The doctors of St. Francis Hospital are constantly working on innovations to improve the quality of care for their patients both in and out of the operating room.
Dr. Newell Robinson, the hospital’s chief of cardiac surgery, said in some cases, patients will meet with a cardiologist and a surgeon as a team so the best approach to treatment can be determined, often leading to a shorter gap between initial diagnosis and treatment.
An example of this is a patient who is a potential candidate for trans-catheter aortic valve replacement surgery.
“The value of that is it takes any bias out of the formula of management and allows team to evaluate needs and then to decide in some cases surgery is better or trans-catheter valve therapy is better,” Robinson said.
Robinson and Dr. Richard Schlofmitz, the chief of cardiology, have both seen innovations in their fields during their tenure at St. Francis Hospital, including the evolution of coronary artery bypass grafting, more commonly known as bypass surgery.
Schlofmitz said about 20 years ago, angioplasty with balloons to clear blockages was developing to open arteries without bypass surgery, but before the addition of stenting, about 70 percent of patients were later readmitted.
The addition of metal stents in the artery marginally diminished the chance of blockages returning to about 40 percent, but stents brought scar tissue, which was also the cause of some blockages.
Now, Schlofmitz said he uses stents with a chemotherapeutic drug to keep scar tissue from forming with only about 10 to 20 percent of patients needing further blockage clearing.
Robinson said the improvement in stents has had an impact on the volume of bypass surgery performed but there are still cases where an operation is preferred, such as multi-vessels coronary artery disease patients.
Robinson said operations can now be performed without the heart/lung machine and this allows a reduction in detrimental side effects such as neurocognitive deficits with the additional benefit of decreased blood utilization and hospital stays.
Schlofmitz has a seven-step process for precision angioplasty, starting with optical coherence tomography, a computerized light image that is quick to produce and gives a three-dimensional view of the area and the composition of the plaque.
“If something is very calcified and very hard, it’s difficult to get open with a balloon,” Schlofmitz said. “This technology lets me know precisely.”
Schlofmitz is also able to measure down to the millimeter the length of stent needed for each patient, which is a common problem, he said, when stents are slightly too short or too long.
Schlofmitz said he can also look at the image and see if the stent is off the arterial wall and how far so it can be quickly corrected with little guesswork.
“One of the complications of stenting is at the edge of the stent, tissue can have a little flap hanging down and close the artery,” Schlofmitz said. “We do these seven steps, four before and three after, in every patient getting stents, and that guarantees us precision angioplasty with the best results on the planet. We do that 95 percent of the time.”
The hospital has also mastered a number of procedures with small incisions that replace former open-heart procedures.
Robinson said over the past two decades, St. Francis started a minimally invasive heart surgery program to treat aortic, mitral and tricuspid valve diseases.
“It utilizes a small incision in the chest and avoids the so-called cracking the chest of sternotomy,” Robinson said. “It allows us to go through smaller incisions to achieve the same result with respect to replacing and repairing valves. This comes at a time in the history of cardiac surgery where patients not only want to have a good, quality operation, but they are also interested in less invasive approaches to achieve that goal.”
Schlofmitz said patients with weak heart muscles can benefit from CardioMems, a small mosquito clip inserted through a leg vein and fed to the lungs. The device stays in the pulmonary artery and sends pulmonary pressure numbers to the doctor’s smartphone, similar to a patient being constantly monitored in the intensive care unit.
Schlofmitz said the clip allows doctors to change medications without having patients re-admitted.
“It’s an amazing technology where heart failure patients, who have one of highest readmission rates at hospitals, almost never have revisits in the first year,” Schlofmitz said.