Saving Hearts and Lives through Dramatically Advanced Treatments of Heart Disease

Since the mid-1960s, February has been designated as Heart Month, and as I think about our UH Harrington Heart & Vascular Institute and the care we provide, I realize that people who encountered procedures in the past – perhaps through a parent or grandparent – might not be aware of how vastly different heart and vascular interventions are today and how UH Harrington HVI is leading the way.

Twenty some years ago, a patient with aortic stenosis or coronary artery disease had open-heart surgery. The surgeon cut through the breastbone, making an incision from the sternum almost to the belly button to expose the heart, while a heart-lung machine pumped the blood in its stead during the operation.

A patient stayed in the hospital for about a week and endured several months of rehabilitation as the bones in the chest knit back together. The surgery placed huge stress on the body, and recovery took months.

When the scar down the middle of the chest healed, it resembled a very long zipper.

Today, a patient with those same conditions may have a radically different experience. Instead of opening the chest, a wire and catheters are inserted through a five-millimeter incision in the patient’s groin or wrist, and wended up to the heart to perform the procedure from inside the body. 

This minimally invasive treatment can allow some patients to go home the same day. It also puts far less stress on the body, with a far lesser chance of complications or co-morbidities during and after treatment, and a dramatically quicker recovery.

These days, some patients can’t even find their scars.

Parallel to all the minimally invasive advances, our cardiac surgeons at UH Harrington HVI are leading the effort on minimally invasive direct coronary artery bypass (MIDCAB) procedure where UH is a national leader, ranking 4th in terms of volume of cases performed.

Working in interdisciplinary teams, the MIDCAB is sometimes combined with a minimally invasive interventional cardiology procedure to place one or more stents in the smaller arteries, making a hybrid approach. The MIDCAB is less invasive and has a much shorter recovery time. ‌Surgeons make a small incision under the left breast to reach the left anterior descending artery and attach the left internal mammary artery to it. 

‌Another example, the minimally invasive technique to replace the aortic valve – transcatheter aortic valve replacement (TAVR). It’s another awe-inspiring procedure where a special long, thin catheter is threaded into a blood vessel through the groin and guided inside the heart. Over the past 10 years, UH has pioneered a minimalist approach, performing the technique while the patient is awake and talking. 

‌What was once a procedure just offered in a clinical trial for high-risk patients is now offered as an FDA-approved option for patients at low risk – due in no small part to UH research, advocacy and leadership. At the same time, as TAVR has evolved clinically, UH Harrington HVI experts in the procedure have trained more than 700 providers from all over the world.‌

‌Interventional cardiology has moved from pharmacological therapy to mechanical therapies. Not all that long ago, a patient with a heart attack was treated with tissue plasminogen activator (TPA), a powerful clot-busting drug. But this blood thinner could lead to profound complications, including brain bleeds. 

‌Now a patient goes directly to the catheterization lab, where stents are inserted to open the arteries mechanically, restoring blood flow and preventing further heart damage. 

‌UH offers heart attack treatment at 10 centers across Northeast Ohio. In fact, we were recently recognized in the top 90% for door-to-balloon time – an important measure of how fast the clogged arteries are opened since symptom onset.

Similarly, pulmonary embolism (PE) – blood clots in the lungs, the third leading cause of death in this country – was treated only with blood thinners such as Coumadin and occasionally with potent medications like TPA, which have many dangerous side effects. Now, clinicians use mechanical devices to remove the blood clots. Each year, UH performs between 100 and 150 of these thrombectomies. 

Our Pulmonary Embolism Response Team (PERT) – formed just a short time ago as a multidisciplinary group of specialists to provide rapid, real-time consultation and collaboration – is showing the world the wisdom of its approach. Patients for whom the primary care team activated PERT had significantly better outcomes in terms of readmissions, major bleeding and mortality than those for whom PERT was not activated. Patients managed by PERT were also more likely to undergo advanced therapies for the PE than other patients.

‌Aortic aneurysms are often deadly, and the surgery used to save the patient was a complex eight to 10 hour operation, with up to a 30% mortality rate. Today, in 80% of cases, we perform this life-saving procedure using endovascular devices in a minimally invasive way.

‌Many if not most of these life- and health-saving procedures are possible because of the interdisciplinary teams of clinicians who work together to provide the best patient-centric care. The days when heart and vascular specialists worked in silos are gone.

However, no discussion on innovations changing the face of heart and vascular care would be complete without the subject of limb salvage. In the U.S. more than 180,000 amputations occur each year, with more than 80% of these related to peripheral artery disease, stemming from diabetes and chronic kidney disease. Ultimately, most undergo major amputation, below or above the knee. 

Our program at UH Harrington HVI to save patients from a leg amputation is renowned around the world – and for good reason. Last September, the FDA approved a therapy that’s now giving hope to thousands of patients who suffer from chronic limb-threatening ischemia (CLTI). UH experts were deeply involved in developing the technology – which diverts the blood from the diseased arteries into the veins in the calf and gets oxygenated blood to the foot –  and co-led the clinical trials showing that 76% of patients could avoid amputation and experience wound healing. 

After the New England Journal of Medicine published the results of this technology, the FDA approved the procedure, which will likely save many limbs and lives in the future.

‌This is a wonderful example of how a team of UH Harrington HVI specialists works together, giving patients a brighter future.

Just as important as all these innovations – if not more so – is how we are addressing racial disparities that affect the health of people who live in our surrounding communities. 

We know that social determinants of health have a disproportionate impact on health outcomes. These determinants include poor air and water quality, the stress and preoccupation of low incomes and making ends meet, the stress and dangers associated with living in a crime-infested neighborhood and the effect of living in a food desert, to name just a few.

We are currently leading a multi-year study isolating the impact of these factors on the health of many Clevelanders, called ACHIEVE GreatER. This study leverages many investments UH has made in the community, including its no-charge calcium scoring program and other wearable precision health technologies. 

‌ACHIEVE GreatER's ultimate goal is to reduce cardiovascular complications by improving blood pressure, lipids and metabolic measures for Black patients at risk of heart health issues. This study, funded through a grant by the National Institutes of Health, will be the initial building block around which UH Harrington HVI will launch programs addressing the glaring inequities in healthcare in Northeast Ohio.

UH Harrington HVI has also broadened its reach beyond our quaternary academic medical center with seven specialty hubs at UH Elyria, UH Parma, UH Samaritan, UH Ahuja, UH Geauga, UH Portage and UH Lake West medical centers, and two joint ventures with Southwest General Hospital and Western Reserve Hospital, enabling patients to be cared for closer to home where families and friends are nearby to provide support and contribute to their healing. 

‌For all the progress that has been made in recent decades, one in five deaths in this country still is caused by heart disease. UH Harrington HVI will continue to pioneer research and create breakthroughs in cardiac disease prevention and care, for our patients, and for all those who live in the region we serve.