Here's a look at some of the projects changing heart and vascular care in Central Ohio.
Columbus hospitals are at the forefront of innovative approaches to cardiovascular care, from customized heart valves to the expanding use of catheter-based techniques that spare patients from open-heart procedures and get them on the road to recovery faster than ever before.
The medical centers also are working aggressively to avert and treat catastrophic events that lead to death and disability, and bringing experts together for collaborative care that addresses the some of the most common and troublesome heart conditions.
Here’s a look at some of the projects changing heart and vascular care in Central Ohio.Stay up to date with the region’s thriving business scene. Subscribe to Columbus CEO’s weekly newsletter.
Less invasive surgery
Patients have more options than ever for treating complex structural heart problems without having to undergo major surgery.
One of the more successful has been the transcatheter aortic valve replacement (TAVR) used to treat severe narrowing (stenosis) of the aortic artery. This narrowing impedes the heart’s ability to function properly, says Dr. Carlos Sanchez, an interventional and structural cardiologist at OhioHealth Riverside Methodist Hospital. “It is a lethal disease and has a higher mortality rate than some cancers,” he says. “It’s touching a lot of lives.”
Where treatment used to mean open heart surgery, it’s now done via a catheter inserted through the groin and advanced to the heart. That dramatically reduces both recovery and procedure time, which can take as little as 30-45 minutes at high-volume centers with experienced physicians, Sanchez says, Most patients go home the next day. In a major clinical trial, TAVR competed favorably with traditional open-heart procedures and is expanding to a wider pool of patients.
Riverside is an epicenter for using catheters to treat pulmonary embolism—the No. 1 cause of hospital deaths and the third-leading cause of cardiovascular deaths, says interventional cardiologist Dr. Christopher Huff. Unlike heart attack and stroke, treatment of PE hasn’t evolved much, with most patients receiving blood-thinning drugs and staying in the hospital in the hope they recover, he says. The new catheter approach “rapidly removes the clot from the lung without the risk of bleeding caused by anticoagulants. You can theoretically go from the emergency room to the cath lab to home.”
Physicians also use a catheter approach to ward off stroke and other problems in patients with atrial fibrillation, a heart rhythm disorder that affects more than 2.7 million people in the U.S. In some people with Afib, clots form in a sac in the outer wall of the left atrium (upper chamber). When those clots escape, they can travel to the brain and cause stroke. Physicians at Riverside are at the forefront of new catheter technology that deploys an umbrella-like device to prevent those clots from entering the blood stream.
The connection between Afib and heart failure is a major focus of the new Bob and Corrine Frick Center for Heart Failure and Arrhythmia at Ohio State University Wexner Medical Center, which combines research and clinical expertise with the aim of delivering more comprehensive treatment.
Many patients have both conditions, but “historically, they have been treated in separate silos and were never really integrated,” says Dr. Thomas Ryan, executive director of the Richard M. Ross Hospital and director of Ohio State’s Heart and Vascular Center.
“Modern health care is so specialized,” he says, “but the more we can think of a patient as a whole, the better off we’re going to be. This also provides the opportunity to do some really exciting research.”
The center will bring together specialists from many fields, including genetics, electrophysiology, pharmacy and heart failure, to tackle the problem from all angles. After seeing each patient, specialists sit down together to share information in order to guide treatment, Ryan says.
OSU is on the leading edge of developing a heart valve that is more customized for each patient by using 3D printing technology. Valves traditionally come in the equivalent of small, medium and large, and the new technology would allow the devices to be more precisely tailored to a patient’s own heart and valves, Ryan says. Specialists in biomedical engineering and cardiology analyze CT scans of the heart with 3D printing technology to model the individual valves.
Better care for kids
Work in one of the newest fields of medicine is happening at Nationwide Children’s Hospital, where specialists at the Center for Regenerative Medicine are participating in a clinical trial to grow tissue from a child’s own cells to treat serious heart conditions.
The process involves growing cells harvested from a child’s bone marrow to build new blood vessels and is being applied to a surgery required for children who have just one pumping chamber instead of two, says Dr. Catherine Krawczeski, division chief of cardiology at the Heart Center at Nationwide Children’s.
The use of native cells potentially solves problems related to using vessel grafts made from man-made materials because those don’t grow as a child does, Krawczeski says.
Children’s is on the leading edge of other highly specialized treatment, such as finding ways to miniaturize devices so babies can undergo treatment in the cath lab rather than have an open-heart procedure. The center continues to explore the frontier of genetics, as well as advances in fetal medicine interventions to treat some conditions before birth.
On the community level, Children’s continues its push to expand use of automatic electronic defibrillators (AEDs) in schools. “We’re working with schools so that the people there are comfortable using them, and to make sure the devices are accessible, not locked in a coach’s office.” Krawczeski says. “This will save lives.”
On-time and appropriate treatment will be the focus of a new cardiac care clinic planned at Mount Carmel East Hospital slated to open late this year or early in 2021.
Cardiac electrophysiologist Dr. Josh Silverstein says the new services aim to eliminate lengthy waits in the emergency room, get patients the treatment they need immediately and ultimately reduce re-admissions.
Saving lives is the aim of a protocol OSU launched in November to deliver rapid care to patients suffering from cardiogenic shock, which occurs when the heart’s pumping ability fails. Often the result of a sudden event, such as heart attack or arrhythmia, the condition requires “a very aggressive approach to treat these very sick patients,” Ryan says. OSU is one of a few sites in the country to deploy a “shock” team that begins treatment in the field and relays information to the emergency department so it can be ready upon the patient’s arrival.
Laurie Allen is a freelance writer for Columbus CEO.