Physician’s Brief clinical and research highlights for our colleagues in cardiovascular medicine Ye a r- E n d 2014
Unique U-M Clinic Addresses Cardiac Complications of Cancer Treatment The U-M Frankel Cardiovascular Center is one of only a handful of top centers – and the first in Michigan – to offer a dedicated Cardio-Oncology clinic focused on preventing or minimizing heart damage caused by chemotherapy and radiation therapy for cancer. The clinic is led by cardiologists Monika Leja, M.D., and Elina Yamada, M.D. “Advances in treatment have reduced cancer deaths, but in the past 10 to 15 years there’s been an emerging trend of premature heart disease among cancer survivors,” says Leja. “Using sophisticated imaging technology and biomarkers, we can better identify those patients whose hearts have been weakened as a result of cancer treatment.” Common cardiovascular complications linked to cancer treatment include heart failure, chemotherapy-induced hypertension, acute myocardial
infarction and arrhythmias. Cancer patients with or without known heart disease or risk can benefit from a clinical assessment of heart function and, if needed, continued cardiovascular care once their cancer treatment is completed. Cancer survivors, even those diagnosed and treated at a young age, are also evaluated and treated at the clinic when a major illness, injury or even pregnancy could trigger a reaction in the heart to the toxic effects of previous cancer treatment.
In addition, The U-M Frankel Cardiovascular Center’s Cardio-Oncology clinic has the multidisciplinary expertise to treat rare but potentially deadly heart tumors. Tumors may either originate in the heart itself or spread from primary tumors in nearby organs such as the lungs or kidneys. Roughly 75 percent of primary cardiac tumors are benign, but they can lead to serious heart problems and interfere with the heart’s normal functioning. Continued on page 2
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Continued from page 1 Preventing heart disease in cancer patients is gaining more importance as aggressive cancer therapies are applied to older patients and as researchers identify a growing number of cardiovascular side effects of anti-cancer therapy. Careful evaluation of heart disease in cancer patients will likely improve quality of life but may also improve mortality as the presence or development of heart disease may significantly limit lifesaving cancer therapies. “If we ignore what’s happening in the heart, we could lose the gains we’ve made in cancer survival,” Leja says. “Heart disease, and not cancer, poses the larger risk to the 2.2 million breast cancer survivors in the United States. Organizations including the American Society of Clinical Oncology believe the rise of cardiology-oncology clinics like U-M’s could have a great impact on treatment outcomes and patient care. A dedicated clinic has the potential to allow the safe completion of cancer treatment without significantly increasing heart risk.
Heart disease in a 30-yearold is rare; heart disease in a 30-year-old sarcoma survivor is not. A specific area of focus at U-M is monitoring and treating sarcoma survivors. While the majority of sarcoma patients will be cured of
different is that this particular population will face these issues at a younger age than you’d typically see. Because of that, our emphasis will be on early detection,” says Leja.
Laurence Baker, D.O., and Monika Leja, M.D.
their disease and live cancer-free, as they age, these patients – who are diagnosed as children, teens or young adults – are at great risk of developing a severe or life-threatening chronic medical condition related to their treatment. The main issue facing sarcoma survivors is heart disease –nearly a third will develop a cardiac issue after treatment. To help these patients, U-M opened a first-of-its-kind Adult Sarcoma Survivorship Clinic in October, 2014. In addition to cardiac care, the multidisciplinary clinic includes specialists in kidney disease, endocrinology, physical medicine and rehabilitation, and psychiatry to help manage the conditions most often seen in sarcoma survivors. “Many of these issues can be treated effectively with early interventions using common, established techniques. What’s
“Patients who are cured of sarcoma as teens should be able to live into their 80s,” adds Laurence Baker, D.O., who has been treating sarcoma patients for more than 40 years. “But we see many of these patients develop heart disease, renal disease or other late effects in their 30s or 40s. We have a tremendous potential with this clinic to impact long-term survival for these patients.” This is a new clinical model in cancer survivorship, with Baker, an oncologist, and Leja, a cardiologist, working side by side to evaluate sarcoma survivors. The clinic is open to bone sarcoma and soft tissue sarcoma survivors 18 and older who have been off all therapy for at least two years. Patients are eligible even if they received their sarcoma treatment outside of the University of Michigan.
To connect with a physician in the U-M Frankel Cardiovascular Center’s Cardio-Oncology Clinic or the Adult Sarcoma Survivorship Clinic, call M-LINE at 800-962-3555.
U-M First to Implant Investigational Device for Thoracic Aneurysm Early in 2014, a U-M Frankel Cardiovascular Center team performed the first ever implantation of the GORE® TAG® Thoracic Branch Endoprosthesis. The investigational device treats thoracic aortic aneurysms, which generally occur in the elderly and can lead to a life-threatening rupture of the aorta. Although thoracic aortic aneurysms are less common than abdominal aortic aneurysms, a TAA rupture remains a fatal event. Designed to seal-off a hard-to-treat section of the aorta, the device potentially provides a safe and less invasive alternative to open heart surgery. The first human recipient of the GORE® TAG® Thoracic Branch Endoprosthesis was an 84-year-old woman. The device had previously only been used in laboratory studies. The procedure marks the beginning of Evaluation of the GORE® TAG ® Thoracic Branch Endoprosthesis in the Treatment of Proximal Descending Thoracic Aortic Aneurysms, a U.S.-based multi-center feasibility study sponsored by W.L. Gore & Associates. “Thoracic aortic aneurysms that encroach on the aortic arch make treating these challenging anatomies very difficult, leaving physicians no choice but to use
more invasive surgical techniques or to cover the branch vessel,” says Himanshu Patel, M.D., a cardiothoracic surgeon and the leader of the team coordinating the study at U-M. “Using GORE® TAG® Thoracic Branch Endoprosthesis, we were able to successfully treat the first patient in the study using endovascular means only. These results demonstrate the feasibility of using branched stentgrafts to treat aortic aneurysms that involve the left subclavian artery.”
Himanshu J. Patel, M.D.
Through thoracic branch technology and design, the Gore device fits the unique characteristics of the descending aorta, allowing physicians to treat a subset of patients that in the past could not be considered for total endovascular repair. Endovascular repair uses realtime x-ray and guide wires to help deliver a graft, inserted via catheter, to exclude the lesion inside the diseased aorta, making a new path for blood to flow. Through this less invasive technique, physicians can treat conditions through small incisions in the groin that might otherwise require open chest surgery.
To connect with a member of the U-M team coordinating the study, call M-LINE at 800-962-3555.
U-M TAVR TICKER: 400 aortic valves replaced and counting
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University of Michigan Samuel and Jean Frankel Cardiovascular Center Kim A. Eagle, M.D., David J. Pinsky, M.D., Richard L. Prager, M.D., Thomas Wakefield, M.D., Directors Executive Officers of the University of Michigan Health System
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