MARCH 2010
Wake Heart & Vascular Associates On Cardiology’s Leading Edge
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From the Cover
Wake Heart & Vascular Associates:
PHOTO BY BRIAN STRICKLAND
On Cardiology’s Leading Edge
Wake Heart & Vascular Associates, founded in 1985, has grown to become eastern North Carolina’s largest cardiology practice. Its growth is a reflection of founding principles to provide the highest level of cardiac care and cutting-edge technology in the region. Its mission is to serve patients and work with their primary doctors in the prevention and treatment of complex cardiac and vascular disease. 6
The Triangle Physician | MARCH 2010
The practice has broadened beyond cardiac care to include expertise in peripheral vascular and carotid artery disease, including the treatment of stroke. This extension of the practice is a result of the similar nature of the disease processes and treatment strategies for most types of vascular disease. Many of the techniques are transferable to other vascular beds, but all have their own nuances. The basic primary and secondary preventive strategies are similar. In fact, the overlap of patients with atherosclerosis involving more than one vascular territory is over 50 percent.
Today, 24 cardiolovascular specialists at
Dr. Schneider went on to establish the first endovascular program in 1998, when the new WakeMed Heart Center opened. The expansion of angioplasty and stenting in patients with peripheral vascular disease was a natural extension of his interventional cardiology work. The program has since expanded to include carotid artery stenting, acute stroke management and endovascular repair of abdominal and thoracic aneurysms. Nearly 50 patients underwent endovascular repair of abdominal aortic aneurysm last year, allowing minimally invasive care to patients who otherwise would require a complex
Wake Heart & Vascular Associates provide the full complement of cardiology and vascular services: clinical cardiology, echocardiography, nuclear cardiology, cardiac catheterization, interventional cardiology, electrophysiology, cardiac magnetic resonance angiography; treatments for peripheral vascular, carotid artery and cerebrovascular diseases; even pediatric interventional cardiology.
open operation.
PHOTO BY BRIAN STRICKLAND
“All 150 staff members at Wake Heart are integral to our excellent patient care and services. Like our doctors, they come from diverse backgrounds, and are dedicated to supporting the physicians in their delivery of the best possible cardiovascular care. We all treat our patients like family, with the utmost care and understanding.”
Joel Schneider, M.D., F.A.C.C.
Joel Schneider, M.D., F.A.C.C., was recruited by Wake Heart in 1993, after completing an
This past December, Dr. Schneider performed the first elective endovascular thoracic aneurysm repair, in collaboration with cardiothoracic surgeon Abdul Chaudhry, M.D., of Capital Cardiovascular Surgery. “This advanced technology allows patients far easier and safer approaches to managing aneurysmal disease,” says Dr. Schneider.
interventional cardiology fellowship at Emory
Wake Heart founding partner James Tift
University Hospital. Interventional cardiology
Mann III, M.D., is one of the world leaders in
specializes in the prevention and repair of
radial artery catheterization and interventions,
atherosclerotic arteries, caring for a range of
and helps train physicians in the United States
issues from acute myocardial infarction to
in that technique. Robert Lee Jobe, M.D.,
“The strength of Wake Heart lies in the
stable chronic angina. He was instrumental in
F.A.C.C., F.S.C.A.I; Jimmy Locklear, M.D.,
broad range of services we provide, the
starting the coronary stent program at
F.A.C.C.; William N. Newman, M.D.; and
excellent doctors and the commitment to
WakeMed, introducing the new and now widely
Gregory C. Rose, M.D., F.A.C.C., are all
excellent care,” says Eric M. Janis, M.D.,
accepted technology to the region.
actively involved in the Wake Heart cardiac
F.A.C.C., a cardiologist at Wake Heart’s
James Tift Mann III, M.D., F.A.C.C.
stenting program.
Dee Darkes Chief Operating Officer
Smithfield office. “What this group brings is the ability to work together, to collaborate and get input from colleagues who are experts in their fields, and to take care of all patients with any cardiovascular problem under one big umbrella.” MEDICAL LEADERS “Over the years, each new physician who has come to the practice has brought a new set of skills to enhance our comprehensive care and keep us on the leading edge,” says Dr. Janis, whose areas of expertise include
PHOTO BY BRIAN STRICKLAND
echocardiography, nuclear cardiology and cardiac catheterization. In addition to advanced training, most of the medical staff are board certified and many are Fellows of the American College of Cardiology. MARCH 2010 | The Triangle Physician
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PHOTOS BY BRIAN STRICKLAND
Robert Lee Jobe, M.D., F.A.C.C., F.S.C.A.I
Matthew A. Hook, M.D.
Christian N. Gring, M.D., F.A.C.C.
At about the same time that the Food and
The newest member of the Wake Heart
ablation, a non-surgical technique for treating
Drug Administration approved carotid
medical staff is electrophysiologist Matthew
atrial fibrillation and restoring normal rhythm.
stenting in 2004, Ravish Sachar, M.D., F.A.C.C.,
S. Forcina, M.D., from Duke University
was recruited from The Cleveland Clinic to
Medical Center and the Medical University
Wake Heart electrophysiologist Randolph
develop the carotid stenting program at
of South Carolina. Soon after joining the
Cooper, M.D., F.A.C.C., says his colleagues are
WakeMed. Since then, more than 1,000
practice in 2009, Dr. Forcina led the devel-
encouraged by the use of wireless-monitoring
carotid stenting procedures have been per-
opment of a specialized lab at WakeMed
capabilities of implantable defibrillators and
formed, with a less than 1 percent stroke risk.
Heart Center that now provides the newest
pacemakers. “We’re expanding our ability to
Dr. Sachar, one of the authors of the book:
procedures to treat and potentially cure
follow patients with heart failure and not only
Manual of Peripheral Vascular Intervention,
atrial fibrillation.
treat them but diagnose them remotely. That
also has helped develop what has become
way we can manage patient care over the phone
the region’s largest peripheral vascular
Wake Heart’s team of electrophysiologists,
disease treatment program at WakeMed
who specialize in the study and treatment of
Heart Center.
rhythm disorders of the heart, include: Kevin
COMMUNITY-BASED CARE
Ray Campbell, M.D., F.A.C.C.; Randolph Cooper,
As Wake Heart & Vascular Associates’
Matthew A. Hook, M.D., joined Wake
M.D., F.A.C.C.; and James R. Foster, M.D.,
services have expanded, so too has its reach.
Heart from The Cleveland Clinic in 2007 to
F.A.C.C. Therapeutic modalities include antiar-
Today, 15 Wake Heart locations serve an
expand the WakeMed coronary artery
rhythmic drug therapy; surgical implantation
area from southern Virginia to multiple
stenting program. He also brought with him
of pacemakers, cardioverter-defibrillators and
locations in eastern North Carolina. Wake
solid expertise in peripheral vascular
resynchronization devices; and radiofrequency
Heart’s newest office in Oxford, N.C., opens
procedures, carotid stenting and intracranial
Randolph Cooper, M.D., F.A.C.C.
in association with Granville Medical Center
interventions.
instead of in the hospital,” says Dr. Cooper.
this summer. The Goldsboro office is being relocated across from Wayne Memorial
Christian N. Gring, M.D., F.A.C.C., also
Hospital, and will offer expanded services and
trained at The Cleveland Clinic in dedicated
more examination rooms. “The new office
non-invasive heart imaging, including cardiac-
will allow us to see more patients and offer
computed tomography, angiography and
additional noninvasive services, such as
cardiac MRI. He brought his skills to Wake
echocardiology, nuclear cardiology, stress
Heart in 2006.
testing and peripheral vascular studies,” says Dr. Schneider.
8
The Triangle Physician | MARCH 2010
Mateen Akhtar, M.D.; Benjamin G. Atkeson,
Dr. Zellinger says many of Wake Heart’s
North Carolina, making Wake Heart &
M.D., F.A.C.C.; Arthur Y. Chow, M.D., F.A.C.C.;
relationships with referral physicians began
Vascular the busiest cardiology practice.
Joseph M. Falsone, M.D., F.A.C.C.; Andrew C.
with the practice founders some 25 years
Kronenberg, M.D., F.A.C.C.; Robert B. Wesley II,
ago. “Wake Heart values and nurtures its
M.D., F.A.C.C.; and Michael Jay Zellinger, M.D.,
working relationships in the various com-
F.A.C.C., are all instrumental in providing
munities. That’s what’s helped build the
care to the community in locations like Cary,
practice,” he says. It also assures continuity
Clayton, Knightdale, Lewisburg, North Wake
of care. As soon as patients have been
and Smithfield. “We want to bring cardiology
treated for their cardiovascular problems by
care to the community, so the community
Wake Heart, they are returned to the care
doesn’t have to travel long distances to us,” says
of their referring physician, with ongoing
Dr. Zellinger, a founding Wake Heart partner.
communication between all doctors
Dr. Schneider points to Wake Heart’s participation in WakeMed’s “STEMI” (ST-Segment, E-Elevation, M-Myocardial, I-Infarction) program, designed to achieve the national “door-to-balloon time” standard for opening an infarct-related artery in under 90 minutes. The Code STEMI program boasts an average door-to-balloon time of 55 minutes. The STEMI team is activated as soon as the
involved in their care.
emergency medical technician reaches the
“No. 1, Wake Heart has always been available, reliable and provided great expertise; response for follow up has been excellent. It’s just a great group to work with,” says Dr. Samuel
is sent to the WakeMed Emergency
ageal echo test and heart catheterization in
with Dr. William J. Stackhouse at Goldsboro
the 90-minute goal, meaning that a patient
Smithfield. The procedures showed both
Medical Specialists. They’re referral relation-
coronary artery disease and a severe heart
ship traces back to Wake Heart’s early years.
receiving the best care possible,” says Dr.
Dr. Janis points to the case of a 77-year-old Clinton woman who suffered from dizziness. She was referred to Dr. Hook in the Wake Heart Smithfield office, saving her a 30-to-40-minute drive to Raleigh. After testing in the office showed she had blockages in both neck arteries and a loud heart murmur due to a heart valve problem,
Department to be analyzed. If an acute myocardial infarction is suspected, a special cardiac team prepares for the patient’s arrival and alerts the on-call interventional cardiologist. “This past year, Wake Heart physicians achieved a 100 percent success in reaching experiencing a heart attack can count on
PHOTO BY BRIAN STRICKLAND
she was set up for a specialized transesoph-
B. McLamb Jr., who practices internal medicine
patient in the field and takes an EKG, which
Dr. Gring reading a CT angiogram of the heart.
TIME AND EXPERIENCE
Schneider. “What we do is life changing, not
WakeMed, where Dr. Hook first placed a
OF THE ESSENCE
only life saving.”
stent in one of the patient’s neck arteries
By virtue of its expertise, size and proximity,
and then referred the patient for heart valve
Wake Heart physicians have been at the
surgery. “By providing services in multiple
forefront of advances in cardiac and vascular
locations at different hospitals, we were
care at WakeMed Heart Center in Raleigh,
able to give superior service for the patient,
and have been integral to its success. With
with a minimum of difficulty for her and
more than 27,900 total procedures performed
her family,” says Dr. Janis.
each year, it is the busiest heart center in
valve problem. Surgery was scheduled at
Dr. Schneider points to a complicated case recently involving a 51-year-old man who arrived at the hospital having a heart attack. With the Code STEMI team ready, the man was taken directly from the ambulance to the catheterization lab. The patient’s heart MARCH 2010 | The Triangle Physician
9
salvage result in a dramatic improvement in
in and lead numerous cutting-edge clinical
quality of life.”
trials for new devices, drugs and protocols.”
Drs. Sachar and Hook also helped lead the
COMMUNITY COMMITMENT
development of Wake County’s first acute
Wake Heart & Vascular Associates cardiol-
interventional stroke program at WakeMed
ogists are involved in the community, serv-
Heart Center, which is the only Joint
ing on boards and committees, speaking at
Commission-certified primary stroke center
community forums and promoting good
in Wake County. Until recently, stroke could
cardiovascular health for all.
PHOTO BY BRIAN STRICKLAND
only be treated by giving clot-dissolving
Ravish Sachar, M.D., F.A.C.C.
repeatedly stopped and had to be defibrillated 16 times. The blocked artery was opened within 30 minutes of arrival and afterward the patient was transferred to the coronary care unit. When delivering the good news to the family, Dr. Schneider recalls noting that only the patient’s young daughter and her grandmother were in the waiting room. He came to learn the girl’s mother had died of cancer last year, and by saving the patient, he also had prevented the child from becoming an orphan. “The most rewarding part of our work, probably for all of us, is the impact we make for patients and their families,” says Dr. Schneider. PERIPHERAL VASCULAR AND CEREBROVASCULAR PIONEERS
agents intravenously, called thrombolysis.
On Saturday, Feb. 27, the practice will join
With FDA approval, Wake Heart physicians
WakeMed Heart Center in hosting the fifth
are now able to remove clots directly from
annual cardiovascular education symposium
the brain, often with dramatic clinical
to share information on advances in cardiology
results. “It’s very cutting edge. No one else
and heart/vascular care, with an emphasis on
in Wake County is doing this and there are
prevention. This year’s “Health Care in Evolu-
only a handful of centers of this kind in the
tion: Opportunities and Challenges for the
country,” says Dr. Sachar.
Cardiovascular Patient” will shed light on health care reform. The symposium will be from 8:30
He recalls the case last March of a 37-year-
a.m. to 3:45 p.m. at WakeMed Heart Center
old woman who had delivered twins by
Conference Center. It is open to all medical
C-section two weeks prior. She arrived at
professionals. Call (919) 350-8547 for details.
WakeMed completely paralyzed on her left side, after suffering a stroke on the right side of her brain. During an eight-hour procedure, Dr. Sachar removed all the blood clots and the woman made a complete recovery. Today, he calls the case a “career standout.” Had intravenous thrombolytic agents been administered, the outcome may not have been so successful. “Everything we do in our practice is done in an evidence-based way or as part of clinical trials,” says Dr. Sachar. “The physicians who are doing these procedures are very welltrained. They are leaders in their field nationally and internationally, and they bring that expertise to the area. They are involved Christy Moore, P.A. making rounds at WakeMed
For their quality of life contributions, the cardiologists at Wake Heart have won numerous accolades and awards. Two have been named Health Care Heroes by The Triangle Business Journal, Dr. Sachar in 2009 and Dr. Janis in 2007. Drs. Mann and Janis were selected by The Triangle Business Journal and Best Doctors Inc. as two of the Best Doctors in America for 2009-2010. Janis reflects on all the rewards of his calling: “being a part of the medical community and the community as a whole; helping patients work on preventing heart disease; helping people focus on staying healthy; keeping a positive attitude even in the face of serious illness or a disabling medical condition; and allowing people to stay healthy and active.”
“We are expanding the frontiers at both ends of the body, in the brain and in the feet,” says Dr. Sachar. “Advances in restoring blood flow to the legs and feet are saving legs that would have been technology uses a combination of balloons, stents, lasers and atherectomy devices to go into the small arteries below the knee and into the feet. “Procedures that result in limb 10
The Triangle Physician | MARCH 2010
PHOTO BY JIM SHAW
amputated five or 10 years ago,” he says. The