The Heart & Vascular Institute, a member of the Westchester Medical Center Health Network (WMCHealth), has been a local leader in cardiovascular care since its inception. With the recent development and expansion of WMCHealth, the Institute has extended its regional footprint, enhancing accessibility to evidence-based, innovative cardiovascular care.
Westchester Medical Center, the flagship of WMCHealth, has been home to leading-edge cardiac care for decades and formed the Heart & Vascular Institute in 2015 with the intention of facilitating multidisciplinary collaboration among physicians practicing adult cardiology, cardiothoracic surgery, and vascular and endovascular surgery. Today, the Institute encompasses these specialties, as well as all pediatric cardiac services.
The Heart & Vascular Institute specializes in the care of complex cardiovascular conditions, including advanced heart failure, congenital heart defects, arrhythmias and valvular heart disease, particularly conditions of the aorta. Cardiac transplantation, mechanical circulatory support and ventricular assist devices, transcatheter valve replacement procedures, and fetal cardiology are among the Heart & Vascular Institute’s capabilities.
The Heart & Vascular Institute facilitates multidisciplinary collaboration among physicians practicing adult cardiology, cardiothoracic surgery, and vascular and endovascular surgery. From left are Steven Lansman, MD, PhD, Chief of Cardiothoracic Surgery; Michael Gewitz, MD, FAHA, FACC, FAAP, William Russell McCurdy Physician-in-Chief and Chief of Pediatric Cardiology at Maria Fareri Children’s Hospital; Julio Panza, MD, Chief of Cardiology; and Sateesh Babu, MD, Chief of Vascular and Endovascular Surgery.
The Vascular Division deals with diagnosis and treatment of all kinds of vascular problems, including procedures to prevent stroke (carotid artery disease), complex aortic aneurysms, and treatment of peripheral vascular disease which results in compromised circulation to legs with potential for limb loss. Other areas of expertise involve mesenteric artery occlusive disease, deep vein thrombosis and other venous disorders.
A Regional Hub for Cardiovascular Care
“Westchester Medical Center has embarked on a transformative process in which the center is expanding from a single-campus hospital to a network of care that encompasses the entire Hudson Valley,” says Julio Panza, MD, Chief of Cardiology at WMCHealth. “WMCHealth covers a very large geographic area, across which the Heart & Vascular Institute can now better facilitate advanced care.”
Dr. Babu in Westchester Medical Center’s 1,000-square-foot, state-of-the-art hybrid operating room
The WMCHealth expansion initiative began two years ago with a partnership between Westchester Medical Center and MidHudson Regional Hospital in Poughkeepsie. In May 2015, Westchester Medical Center signed an agreement with Bon Secours Charity Health System, welcoming hospitals in Suffern, Warwick and Port Jervis, and launching WMCHealth. A partnership with HealthAlliance in March 2016 further extends WMCHealth’s reach to Ulster and Delaware counties.
The Heart & Vascular Institute’s office locations span from Hawthorne to Carmel, Mount Kisco, New Windsor, White Plains and Putnam Valley. The Institute’s team of physicians and other providers also participates in advanced cardiac care outreach for regional patients with cardiac arrhythmias, heart failure and valvular heart disease. These outreach services are available in New Windsor and Suffern, with plans to expand to Kingston. Through an affiliation with Maria Fareri Children’s Hospital’s pediatric cardiology consultant program, pediatric cardiovascular services for the Institute are provided at sites in Suffern, New Windsor, Poughkeepsie and Middletown, New York, and in Norwalk and Danbury, Connecticut.
Dr. Panza monitors a patient with Debra Coyne, RN, staff nurse in Westchester Medical Center’s Coronary Care Unit.
Protocols are in place to enable seamless integration between network hospitals and expand the quality improvement measures at Westchester Medical Center — the Heart & Vascular Institute’s flagship hospital — to affiliated facilities, including Good Samaritan Hospital in Rockland County and MidHudson Regional Hospital in Dutchess County. In May 2016, cardiothoracic surgeons from the Heart & Vascular Institute also began seeing patients at Good Samaritan Hospital.
Cardiologists at Good Samaritan Hospital have a wide array of expertise and outstanding clinical skills. In fact, the Heart & Vascular Institute has established a collaborative relationship that has extended beyond the realm of clinical care. Earlier this year, a formal rotation was initiated for WMCHealth’s cardiology fellows to take advantage of the educational opportunities provided by the cardiac catheterization laboratory at Good Samaritan Hospital.
“One of the goals of this affiliation is to ensure that the quality of care is the same at all hospitals across the region,” says Sateesh Babu, MD, Chief of Vascular and Endovascular Surgery at WMCHealth and Professor of Clinical Surgery at New York Medical College. “Whether a physician is treating patients in Poughkeepsie, Valhalla, Port Jervis, Suffern or Kingston, patients will receive the same standard of care because all hospitals adhere to the same standards and guidelines.”
Dr. Lansman discusses a patient case with Joanne Bennett, FNP-BC, Valve Program Coordinator.
Physicians affiliated with the Heart & Vascular Institute meet monthly to discuss complex cases and complication rates. Teleconferencing capabilities also allow the Heart & Vascular Institute physicians based in Valhalla or Hawthorne to review diagnostic images and other information with teams in regional hospitals. Additionally, pediatric specialists plan to expand regional newborn screening and telehealth capabilities, which may help prevent avoidable transfers.
“Many services will be available locally,” Dr. Babu says. “For example, we are currently recruiting well-trained vascular surgeons who can serve patients in regional hospitals. If patients require transfer, they can receive care at the nucleus of our system, Westchester Medical Center, instead of having to travel up to 150 miles to Manhattan.”
“Because of the integration of hospitals in the WMCHealth network, patients in need of transfer have seamless transitions from their community hospital to Westchester Medical Center and back to home,” adds Michael Gewitz, MD, FAHA, FACC, FAAP, William Russell McCurdy Physician-in-Chief and Chief of Pediatric Cardiology at WMCHealth’s Maria Fareri Children’s Hospital. “Securing patients in a system in which they are already comfortable and in which physicians routinely communicate promotes patient compliance and continuity of care, enhances outcomes, and helps reduce patient dropout rates.”
An Interdisciplinary Focus
The overarching goal of the Heart & Vascular Institute is to bring together the specialties of adult cardiology, cardiothoracic surgery, vascular surgery and pediatric cardiology in one location to facilitate referrals and enhance patient care on a local and regional level. In the realm of cardiovascular disease, where patients often have related comorbid conditions, collaboration also helps improve patient outcomes.
“For example, atherosclerosis is a diffuse disease that can affect multiple parts of the body and requires the expertise of cardiologists, vascular surgeons and cardiothoracic surgeons,” Dr. Babu says. “Similarly, the literature suggests that 20 to 30 percent of patients who have an aortic aneurysm have comorbid cardiovascular disease, even if they have no symptoms.”
Before any major vascular procedure or before aneurysm repair, patients are evaluated by a WMCHealth cardiologist. If a stress test reveals abnormalities, a cardiac catheterization may be necessary to evaluate the extent of heart disease. Patients in need of treatment may then benefit from coronary bypass surgery or interventional procedures such as angioplasty.
Another common area of collaboration is in the treatment of advanced heart failure. Physicians comprising the Heart & Vascular Institute heart failure and transplant teams meet for at least one hour every week, according to Steven Lansman, MD, PhD, Chief of Cardiothoracic Surgery at WMCHealth. The heart failure team includes cardiologists who specialize in heart failure management, cardiac transplant surgeons, radiologists, allied professionals from social services and infectious disease specialists.
“The heart failure team discusses each patient’s case and collectively develops the best possible treatment plan,” Dr. Lansman says. “An array of treatments for heart failure is available at the Heart & Vascular Institute, including advanced medical protocols, placement of left ventricular-assist devices and transplantation.”
Easing the Transition from Pediatric to Adult Cardiology
As children with congenital heart disease transition into adulthood, the handoff of care can be difficult. When there is no structured program in place to ease the transition, teens are at risk for inappropriate care or undue emotional or financial stress, or may drop out of the healthcare system entirely and fail to receive follow-up services, according to an American Heart Association Scientific Statement on best practices published in 2011 in Circulation.
The Heart & Vascular Institute cares for patients beginning during the fetal period and lasting through adulthood. To facilitate the changeover in care from pediatric to adult cardiology, several years ago the Institute launched a specialized program, Westchester Adult Teen Congenital Heart (WATCH). Through the WATCH program, which currently serves over 150 patients throughout the region, adult and pediatric cardiologists and nurse-clinicians see patients together and share medical records and other pertinent information.
Dr. Gewitz discusses a pediatric patient case with, from left, Crystal Gregurovic, RDCS, pediatric cardiac sonographer; Markus Erb, MD, pediatric cardiologist; Jean Lavin, RN, pediatric cardiology nurse clinician; Joseph Giamelli, MD, pediatric cardiologist; and Christa Miliaresis, MD, pediatric cardiologist, in the pediatric echocardiography lab.
“As pediatric patients with congenital heart disease transition into adulthood, they have to contend not only with their congenital disease, but also with the impact that aging and other common adult ailments have on heart health,” Dr. Gewitz says. “When adult cardiologists are familiar with their cases and the complex care they have received, the transition is much easier for patients and physicians.”
In addition to easing the transition of care, the WATCH program enables children and teens to see practitioners who are most familiar with the types of care they may need. For example, some children and teens require cardiac procedures that are performed more frequently in adult patients. Dr. Gewitz recounts a recent trauma case that required adult and pediatric cardiologists to share expertise.
“A child recently presented at Maria Fareri Children’s Hospital who had been involved in a serious vehicular accident, which resulted in severe damage to the aorta,” Dr. Gewitz says. “We were able to obtain special permissions for a new application of a cardiac device — a new type of covered stent — to treat and fix the aorta, which was not heretofore available as a standard pediatric treatment. This allowed us to repair the child’s aorta without a complex, invasive open-heart surgery.”
Staying Abreast of the Latest Evolutions in Cardiovascular Care
“In the past few decades, cardiovascular medicine has arguably seen more advances than any other specialty,” Dr. Panza says. “This is a field of constant innovation, which makes subspecialty integration even more important.”
One of the biggest developments in cardiovascular medicine in the past decade is endovascular surgery. At Westchester Medical Center, vascular surgeons, in conjunction with cardiothoracic surgeons and radiologists, can now repair abdominal aortic aneurysms — repairs that only a few years ago would have required general anesthesia and open-heart surgery — through the femoral artery using a stent and graft.
“Before the advent of endovascular techniques, aneurysm repair was the largest operation we performed,” Dr. Babu says. “The procedure required a large abdominal incision, blood transfusions and a six- to eight-week recovery period. With the endovascular procedure, patients don’t even need general anesthesia. We can operate on patients who aren’t typically candidates for surgery, with typical success rates of 98 percent.”
In addition to endovascular treatment of aortic aneurysm, angioplasty and stent placement are used to treat atherosclerosis of the peripheral arteries, a condition that was previously managed with extensive bypass surgeries or, in the case of severe lower extremity arterial disease, amputation.
In the case of structural heart diseases, such as aortic stenosis or mitral valve regurgitation, transcatheter valve repair and replacements enable more patients to benefit from treatment. Transcatheter aortic valve replacement (TAVR), for example, allows surgeons to replace the aortic valve using a transfemoral approach instead of open surgery with a median sternotomy.
Transcatheter valve replacement and repair procedures are further examples of therapies that wouldn’t be available without advanced technology and collaboration. In an article published in the March 5, 2013, issue of the Journal of the American College of Cardiology, the authors underscore the importance of performing TAVR, which is typically indicated for elderly patients and those with extensive comorbidities who present with severe, symptomatic aortic stenosis, only after evaluation from a “Heart Team” that — similar to the Heart & Vascular Institute team — consists of cardiovascular surgeons, interventional cardiologists and noninvasive cardiologists specializing in structural heart disease.
All endovascular and transcatheter procedures performed at Westchester Medical Center are completed in the hospital’s 1,000-square-foot hybrid operating room — an $8 million investment completed in 2013.
“The hybrid operating room combines the sterile environment of an operating room with the advanced imaging capabilities of a modern cardiac catheterization laboratory,” Dr. Lansman says. “We are currently the only center in Westchester County with the capabilities to offer transcatheter aortic valve replacement and mitral valve repair.”
Looking to the Future
The objective of the Heart & Vascular Institute is to continue to provide the best patient care and outcomes by growing its outreach and investment in the latest modalities. In 2015, Westchester Medical Center entered into a $500 million, 15-year relationship with Philips Healthcare. Through the agreement, Philips Healthcare will provide advanced technology, including imaging modalities and enhanced telemedicine capabilities. Plans are in place to implement this technology not only at Westchester Medical Center, but also at MidHudson Regional Hospital and HealthAlliance Hospital: Mary’s Avenue Campus in Kingston. At Westchester Medical Center, WMCHealth is also constructing a 280,000-square-foot ambulatory care center that will house the WMCHealth Heart & Vascular Institute, along with other adult ambulatory services, and will open in 2018.
“WMCHealth’s mission is to be the provider of care, education, training and research in the Hudson Valley area. By bringing the disciplines of cardiology, cardiothoracic surgery, vascular surgery and pediatric cardiology together within the Heart & Vascular Institute, we can better fulfill that mission.”
Julio Panza, MD, Chief of Cardiology at Westchester Medical Center Health Network
“WMCHealth has positioned itself as the organization that will provide comprehensive care to regional patients,” Dr. Panza says. “Our vision is for the Heart & Vascular Institute to be the premier center for the evaluation and treatment of cardiovascular disease in the Hudson Valley.”
For more information about the Heart & Vascular Institute, visit westchestermedicalcenter.com/heart.