Technological Advances Lead to Improved Survival with Permanent Left Ventricular Assist Devices

HEART AND VASCULAR INSTITUTE CARDIOLOGISTS USE LATEST TOOLS TO EXPAND PATIENT OPTIONS

LVAD Case StudySince 1976, when surgeons at Penn State Hershey Medical Center implanted the first Pierce-Donachy left ventricular assist device (LVAD) in the country, the technology has helped thousands of patients with severe heart failure survive until a donor heart is available for transplant. Today, however, Penn State Hershey Heart and Vascular Institute uses LVAD therapy not only as a bridge-to-transplant (BTT), but also as long-term destination therapy (DT). In fact, half of the LVAD placements now performed at Penn State Hershey are for DT usage.

Although heart transplantation remains the gold standard for advanced heart failure, LVAD can provide a viable option for many. Patients must have three main qualifications to be considered for LVAD therapy: 1) must be in advanced heart failure, but contraindicated for a heart transplant, or too sick to wait for a transplant, 2) must have reached the limits of medical therapy, and 3) must have a life expectancy of more than two years. Continue reading

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Transcatheter Aortic Valve Replacement (TAVR) Expands Options for Inoperable Severe Aortic Stenosis Patients

Surgical aortic valve replacement is extremely low-risk for most patients. However, a significant number of patients are at high-risk for surgical valve replacement or are ineligible for surgery because of comorbidities. The less invasive TAVR procedure allows a new valve to be inserted within the native, diseased aortic valve, and can be performed utilizing multiple approaches (e.g., transfemoral, transapical, or transaortic).¹

Penn State Hershey Heart and Vascular Institute is unusual in its balanced case mix, according to chief of cardiac surgery, Walter E. Pae, Jr., M.D., “Our practice is fairly evenly divided among congenital pediatric heart defects, adult coronary disorders, and adult cardiac valve abnormalities. We perform up to 100 aortic valve replacements per year.” Interventional cardiologist Mark Kozak, M.D., concurs, noting that coronary disease is the focus of many institutions, due to its far greater frequency. Continue reading

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Novel Techniques for Removal of Embedded Inferior Vena Cava (IVC) Filters Reduce Risk of Long-Term Complications

Technique for Removal of Embedded Inferior Vena Cava (IVC)

With the loop snare forcefully closed around the filter legs, the metal guide is pulled back with the filter into the sheath. The captured filter legs fold in half and the filter apex begins to invert (arrow).

Retrievable IVC filters are used to treat patients temporarily for pulmonary embolism (PE) prophylaxis, including those facing prolonged bedrest following lower-limb surgery. The devices may be removed to prevent the risk of long-term complications once there is no immediate risk of thromboembolism, with medical management superseding cardiovascular interventions.¹ Complications can include filter fracture, embolization, caval penetration, and, ironically, an increased incidence of recurrent deep vein thrombosis after filter placement.¹ Regular patient follow-up is critical for optimal outcomes, along with periodic chart reviews and multiple attempts to contact patients.¹ Inferior vena cava filters, particularly those in place for many months or years, can embed themselves in surrounding tissue, but novel techniques can often succeed in even the most complicated IVC filter removal cases. Continue reading

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Introducing the Cardio Report: A Publication for Heart Specialists by Heart Specialists

Penn State Hershey Heart and Vascular InstituteGreetings from Penn State Hershey Heart and Vascular Institute! I am pleased to share with you our inaugural issue of the Cardio Report. Our Institute comprises more than forty specialists in general cardiology, electrophysiology, congenital heart disease, interventional services, cardiothoracic surgery, heart failure, vascular surgery, and mechanical circulatory support. We are excited to share with you, our peers, the ways Penn State Hershey Heart and Vascular Institute is moving the field forward.

Our team is dedicated to better understanding and treating congestive heart failure, as we focus on our core mission to care for patients with impaired heart and blood vessels. Our collaborative approach to patient care includes cardiologists, surgeons, and interventional radiologists meeting weekly to streamline, standardize, and improve patient care. At Penn State Hershey, we treat patients with the most severe heart and vascular conditions and offer a multi-disciplinary approach to care, which makes the Institute unique.

Penn State Hershey Heart and Vascular Institute is recognized by the American Heart Association (AHA) with the Get With The Guidelines® Gold Plus award for heart failure treatment. The Joint Commission has also granted advanced certification for the Ventricular Assist Device (VAD) program, and recognized the heart failure program, including heart transplantation. Continue reading

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Heart and Vascular Institute Outpaces National Rate of Transradial versus Transfemoral Artery Catheterization for PCI

Wrist prepped for transradial artery catheterization for PCI.

Wrist prepped for transradial artery catheterization for PCI.

Transradial artery (TRA) access for percutaneous coronary intervention (PCI) versus transfemoral artery access, is a relatively recent development in medicine, with femoral access often the default for many interventional cardiologists since balloon angioplasties were first performed.1

Ongoing data supports that TRA PCI involves less bleeding risk, a reduced rate of vascular complications, lower costs, and greatly improved patient comfort.1

One study of more than 250 patients demonstrated that forearm access is safer than using the femoral vessels.2 However, the United States has lagged behind Europe, Asia, and other developed regions in the adoption of TRA procedures.1 China uses the technique about 80 percent of the time, and the European Society of Cardiology has recently recommended a “radial first” approach.1 According to Ian Gilchrist, M.D., professor of medicine, Penn State Hershey Heart and Vascular Institute, the United States currently averages a 30 percent rate of TRA coronary intervention procedures per year.

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