading cause of death isn’t a designation anyone wants, Clair said more aggressively monitoring and treating elevated blood pressure is one important step toward improving heart health. westtnmedicalnews

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February 2018 WTMN  

West TN Medical News February 2018

February 2018 WTMN  

West TN Medical News February 2018