As the population ages, increasing numbers of patients are presenting with atrial fibrillation, with the number projected to grow to more than 7.5 million in the U.S. by 2050.1 A strong correlation exists between atrial fibrillation and severe acute ischemic stroke.2 Citing large databases such as the PINNACLE-AF registry,3 Gerald Naccarelli M.D., Bernard Trabin Chair in Cardiology and chief, cardiology, Penn State Hershey Heart and Vascular Institute, says, “We have known since the late 1980s that warfarin was able to reduce the risk of stroke by two-thirds in high-risk patients with atrial fibrillation. However, close to half the patients who should be on anticoagulant therapy, according to guidelines, are not receiving it.” He cites multiple co-morbidities, shifting recommendations, and bleeding risk as possible causes, but emphasizes that maintaining brain function must be a key factor in treatment planning for even the most medically complex patients. Continue reading
Tag Archives: cardiology
The CardioMEMS™ HF System is the first Food and Drug Administration (FDA)-approved heart failure (HF) monitor proven to significantly reduce HF hospital admissions and improve quality of life in NYHA class III patients.1 This implanted, wireless, battery-free device measures key vital signs, including pulmonary artery pressure in HF patients, and transmits this information remotely to the patient’s doctors for proactive management. The device was evaluated in 550 people in the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Patients) trial; Penn State Hershey Medical Center participated as an active enrolling center. During 15 months of follow-up, the treatment group had a 39 percent reduction in heart failure-related hospitalization compared with the control group.1
To participate, patients must have been hospitalized for HF in the 12 months prior. “That defines a relatively unstable population,” says John P. Boehmer, M.D., Penn State Hershey Heart and Vascular Institute. Once implanted, the CardioMEMS device requires patients to lie on a special mat every day. The mat includes an antenna that wirelessly connects and transmits data securely to a monitor that records 18 seconds of a pulmonary pressure tracing.
Novel Surgical Approach Results in Significant Improvement of Symptoms for Often Misdiagnosed Thoracic Outlet Syndrome
The upper extremity disorder thoracic outlet syndrome (TOS) is frequently misdiagnosed, as it appears in a younger patient population, typically between 20 and 50 years old, and is easily mistaken for a musculoskeletal disorder. Physical therapy (PT) is often the initial treatment for patients without blood clots; two-thirds with the neurogenic form of TOS can be treated with PT alone. However, a recent retrospective study of 538 patients during a 10-year period who underwent first rib resections (FRRs) for treatment of neurogenic, venous, and arterial TOS, showed that 93 to 96 percent experienced improved or fully resolved symptoms.1 Continue reading
Novel Treatment Tested to Prevent Cardiac Remodeling and Congestive Heart Failure in Post-Acute Myocardial Infarction (AMI) Patients
A new device, bioabsorbable cardiac matrix (BCM), was just investigated in a randomized, double-blind, placebo-controlled trial to determine its safety and efficacy in preventing ventricular remodeling and congestive heart failure (CHF), when administered to subjects who had successful percutaneous coronary intervention (PCI) with stent placement after ST-elevation myocardial infarction (STEMI). Penn State Hershey Medical Center participated in this multi-center trial named PRESERVATION I.
BCM is an aqueous mixture of sodium alginate and calcium gluconate,1 which self-assembles in the body to form a gel-like “scaffold” for the heart in the presence of severely elevated calcium levels that occur as a result of cell death. This scaffold-like structure is designed to replace the damaged extracellular matrix that degraded during infarction, support the damaged myocardial tissue, decrease wall stress and prevent the heart from dilating.1 According to Ian Gilchrist, M.D., Penn State Hershey Heart and Vascular Institute, “It is thought that the heart dilates in the end-stage of congestive heart failure to compensate for areas of the muscle that are no longer viable; however, this causes the heart muscle to stretch and is the beginning of a downward spiral.” Continue reading
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
Novel Techniques for Removal of Embedded Inferior Vena Cava (IVC) Filters Reduce Risk of Long-Term Complications
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
Greetings 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