WMC Cardiac 2011

A S U P P L E M E N T T O W E S T C H E S T E R H E A LT H & L I F E M A G A Z I N E F R O M WESTCHESTER MEDICAL CENTER

heartcare ADVANCES IN

‘I WANT TO BREATHE OUTSIDE AIR’

WMC_Cardiac_0211REV1.indd 1

GOOD DEVICES FOR BAD HEARTS

FETAL CARDIOLOGY SAVES LIVES

CAN STEM CELLS REPAIR A DAMAGED ORGAN?

1/18/11 1:49 PM

contents 12

10

14 4

12

welcome 8

letter

i n T h i s s p e c i a l s upp l e m e n t t o W e s t c h e s t e r

advances in

heart care W e lco m e

3

w h at ’ s n e w i n d i ag n o s i s

and top 10 percent in the nation for cardiac surgery care, and as

You will read about the amazing, life-changing procedures performed by our surgeons on patients young and old—as well as the innovative use of devices such as the Centrimag® and HeartMate® that significantly improve our patients’ health and quality of life.

g o o d d e v i c e s

for bad hearts

8

Westchester Medical Center, ranking us in the top 10 in New York

Award from the American Heart Association.

and treatment

6

of the breadth and depth of the heart services available at

one of a handful of hospitals in the nation to earn the Triple Gold

2

4

H e a lt h & L i f e m a g a z i n e , you will get a solid overview

‘ I wa n t to b r e at h E

Get a glimpse into the future by reading how our new hybrid operating room—opening later this year—will allow interventional cardiologists, cardiac surgeons, neurosurgeons and vascular surgeons

the outside air’

to work together.

RE PAIRING

Department of Medicine and Physiology will contribute to the

tiny hearts

discovery of groundbreaking therapeutic alternatives for patients

And learn how research at Westchester Medical Center’s

with coronary artery disease and cardiomyopathy.

10 THE POWER o f

We hope you enjoy reading about all that

sharing

Westchester Medical Center has to offer for children

12 CAN

and adults in need of advanced cardiac care and STEM CELLS r e pa i r

a damaged heart?

14

invite you to visit us at www.thewestchesterheart. com to learn more about our cardiac services.

Y O U C A N RED U CE YO U R r i s k

of heart disease Advances in Heart Care is published by Wainscot Media, Montvale, N.J. © 2011.

All rights reserved.

2

advances in heart

WMC_Cardiac_0211final.indd 2

Michael D. Israel President and CEO Westchester Medical Center

care 1/18/11 12:08 PM

what’s new in

diagnosis & treatment one of the nation’s leading medical centers offers comprehensive services for heart disease

There’s good news for the more than 80 million Americans who suffer

angina and heart attacks • Heart attack, which occurs when

minimally invasive mitral valve repairs to repair of complex thoracic aortic

from heart disease: Dramatic strides have

your heart is damaged by extended

aneurysms.

been made in prevention, diagnosis and

oxygen deprivation

treatment, leading to a reduction in deaths from this national number-one killer.

That progress is much in evidence at Westchester Heart at Westchester

• Heart defects present at birth, also called congenital heart disease • Irregular heartbeats, which are also termed arrhythmias.

Vascular Diagnostic Services Westchester Heart also offers several vascular diagnostic services to assist in early diagnosis and prevention of serious

When blocked or narrowed coronary

vascular conditions, including diseases of

percent in the nation for overall cardiac

arteries are the cause of congestive heart

the arteries, veins and lymph vessels and

care and best in the region for cardiology

failure, angioplasty—with or without

blood disorders that affect circulation.

services. It’s home to a specialized

stenting—may improve overall heart

coronary care unit, a dedicated cardiology

function and reduce or resolve heart-

New York State for cardiac surgery and

unit, a state-of-the-art cardiac diagnostic

failure symptoms. High-risk interventions

cardiac catheterization, Westchester

center and one of the region’s leading

can now be performed safely with a

Heart at Westchester Medical Center

cardiac catheterization labs. In addition,

new state-of-the-art catheter offering

offers services to patients of all ages,

Westchester Medical Center’s Aortic

hemodynamic (blood-flow) stability while

from diagnostic services and minimally

Aneurysm Program is a lifesaving

the patient’s arteries are worked on.

invasive surgeries to highly technical

Medical Center, ranked among the top 10

resource for patients and referring

The Cardiothoracic Surgery

As one of the top 10 hospitals in

invasive cardiothoracic procedures such

Program at Westchester Heart, ranked

as mitral valve repair, coronary bypass,

among the top 10 percent of such

ventricular assistive devices and heart

ization Lab, one of the busiest on the

programs nationally, offers patients the

transplant surgery. And post-procedure

East Coast, performs more than 5,000

latest surgical techniques. The medical

recovery and rehabilitation are also

diagnostic cardiac catheterizations and

team has expertise across the spectrum

provided without requiring a long trip.

more than 1,600 angioplasty and coronary

of cardiothoracic procedures—from

stent procedures annually. It is available

coronary bypass grafting (CABG) to

physicians throughout the Hudson Valley.

Westchester Heart’s Cardiac Catheter-

Visit thewestchesterheart.com to learn more.

24/7 for emergency lifesaving procedures.

Cardiac catheterization is used to diagnose abnormalities of the coronary blood vessels that supply blood to the heart. It can also be used to observe heart chambers and heart valves, and may be advised for people who have or are suspected to have one of these conditions: • Abnormal enlargement of the heart • Angina, chest pain that results when too little oxygen reaches the heart for a short period • Coronary artery disease, which is a blockage in the arteries that supply blood to your heart, and is often the cause of

to FIND A

physician WMC_Cardiac_0211final.indd 3

Westcheste r M edical C enter 1-877-WMC-DOCS | www.worldclassmedicine.com

1/18/11 12:08 PM

GOOD devices FOr

f o r t Y- s i X-Y e a r old Bill Dehnert owes his life to the good doctors at Westchester Medical Center and the devices they deploy.

neW technologY

The Cortlandt Manor auto appraiser went into cardiac arrest while

helPs in the

being transferred from Hudson Valley

fight against

for emergency angioplasty. While

advanced cardiovascUlar disease

Hospital to Westchester Medical Center healthcare personnel Tyrone Fuller and Pablo Quinones performed CPr, Craig Monsen, M.D., Associate Chief of Cardiology, went to work.

Within minutes, Dr. Monsen performed an angiogram—an imaging study of Dehnert’s heart—that showed that three of his coronary arteries were blocked. Starved of oxygen-rich blood, Dehnert’s heart—particularly his left ventricle—suffered major damage and then stopped.

“Our first priority was to get oxygen into Mr. Dehnert’s blood and then get the blood circulating to restore oxygen to his brain and other major organs,” says Dr. Monsen, an interventional cardiologist and Associate Professor of Clinical Medicine at New York Medical College.

While Fuller and Quinones continued to perform chest compressions, Dr. Monsen threaded two

4

advances in heart

WMC_Cardiac_0211final.indd 4

care 1/18/11 12:08 PM

Westchester is among a very few facilities that combine the new centrimag® with an oxygenator to give damaged hearts a chance to rest and recover. spaghetti-thin tubes called

minimize any brain damage

catheters into an incision made

that might have occurred during

craig monsen, m.d.

for Mr. Dehnert,” says Howard Tarkin, M.D., an attending physician at the

in Dehnert’s groin up to an artery and

the 30 minutes that his brain was without

medical center and an Assistant Clinical

a vein in his heart. The catheters were

oxygen while his heart was stopped,”

Professor of Medicine at New York

attached to two machines outside his

says Dr. Monsen.

Medical College—and Mr. Dehnert’s

body: the CentriMag® ventricular assist

For two days, Dehnert was sedated

device (VAD) that took over the pumping

and his body cooled to about 92 degrees

action of his heart, and an oxygenator,

Fahrenheit. While this “hypothermic

which took over for his lungs, supplying

protocol” protected his brain, the

oxygen to his blood and expelling

CentriMag® gave his heart a chance to

carbon dioxide from it. While Dehnert’s

recover. By day three, his heart function

own heart and lungs rested, Dr. Monsen

and his body temperature were back to

opened up the three blocked arteries and

normal. And by day five, the CentriMag®

put in tiny scaffolds called stents to keep

was removed. Once he was awake,

them open and allow the restoration of

neurological tests showed that his brain,

blood flow to the heart.

remarkably, did not suffer any damage.

“Within 20 minutes we were

Two weeks later, he was home with his

able to install the CentriMag® and get

fiancée, Paula, and their dog, Hershey.

it working, which is about half the

“I’m just happy to wake up every

time it would have taken to put in a TandemHeart®, another type of assist

day,” says Dehnert.

“According to state statistics,

device we’re using here,” explains Dr.

only about 5 percent of New Yorkers

Monsen. The TandemHeart® is a good

survive the type of heart attack and

choice when physicians have more

cardiac arrest that Mr. Dehnert had,”

time to insert a device, and it can keep

says Dr. Monsen. “The fact that we

working for up to 14 days.

were able to bring him back, and that

Although other major medical

he did not sustain any permanent

centers throughout the United States

damage to the rest of his body, is a

are using the CentriMag® to take over

testament to the team effort of our

a damaged heart’s pumping action,

cardiologists, cardiothoracic surgeons

only Westchester Medical Center and

and perfusionists, who over the

a few other facilities are combining the

months leading up to this event fine-

technology with an oxygenator so that

tuned the CentriMag ® procedure so

a patient’s heart can completely rest

that we were ready to utilize it with a

and recover.

moment’s notice.”

more Work to do

and Westchester Medical Center’s

But Dehnert wasn’t out of the woods

24-hour cardiac catheterization

just yet.

and intervention services were the

“Innovative treatment techniques

“Our next objective was to try and

to MAke AN

appointment WMC_Cardiac_0211final.indd 5

primary cardiologist. “His prognosis is excellent for a full and active life.”

techNOlOGy THAT MAKES A

DiffereNce centrimag® is the latest generation of mechanical assist devices to be employed at Westchester medical center. these devices act as either a short-term “bridge to recovery” (as in bill dehnert’s case, at left) or a “bridge to transplant,” or as a long-term “destination therapy” for patients who are too old or too ill to undergo a heart transplant or who decline the surgery for religious reasons. other mechanical assist devices in use at the facility are the short-term percutaneous tandemheart®, which is installed through the groin and does not require a chest incision, and the long-term heartmate® ii, a secondgeneration left ventricular heart-assist device (lvad) that, so far, has kept 70 percent of all patients who have received it alive for up to five years.

difference between life and death

WESTCHESTEr MEDICAL CENTEr 1-877-Wmc-docs | WWW.Worldclassmedicine.com

1/18/11 12:08 PM

‘I WANT TO BREATHE THE

outside air’

TWO HEART-ASSIST DEVICES GIVE A MAN’S HEART TIME TO HEAL

IT’S THE SIMPLE THINGS

one hour was amazing. Even more

routinely perform diagnostic testing and

that sometimes mean the most. After

amazing was that he did not require

interventional procedures in the Cardiac

“living” at Westchester Medical Center for

a heart transplant, says Linda Cuomo,

Catheterization Lab. Using thin tubes

nearly three months following his transfer

M.D., an interventional cardiologist at

called catheters, balloons and stents are

from another facility for an emergency

Westchester Medical Center.

introduced into an artery in the groin

angioplasty, John Kenney, a 60-year-old

or wrist and then threaded into the

auto mechanic from Holmes, N.Y., had only

Catheterization Laboratory, Dr. Cuomo,

arteries leading to and from the heart.

two requests: “I wanted to walk out of the

with assistance from cardiac surgeon

Patients who undergo these procedures

hospital without an IV pole and to breathe

Ramin Malekan, M.D., partners, fellows

can usually go home the following day

the outside air,” he says.

and the Cath Lab nursing and technician

and are spared surgery.

Kenney did both when he left the medical center on November 16, 2010.

That Kenney survived cardiac arrest that left him with no pulse or heartbeat for almost

 BELOW: DURING A CARDIAC CATHETERIZATION PROCEDURE, A DYE IS INJECTED INTO THE CORONARY ARTERIES TO GIVE THE CARDIOLOGIST A BETTER VIEW OF THE ARTERIES VIA FLUOROSCOPY.  INSET: A CARDIAC CATHETER IS INSERTED INTO A PATIENT.

6

In the facility’s advanced Cardiac

advances in heart

WMC_Cardiac_0211REV3.indd 6

staff, brought Kenney back to life.

Interventional

A DANGEROUS BLOCKAGE

cardiologists at

An angiogram—a diagnostic imaging

Westchester Medical Center

test of the heart’s blood vessels— revealed that Kenney’s left main

BOUNCING BACK FROM

A HEART DEFECT

Baby Donovan McCracken won’t remember, but he gave his parents quite a scare when he was just seven days old. That’s when he underwent an interventional heart procedure at Westchester Medical Center.

Donovan was born with pulmonary valve stenosis, narrowing of the heart valve that opens to allow blood to flow from the heart to the lungs. By inflating and then deflating a special balloon atop a catheter threaded into Donovan’s tiny pulmonary valve, Markus Erb, M.D., Director of Pediatric Cardiac Intervention at Maria Fareri Children’s Hospital at Westchester Medical Center, opened up the valve and restored blood flow in the area. That evening, Donovan was home sleeping in his own crib.

“My husband Andrew and I were so devastated when we learned that our newborn had to undergo a heart procedure,” says Donovan’s mother, Rebecca. “But when we met Dr. Erb and the wonderful nurses and technicians who took care of Donovan, we were comforted knowing that they had performed this procedure many times. We’re so lucky that the medical center is so close to our home in Ossining.”

Thanks to the expert treatment Donovan, now nine months old, received at Maria Fareri Children’s Hospital at Westchester Medical Center, he is expected to develop normally, with no restrictions on his activities.

care 1/19/11 11:54 AM

linda cuomo, m.d.

artery was completely blocked. “Most

protect his heart from potentially life-

patients do not survive the massive

threatening arrythmias. It was then that

heart damage Mr. Kenney experienced,”

he was able to walk out of Westchester

says Dr. Cuomo. “A total blockage robs

Medical Center, sans IV pole, to breathe

the heart tissue of oxygen-rich blood,

the crisp autumn air.

causing it to die.”

anthony Pucillo, m.d.

Says Kenney, who continues to see

Using a balloon-tipped catheter

Dr. Gass periodically for his ongoing

threaded through blood vessels from

cardiac care: “It was divine intervention

Kenney’s groin all the way to his heart,

that got me here.”

Dr. Cuomo opened up the artery and inserted a metal stent into the vessel to keep it open. Then she installed a

UPGrADING SErVICES:

What’s NeXt

mechanical heart-assist device called an intra-aortic balloon pump into Kenney’s aorta to help his heart resume pumping blood.

Still, Kenney’s heart was functioning at less than 10 percent capacity. As a result, Dr. Malekan implanted a shortterm TandemHeart® device to pull oxygenated blood from Kenney’s heart to his body. A TandemHeart® can be a “bridge to recovery” or a “bridge to transplantation” if the patient has endstage heart failure.

Kenney’s doctors expected that he’d need a new heart and a long-term left ventricular assist device (LVAD) to keep him alive while he waited for a donor. His care was then assumed by Alan Gass, M.D., the medical center’s Medical Director of Heart Failure, Heart Transplantation and Mechanical Circulatory Support.

Instead, over the next two months, Kenney’s heart rallied, and he was weaned off the intravenous medication helping his heart to pump blood. An implantable cardioverter defibrillator

the cardiac catheterization laboratorY at Westchester medical center is one of the most Patients of all ages—from premature soPhisticated Units of its kind in the region. babies to seniors—have been diagnosed and treated in Westchester medical center’s cardiac catheterization laboratory. later this year, the suite will undergo a complete renovation and upgrade in technology. also, a new “hybrid” operating room will open for patients with heart, vascular and neurological conditions. here interventional cardiologists, cardiac surgeons, neurosurgeons and vascular surgeons will work together. it’s likely that the medical center’s first nonsurgical percutaneous aortic valve replacement procedure will be accomplished in the “hybrid room,” predicts anthony Pucillo, m.d., director of the cardiac catheterization laboratory. “this will bring together interventional cardiologists and cardiothoracic surgeons to treat patients with severe narrowing of the aortic valve,” says dr. Pucillo, an associate Professor of medicine at new York medical college. “it will open up a whole new treatment option for patients who are poor candidates for surgery.” the hybrid room will be used for three main diagnostic and treatment specialties: (1) coronary interventions for patients with acute and chronic heart conditions, including emergency angioplasty/stenting and the placement of short-term and long-term mechanical heart-assist devices; (2) non-coronary interventions to treat narrowing and blockages of blood vessels other than those of the heart, including arteries and veins leading to and from the brain, neck, legs, kidneys, intestines, hands and other areas; and (3) electrophysiology testing and treatment for heart arrhythmias in conjunction with the medical center’s expanded electrophysiology laboratory.

was inserted by Martin Cohen, M.D., to

to MAke AN

appointment WMC_Cardiac_0211final.indd 7

WESTCHESTEr MEDICAL CENTEr 1-877-Wmc-docs | WWW.Worldclassmedicine.com

1/18/11 12:08 PM

repAiriNG Prenatal diagnosis and treatment enhance Positive oUtcomes

all the parts of the heart are in place, to

surgeon and pediatric intensivists to

identify any defects or nonfunctioning

prepare for the birth. This helps achieve

blood vessels or valves and to calculate

the best outcome for the baby.”

heart rhythms,” says Frank Manning, M.D.,

must wait until birth to be addressed,

internationally recognized for creating the

dangerous heart arrhythmias can be

the trUe measUre of the

fetal biophysical profile to evaluate fetal

treated by giving the mother medication

success of the Pediatric Cardiology

anatomy and health. He and his associate,

to regulate the fetus’ heart rate. A

Program at Maria Fareri Children’s Hospital

Geetha rajendran, M.D., provide prenatal

permanent pacemaker can be placed in

at Westchester Medical Center is seeing

care for women with acute or chronic

tiny newborn babies if necessary.

the men and women who have survived

diseases that put them at risk for carrying

childhood heart conditions and are now

a fetus with a heart abnormality, as well as

breakthroUgh sUrgeries

having babies of their own.

healthy women whose fetuses have been

Most fetuses identified as having heart

diagnosed with a congenital heart defect.

abnormalities are delivered by maternal-

More than 100,000 young people have been diagnosed, treated and

If a sonogram shows a fetal heart

fetal medicine specialists and then

monitored for heart ailments ranging from

problem, the mother is referred to Maria

transferred to the Isaac and Naomi

congenital defects to rhythm irregularities

Fareri Children’s Hospital’s fetal cardiology

Kaplan Family Foundation regional

since the program was founded in 1983

services, led by pediatric cardiologist

Neonatal Intensive Care Unit at Maria

by Michael Gewitz, M.D, Physician-in-

Bernard Fish, M.D. Using state-of-the-

Fareri Children’s Hospital. Some of these

Chief of Maria Fareri Children’s Hospital at

art multi-dimensional echocardiography

newborns require surgery within hours

Westchester Medical Center and its Chief

technology, Dr. Fish and his colleagues,

or days. For others, waiting until they

of Pediatric Cardiology.

Henry Issenberg, M.D., Director of the

are bigger and stronger is best.

“There is almost no heart

Pediatric Echocardiography Lab, and

From 2006 through 2009, nearly

abnormality that we can’t diagnose

pediatric cardiologist Deborah Friedman,

300 infants and children underwent

here and then treat,” says Dr. Gewitz.

M.D., further evaluate fetal heart defects.

heart surgery at Maria Fareri Children’s

Each day, the hospital’s 35-person team

(The three physicians also use advanced

Hospital at Westchester Medical Center,

of highly trained professionals and

three-dimensional echocardiography to

most of whom had congenital defects

specialized support staff focuses on

evaluate the heart valves and chambers of

repaired. Pediatric cardiac surgeon Suvro

keeping little hearts beating and growing.

newborns and older children.)

S. Sett, M.D., physician assistants David

“With 95 percent of the fetal cardiologY saves lives

fetuses who are at potential

When a mother-to-be undergoes her

risk for a heart problem,

first routine sonogram at 12 weeks of

we can reassure

pregnancy, her baby’s heart is beating

the parents that

about 140 to 170 times per minute. By 18

nothing is wrong,”

weeks, 90 percent of all heart defects can

says Dr. Fish. “If

be detected in the acorn-sized organ.

there is a defect,

“Our three-dimensional ultrason-

8

Although most fetal heart problems

a maternal-fetal medicine specialist who is

we consult with

ography units examine the four chambers

our neonatologists,

and the large blood vessels to ensure

a pediatric cardiac

advances in heart

WMC_Cardiac_0211final.indd 8

Volpe and Anna riccio and their team achieved a 97.4 percent

With 95% of the fetuses who are at potential risk for heart problems, parents can be reassured that nothing is wrong.

survival rate. No other hospital in the region has an equal record for pediatric cardiac care.

“We are saving the lives of children who would not have lived just 20 years ago,” says Dr. Sett.

care 1/18/11 12:08 PM

michael gewitz, m.d.

bernard fish, m.d.

markus erb, m.d.

testing for YoUng Patients

as little as 1.5 pounds,” says Markus

Noninvasive cardiac tests—including

Erb, M.D., Director of Pediatric Cardiac

electrocardiograms (ECGs), stress tests

Intervention. “Eighty percent of all holes

and echocardiograms—are most often

in the heart can be repaired with an

the first line of diagnostic testing for

interventional procedure.”

children with suspected heart problems.

These tests do not usually require

maPPing heartbeats

anesthesia and are easily tolerated by

When a disturbance in the electrical

babies and young children.

system that regulates a child’s heartbeat

Westchester Medical Center’s

is suspected, pediatric electrophysiologists

256-slice computed tomography (CT)

use advanced technology to pinpoint the

scanner—the only one in the lower

exact area of the heart that is affected.

Hudson Valley—uses ultra-high-resolution

Treatment may include medications,

3-D imaging to capture visual “slices”

radiofrequency ablations, pacemakers

of the heart and blood vessels. This

or implantable cardioverter defibrillators

technology can produce a detailed

(ICDs). Irfan Warsy, M.D., a pediatric

image of a child’s heart in less than two

electrophysiologist at Maria Fareri

heartbeats, reducing the amount of

Children’s Hospital and Assistant

radiation needed to assess congenital

Professor at New York Medical College,

heart defects or abnormalities in blood

recently joined the staff after advanced

flow to the heart. The medical center’s 3

training at Duke University. With catheter-

Tesla Mr imaging system, twice as strong

based technology, he is able to effectively

as conventional magnetic resonance

cure many arrhythmias in children and help

machines, helps to assess a heart problem

them avoid years of daily machines and

without exposing the child to radiation.

lifestyle restrictions.

PictUres tell a storY

move into the hospital’s Adult Congenital

Even after noninvasive testing is

Heart Disease Center, where adult and

completed, a diagnostic imaging study

pediatric cardiologists collaborate on their

called an angiogram may be needed to

continuing care for the rest of their lives. If

assess how blood flows to and from the

female patients want to have children, they

heart in complex congenital defects.

are referred to Drs. Manning and rajendran

Once patients are about 18, they

Many heart defects can be

for their prenatal care as well as to fetal

repaired without open-heart surgery

cardiology services and genetic counseling

in an interventional procedure during

to evaluate the risk of a congenital heart

catheterization that may involve placing

problem in the developing fetus.

balloons, stents or devices to open up

of my patients who have grown up into

or unnecessary vessels in the heart or lungs.

successful young adults,” says Dr. Gewitz.

to MAke AN

appointment WMC_Cardiac_0211final.indd 9

suvro s. sett, m.d.

CUrBING

chilDhOOD OBesity

Pediatric cardiologist karen seligman, m.d., is on a mission to stem the rising tide of childhood obesity. a risk factor for heart disease, obesity also contributes to high blood pressure, type ii diabetes, sleep apnea and endocrine and orthopaedic problems. dr. seligman’s Preventive cardiology Program takes a nonjudgmental approach to helping kids make healthy lifestyle decisions. services include physical evaluations, body mass index (bmi) assessments, nutrition counseling and exercise advice. dr. seligman works closely with other pediatric subspecialists such as endocrinologists and nephrologists to provide comprehensive care. she notes that the best way to get atrisk kids moving and eating healthfully is to slip exercise and wise food choices into their everyday activities. “Put the treadmill near the tv, serve breakfast every day, don’t use food as a reward, and keep the junk food out of the house,” she says. “dad can’t have soda if the kids are banned from drinking it.” dr. seligman says it’s rare for a teenager to have a heart attack.

“We want to keep it that way and also help our patients prevent the onset of heart disease in adulthood,” she adds.

“It’s gratifying to meet the children

blocked valves or vessels, and to plug holes “We’ve treated newborns weighing

frank manning, m.d.

“They are like my grandchildren.”

WESTCHESTEr MEDICAL CENTEr 1-877-Wmc-docs | WWW.Worldclassmedicine.com

1/18/11 12:08 PM

the power of

sharing

A special s upport group helps patients deal with life before and after trans plant

“ Yo u c a n n e v e r k n ow a

So once a month they meet to

are invited to speak at meetings. But

man until you walk around in his shoes,”

support each other and their loved ones.

mostly it’s the recipients themselves

said Atticus Finch in Harper Lee’s Pulitzer-

And they visit patients in Westchester

who educate and encourage.

prize winning novel To Kill a Mockingbird.

Medical Center’s heart transplantation

Members of a heart-transplant recipient

unit, who are either awaiting a donor

an outlet to discuss your concerns

support group at Westchester Medical

heart or learning to live with a long-term

after your transplant, and that’s with

Center have, in effect, walked in one

mechanical left ventricular assist device

us,’” says realtor Paul Brand, 66, of

another’s shoes. Only they know what

(LVAD) that performs the circulatory

Tuckahoe, who received his donor

it’s like to worry about every unexplained

work of one’s own damaged heart.

heart and kidney on June 26, 2007—the

twinge they feel, or to live with the effects

Occasionally, physicians, nurses and

“I tell each member, ‘You have

first patient at Westchester Medical

of immunosuppressant medications. Only

other members of the medical center’s

Center to receive such a two-organ

they can say that someone else’s heart is

Heart Failure, Heart Transplantation and

transplant—and helped found the group.

beating within their chests.

Mechanical Circulatory Support Team

“We visit patients before and after their transplants, because no one should be afraid of their new life with a new heart.”

“This group is a great launching pad,” says Warren D. Rosenblum, M.D., Associate Medical Director, Heart Failure, Heart Transplant and Mechanical Circulatory Support and an Associate Professor of Medicine at New York Medical College. “Meeting others who have the same medical concerns helps to build camaraderie among patients and confidence that they will lead normal lives after transplantation.”

In addition to general discussion about their medical conditions, members share information about practical issues, such as navigating the health-insurance landscape and temporary living arrangements.

Turning Fear Into Action John Newton, 55, of Wantage, N.J., says pre-transplant visits from Paul Brand and two other members of the support group helped allay fears he and his wife, Maria, experienced after he was admitted to Westchester Medical Center

used with permission from thoratec

10

advances in heart

WMC_Cardiac_0211final.indd 10

care 1/18/11 12:08 PM

Warren D. Rosenblum, M.D.

Alan Gass, M.D.

the day after Father’s Day 2008 to be

meeting since my transplant, even though

placed on the waiting list for a new

Westchester Medical Center is about an

heart. Two weeks earlier, he had suffered

hour-and-a-half drive from my job,” he

guitar, writing music and producing

his eighth heart attack in two decades

says. “When I go for my biopsies, I visit

music videos,” says Maffei, whose song

and had a stent inserted near his heart

other transplant patients. This is my Band

and video “Mama” talks about outliving

to stabilize the organ. His heart was

of Brothers. We’re a diverse group, but we

his mother, Jane, and two brothers,

damaged beyond repair.

all share the experience of having been

Doug and Frank, who all died of heart

saved at Westchester Medical Center.”

disease at 57, 32 and 38, respectively.

my dogs, not knowing whether I would

embracing the new

received his donor heart July 18, 2008,

see them again,” recalls Newton, a vice

Nicholas Baker Maffei of Hopewell

says he’s developed his sense of humor.

president at Fujinon, an optical systems

Junction, who received a new heart on

“I’m retired from teaching high school

company. “Then Maria and I met Paul,

August 23, 2009, says support-group

math in the South Bronx, so I have good

Vinny and David, who wore their heart

members taught him to focus on the

stories to tell,” he says with a laugh.

“I had just said goodbye to my children, my grandson, my house and

positive and to try new things.

“I am concentrating on playing my

And Tom Ryan, 62, of Mahopac, who

hats from the support group. They were having their routine heart biopsies to check if their donor hearts were showing any signs of rejection. I saw how healthy

Does spirituality

help heal?

they looked, and I turned to Maria and said, ‘If they can do it, so can I.’” Newton’s journey toward a heart transplant took a detour when his ailing heart stopped on July 3. A mechanical heart-assist device called a TandemHeart®, inserted through his skin, provided shortterm pumping support for his heart.

A week later, a long-term LVAD called HeartMate® replaced the TandemHeart®.

Although Newton’s LVAD might have kept him alive indefinitely, he was put back on the donor heart waiting list.

“Throughout the fall, I attended the support group meetings with my wife and niece,” says Newton. “We knew we were not alone.”

Finally, on January 25, 2009, Newton received his new heart. The next day, cardiothoracic surgeons removed the LVAD that had kept him alive for six months.

Alan Gass, M.D., Medical Director of Heart Failure, Heart Transplantation and Mechanical Circulatory Support, says both research studies and his personal observations over the past 20 years suggest that mental imagery, positive thinking—and even prayer—may explain why some patients’ bodies do not reject donor hearts while others do.

“I have one patient who places a little figure of an Indian deity over the area of his heart that is to be biopsied, and he has never had any signs of rejection,” says Dr. Gass, an Associate Professor of Medicine at New York Medical College.

“Another patient swears that by picturing images of a clear biopsy, he has been able to avoid rejection. A third patient had a fungal infection stop 1 millimeter short of his carotid artery after he focused on a positive outcome.”

Although Dr. Gass says these examples are hard to explain objectively, there is reason to believe that a successful recovery from heart transplantation depends on more than surgery and medical intervention.

“When patients embrace their transplant and make it part of their lives, they are more likely to make healthy lifestyle changes and take their immunosuppressants and other medications regularly and properly,” says Dr. Gass.

“Noncompliance is the leading cause of death after heart transplantation.”

“I have never missed a support group

to make An

appointment WMC_Cardiac_0211final.indd 11

Westcheste r Medical C enter 1-877-WMC-DOCS | www.worldclassmedicine.com

1/18/11 12:08 PM

CAN steM CeLLs repAir A

damaged heart?

stUdies on heart regeneration shoW that a Whole organ transPlant isn’t the onlY WaY to combat advanced cardiovascUlar disease researchers on the campus of Westchester Medical Center and New York Medical College are working hard to debunk the old notion that hearts, once they are damaged, forever lose their ability to heal. And their discoveries suggest that exciting new treatments for heart disease may be just around the corner.

In studies funded by the National Institutes of Health, investigators in the Departments of Medicine and Physiology, directed by William Frishman, M.D., and Thomas Hintze, Ph.D., have discovered that stem cells found in the heart can be removed by a simple biopsy procedure, cultured in a laboratory to grow more heart stem cells, and then placed back into a subject’s heart. The new cells then grow new tissue in a process called cardiomyogenesis. While it may take at least six months to assess whether the procedure has been successful—clinical trials are currently under way at several research centers in the United States—scientists already have succeeded in growing new heart

12

advances in heart

WMC_Cardiac_0211final.indd 12

care 1/18/11 12:09 PM

tissue in laboratory rodents and dogs

Unlike the controversial embryonic stem cells that require the destruction of a daysold embryo, heart stem cells are found within the heart itself.

William frishman, m.d.

the patient is awake. A catheter, or thin tube, containing small pincers

using stem cells.

is threaded into a neck vein.

This research may

Once heart tissue is secured, stem

soon provide additional

melvin Weiss, m.d.

“As these studies progress into multicenter clinical trials involving hundreds of patients, Westchester Medical Center is ready to test this promising new therapy.”

treatment options for patients

cells are then isolated from the rest of

with coronary artery disease,

the specimen. Over the next six weeks,

research that sets the medical

cardiomyopathy (enlarged heart) or

using cell culture techniques, millions

center apart in the fight against

congestive heart failure—many of

of new heart cells can be grown.

cardiovascular disease. Physicians

whom die each year from acute cardiac

Because these new cells originate

there are responsible for many of

events while waiting for a donor heart.

directly from the patient’s heart, there

today’s lifesaving treatments; for

Every year, more than 1,000 patients

is no worry that his or her immune

example, the groundbreaking trials

with end-stage heart failure in the

system will reject the new cells, as

that assessed the effects of using

United States receive a new heart.

could happen with donor stem cells.

tissue plasminogen activator (TPA) to

Unlike the controversial embryonic

“We’re not sure yet about the

It’s just this type of innovative

dissolve blood clots. The first patient

stem cells that require the destruction

best way to reintroduce these new

to receive treatment just turned 70

of a days-old embryo, heart stem cells

heart stem cells into the patient,

years old. Other trials assess the

are found within the heart itself, and

whether by putting them back

following therapies for patients with

there is no issue of rejection when they

through a catheter or injecting them

both Type 2 diabetes and coronary

are used in the same person.

directly into the heart via an open

artery disease: the safety of using

procedure or through the skin,” says

angioplasty and stenting to open

heart stem cells originate—whether

Dr. Frishman, whose Cardiovascular

narrowed carotid arteries and screen

they begin in the heart or begin in the

Regeneration and Stem Cell Therapy,

patients for other types of vascular

bone marrow, as do blood cells, and

edited with colleagues Piero Anversa,

disease; and the effects of combining

then migrate to the heart,” explains Dr.

M.D., and Annarosa Leri, M.D., is the

antiplatelet drugs for the prevention of

Frishman, who is also Chairman and

definitive research textbook in this

blood clots.

rosenthal Professor of Medicine at New

area. However, once the new cells are

York Medical College. “researchers in

introduced, a synthetic hormone given

signs of a bright fUtUre

North Carolina have already succeeded

to the patient could accelerate the

The dramatic progress already made

in using stem cells to grow an entirely

regrowth of heart tissue.

in treating heart disease is surely

“We’re not yet sure where the

new bladder in a lab for a child born

With congestive heart failure

a good omen for these promising

with a damaged one. A heart is more

ranking as the number-one reason

developments. After all, says Melvin

complicated than a bladder, but we are

for hospital admissions in the United

Weiss, M.D, Chief of Cardiology at

very excited that soon we may be able

States, heart stem-cell therapy holds

Westchester Medical Center and a

to save patients with this technology

great potential for patients who are

Professor of Medicine at New York

who otherwise might not survive.”

not candidates for a heart transplant.

Medical College, “already patients who

“Long-term clinical trials are

once spent weeks recuperating from a

groWing neW heart cells

needed to refine the process until it

major heart procedure now routinely

The process involves obtaining a piece

can be used on a widespread basis in

go home just days after undergoing

of heart tissue from a biopsy while

the United States,” adds Dr. Frishman.

emergency heart care and treatment.”

to MAke AN

appointment WMC_Cardiac_0211final.indd 13

WESTCHESTEr MEDICAL CENTEr 1-877-Wmc-docs | WWW.Worldclassmedicine.com

1/18/11 12:09 PM

YOU CAN REDUCE YOUR RISK OF

heart disease

be done to treat and stabilize patients with it. For example, atherosclerosis, the narrowing and hardening of arteries, is known to cause cardiovascular disease.

The process starts slowly when high blood pressure and cholesterol damage cells; it’s then that plaque—consisting of cholesterol, fatty substances, cellular waste products, calcium and fibrin (clotting material)—begins to form.

Elevated levels of triglycerides in the blood and damage caused by cigarette smoking further injure arteries by harming the endothelium, the innermost layer of the blood vessel.

“We have learned that chronic coronary artery disease is a systemic

6 HEART-SMART TIPS KEEPIN G INFLAMMATION IN CHECK IS ONE OF THE BEST STRATEGIES HOW IS AMERICA DOING IN

■ 1 Eat a healthy diet made up of fresh, not processed foods.

its fight against heart disease? Very

modern miracles of cardiac surgery, heart

■ 2 Exercise every day for at least

well—and not so well, according to the

transplants, angioplasty and mechanical

30 minutes.

American Heart Association’s “Heart

heart-assist devices have helped reduce

■ 3 Lose weight if necessary.

Disease and Stroke Statistics 2011

heart-disease deaths. But cardiologists at

Update.” The good news, reported in the

Westchester Medical Center say we need

December 15, 2010, issue of Circulation,

to do more to prevent the disease from

■ 5 Manage your blood pressure.

includes the fact that deaths from heart

developing in the first place.

■ 6 Ask your physician about

disease fell 28 percent from 1997 to 2007.

On the flip side, the update reveals

14

period rose 27 percent. Of course, the

Arthur Fass, M.D., and Franklin Zimmerman, M.D., cardiologists at the North State Division of Westchester Heart at Westchester Medical Center, suggest:

Research conducted over the past decade by Arthur Fass, M.D., and other

that the number of heart procedures

scientists has revealed new insight into

performed during the same 10-year

what causes heart disease and what can

advances in heart

WMC_Cardiac_0211REV3.indd 14

■ 4 Control your cholesterol.

taking a low-dose (81 mg.) aspirin once a day to prevent the formation of blood clots.

care 1/19/11 11:44 AM

“There is no reason why heart disease must always be the scourge it is.”

Arthur Fass, M.D.

disease throughout the circulatory

blood pressure-lowering medications are

system and that it starts at a young age,

the real “aggressive therapies” that are

sometimes in childhood or in the teen-

reducing deaths from heart disease, not

age years,” explains Dr. Fass, an Assistant

angioplasty and cardiac surgery.

Clinical Professor of Medicine at New York

“Taking care of your heart by treating

Medical College. “But is coronary artery

elevated cholesterol and high blood

disease inevitable? The answer is no.”

pressure is much like changing the oil in your car to prevent engine trouble,” he

PREVENTION, THE KEY

says. “It won’t make the car run any better

Plaque alone does not cause a heart

that day, but if you don’t, the engine will

attack. Instead, inflammation in the

be harmed over time.”

body causes a disruption of the plaque,

Dr. Zimmerman uses this analogy

creating a blood clot. The clot, or

to encourage patients to take their

thrombus, wedges itself atop the resident

medications. The stumbling block, he

plaque in the artery, where, if it breaks

says, is that high blood pressure and

off, it may block the flow of blood to the

high cholesterol cannot be felt. “If these

heart. Robbed of oxygen-rich blood, the

conditions caused pain as arthritis does,

heart tissue dies. Disruption of plaque can

we’d never have to remind our patients,”

also lead to disturbances in the heart’s

says Dr. Zimmerman, an Assistant Clinical

electrical system, resulting in a potentially

Professor of Medicine at Columbia University

lethal arrhythmia.

College of Physicians and Surgeons.

The key, then, writes Dr. Fass in

Statin drugs have revolutionized

“Chronic Coronary Disease in the Post-

cardiology practice, he says, by lowering

COURAGE Era: A New Paradigm,”

“bad” LDL cholesterol in the blood.

published in the November/December

Scientists are learning there may be

2010 issue of Cardiology in Review, is to

hundreds of chemical reactions in the

stop the buildup of plaque or to stabilize

body that lead to atherosclerosis, most

plaque that is already lurking in our

of which are still a mystery, but what

bodies, thus preventing a heart attack

is certain is that statins modify the

or other acute coronary event. Research

sequence of events. Long-acting, once-

suggests that cigarette smoking and

a-day medications that lower blood

elevated levels of “bad” LDL cholesterol

pressure have virtually no side effects as

increase the likelihood that unstable

their predecessors did years ago.

“Heart disease did not become

plaque will rupture.

Westchester Medical Center

the leading killer of Americans until the

cardiologist Franklin Zimmerman, M.D.,

1940s,” Dr. Fass points out. “And there

points out that lifestyle modifications—

is no reason why it must always be the

including a healthy diet, no tobacco use,

scourge it is. Our goal in the next 25 years

and at least 30 minutes of daily exercise—

is to see heart disease lose its number-

combined with cholesterol- and high

one ranking.”

TO MAKE AN

appointment WMC_Cardiac_0211REV3.indd 15

Franklin Zimmerman, M.D.

Dina R. Katz, M.D.

WOMEN AND

HEART DISEASE Heart disease kills more women than all cancers combined. Yet many women don’t have their cholesterol level or blood pressure checked regularly. And they don’t realize that symptoms of heart attack in women are often different from those in men.

“Because women do not always exhibit the classic signs of heart attack—crushing chest pain, clammy skin, and numbness in the left shoulder or arm—they may not recognize that extreme weakness, shortness of breath, right-sided pain or even flu-like symptoms may indicate a heart attack,” says Dina R. Katz, M.D., a cardiologist at Westchester Medical Center.

“Women tend to ignore their own healthcare. If something ‘doesn’t feel right,’ see your doctor!”

Dr. Katz recommends that women have a yearly physical exam to check their blood pressure, cholesterol levels, blood glucose level and vitamin D level, since this vitamin regulates the body’s inflammatory process. Walk at least 10,000 steps a day, and try a “women-friendly” gym. Most important, stop smoking.

“Two cigarettes a day are as bad as two packs a day,” she adds.

“Women who smoke lose all of the protection of estrogen, and they have heart attacks, on average, 10 years before nonsmokers.”

WESTCHESTER MEDICAL CENTER 1-877-WMC-DOCS | WWW.WORLDCLASSMEDICINE.COM

1/19/11 11:45 AM

175,000 people didn’t plan on having cardiac procedures.

Fortunately, we did.

Since 1977, over 175,000 people have come to Westchester Medical Center for the treatment of some of the most severe and complex heart conditions. The talent and dedication of our doctors, nurses and staff, and our exceptional outcomes, are the reasons Westchester Heart is the premier provider of cardiac care in the region.

• In the last 10 years alone, we have performed: 45,000 diagnostic cardiac procedures 15,000 cardiac interventions 7,000 electrophysiology procedures 5,000 pacemaker & related device implants • Five full-service catheterization labs; the largest number of sophisticated labs in the Hudson Valley including a new state-of-the-art electrophysiology lab • The only cardiac surgery program in Westchester • The only Medicare-approved heart transplant center and Joint Commission certified VAD program in the Hudson Valley

• Awarded the 2010 HealthGrades® Cardiac Surgery Excellence Award • Awarded HealthGrades® five-star rating for treatment of heart failure and for carotid surgery in 2010 • One of only a handful of hospitals in the nation to earn the Triple Gold Award from the American Heart Association • One of only three hospitals in NY to earn a designation of low-risk for valve or valve/bypass surgery* * NYSDOH report – April, 2010

• Ranked in the top 10 in New York and the top 10% in the nation for cardiac surgery care by HealthGrades®

Westchester Heart.

One hospital, changing countless lives. thewestchesterheart.com Maria Fareri Children’s Hospital • Westchester Heart • Cancer Center • Transplant Center • Neuroscience Center Joel A. Halpern Regional Trauma Center • Burn Center • Behavioral Health Center • Advanced Imaging Center • Advanced OB/GYN Associates

Untitled-16 1 WMC_Cardiac_0211REV3.indd 16

1/19/11 11:46 10:57 AM