THE BEAT GOES ON
Under the Direction of Dr. Mo Imam, SIUH’s Heart Institute Continues to Make Dramatic Strides in the Field of Cardiac Surgery
By Jessica Jones-Gorman
?For many high-risk heart valve patients, the introduction of the transcatheter aortic valve replacement to the field of cardiology several years ago was big news. The minimally invasive procedure, dubbed TAVR, not only shortened recovery periods, it also allowed many health-compromised patients to get the life-saving surgery they so desperately needed. Now that the surgical approach is being performed at Staten Island University Hospital (SIUH), the borough’s residents are benefitting from an elevated level of cardiac care.
“It’s a complete game changer,” noted Dr. Mo Imam, chairman of cardiothoracic surgery and the executive director of The Heart Institute at SIUH, who has been working with Northwell Health since September to compile and train a team of six specialists who work together on each TAVR case.
“This is a very experienced team. Together we have a combined experience of about 500 TAVR cases,” Imam said. “It’s a very exciting innovation that allows surgeons to replace valves through a small incision in the groin instead of having to perform open-heart surgery, all done while the heart remains beating.”
It’s a major part of SIUH’s cutting-edge approach to cardiac surgery, which has earned the hospital international acclaim over the past decade. Not only did the hospital perform the first minimally invasive cardiac surgery/coronary artery bypass grafting (MICS/CABG), it also became home to the first and only dedicated MICS/CABG training program on the entire East Coast, and performed the world’s first minimally invasive triple bypass and minimally invasive aortic valve replacement. It was also the first hospital in the New York tristate area to perform cryoballoon ablation – which eliminates the need to use dangerous chemicals and extreme heat during catheter ablation.
“The Heart Institute is one of the nation’s foremost cardiac care centers,” Imam said. “And we are constantly evolving. We recently restructured, placing a strong emphasis on a complete team approach. Every case is now discussed by a team of heart specialists, so you get multiple opinions on the proper mode of care, which is always best for the patient. It’s a multidisciplinary approach to heart care, which we feel provides the very best outcome.”
Since opening in 2005, The Heart Institute has pioneered and then perfected a number of leading-edge techniques and procedures across a range of cardiac services, including groundbreaking minimally invasive coronary bypass operations, heart valve repair/replacements, angioplasties, and cardiac catheterizations, as well as, the implantation of cardiac assist devices.
For Dr. Imam, who grew up in Mumbai, India, and was admitted to medical school at the age of 17, SIUH and its highly acclaimed Heart Institute was the perfect location for him to continue making extensive strides in the field of cardiac surgery.
“I think I always knew I wanted to be a heart surgeon,” he said. “It’s a field that is technically demanding and challenging, and I’ve just always felt that it is the most gratifying of all the surgical fields. People come in so sick – in many cases near death – and after one successful surgery, they are full of life the very next day. To be able to help patients live a longer and fuller life is gratifying.”
Imam came to the United States in 1991 as a research fellow at the University of Colorado, where he studied, among other things, Alzheimer’s disease, hepatitis C, and brain tumors. He then relocated to New York for his general surgery training and completed his cardiothoracic surgery training at the Tufts Medical Center in Boston. Prior to coming to SIUH, he was the chief of cardiac surgery and director of the Heart Valve Center at Baptist Health Lexington in Kentucky.
In September 2016, Imam accepted the position with Northwell, where his areas of expertise – coronary bypass grafting, minimally invasive valve surgery, TAVR, surgery for irregular rhythm, mitral valve repair, minimally invasive aneurysm repair, and lung cancer surgery – blended seamlessly with those of other staff members.
“There are close to 100 people in the cardiothoracic department, including four surgeons, 10 physician assistants, and about 50 specialized nurses,” Imam explained. “It’s a very dedicated staff that makes patient care their top priority.”
Under the executive director’s direction, The Heart Institute continues to maintain its world-renowned reputation for the management of cardiac and vascular disease – a stellar rating that the surgeon says will only grow in the future.
“I have always tried to be on the leading-edge of medicine while placing the utmost importance on patient safety and comfort,” he concluded. “And that is our goal for the future of The Heart Institute and cardiothoracic surgery here at Staten Island University Hospital. We want to provide patients with the most innovative procedures, those that will offer the most beneficial outcomes.”
TAVR Takes Center Stage at The Heart Institute of Staten Island University Hospital
NY Daily News • Tuesday, February 14, 2017
When we think of heart health, some of the immediate things that come to mind are diet, exercise and better health habits like managing stress and living a tobacco-free lifestyle. The great news is that the emphasis public health organizations, hospitals and cardiologists have given to promoting healthier lifestyles has done an impressive job
of lowering the rate of heart disease and preventing heart attacks and the need for major surgical interventions like coronary bypass.
The obvious fact is that people with healthy hearts live longer, but now cardiologists like Dr. Mohammed Imam, Executive Director of The Heart Institute and Chairman of Cardiothoracic Surgery at Staten Island University Hospital, are seeing a rise in a different type of heart issue. “Aortic stenosis is a common and growing problem,” observes Dr. Imam. “We are seeing it more often as Baby Boomers transition into their elder years. More worrisome, is that the condition often goes undiagnosed.”
Aortic stenosis is a narrowing of the aortic valve of the heart, which is the most important valve for the ?ow of blood through the body. When the aortic valve begins to narrow and weaken, blood ?ow is diminished and so, too, is the level of life-sustaining oxygen in the blood. Rather than a dis-ease caused by a specific habit like inactivity or smoking, aortic stenosis is the result of age, and the wear and tear on the heart over many years. Fortunately, the condition is highly treatable with minimally invasive surgery.
One of the priority changes Dr. Imam brought to The Heart Institute when he assumed its leadership last fall was to introduce a procedure specific to the treatment of aortic stenosis. Transcatheter Aortic Valve Replacement, or TAVR, is a procedure in which a small catheter is inserted through a large vein in the leg, and a replacement valve is delivered and placed directly over the worn valve, shoring it up and widening the narrowed opening back to full capacity and strength.
Patients undergo general anesthesia for the TAVR procedure, but there are no wounds or stitches, and Dr. Imam reports that TAVR patients notice an immediate post-op boost in their energy level and heart function. While other options, such as open heart surgery, may be just as effective, they are far more invasive, require a much longer recovery period, and have greater risk of complication.
Imam glows with enthusiasm when he says, “TAVR is a dramatic procedure; a game changer. Patients say, ‘Wow, doctor I feel great again!’, when just 48 hours earlier they felt so down and ill. Quite gratifying as a doctor, because you see the change in people’s health immediately.”
As for the main symptoms for aortic stenosis, Dr. Imam cites three: shortness of breath, light-headedness and chest pain; all of which are caused by a lack of properly-oxygenated blood circulating through the body. He urges anyone who has any of these symptoms to talk with their primary care physician. “Nothing to fear,” reassures Imam. “Your family physician will likely listen to your chest and perform a simple test called an echocardiogram, which is nothing more than an ultrasound. It doesn’t hurt, it’s non-invasive, and there are no needles.” he smiles. Dr. Imam did note that anyone who has been diagnosed with a heart murmur should be especially proactive if they develop shortness of breath, lightheadedness or chest pain.
TAVR has been performed regularly since 2011, and Dr. Imam has been doing the procedure for six years. He concludes with this, “Someone wisely pointed out that TAVR does more than add years to your life…It adds life to your years!”
The Heart Institute of SIUH Performs a Minimally Invasive Hybrid A-Fib Ablation Procedure
NY Daily News • Tuesday, March 7, 2017
Atrial fibrillation (A-Fib) is the most common type of heart arrhythmia (a heart beat that is too fast, too slow, or irregular), and may affect as many as 2.7 million Americans. What may start with a brief feeling of a ?uttering or skipped heartbeat can progress to include symptoms such as strong heart palpitations, rapid pulse, shortness of breath, fatigue, dizziness, and fainting. Early diagnosis and treatment of A-Fib are essential as the longer it goes untreated, the higher the risk factor for potentially fatal complications.
Staten Island University Hospital (SIUH), a member of Northwell Health, is home to The Heart Institute, one of the nation’s foremost cardiac care centers. Patients turn to them for the most progressive cardiac diagnostics, treatment, post-surgical outpatient care, and cardiac prevention programs. They can diagnose A-Fib painlessly with an electrocardiogram (EKG), and correct it with minimally invasive procedures.
There are many possible causes of A-Fib, including a leaky mitral valve, coronary disease, congenital heart defects, overactive thyroid gland, scar tissue from previous heart surgery, sleep apnea, stress, and exposure to stimulants such as caffeine, tobacco, alcohol, and certain medications. This can reduce blood flow and result in stroke or heart failure.
The Daily News spoke with cardiothoracic surgeon Alexander Wohler, MD from The Heart Institute of SIUH about their Hybrid Atrial Fibrillation Ablation program , which he co-developed with electrophysiologist Marcin Kowalski, MD. The team first performed this procedure combining convergent ablation with catheter ablation, in 2014. Today, there are still just a few hospitals in the New York metropolitan area that offer this life-saving procedure (none are in Manhattan).
Traditional treatments for A-Fib generally start with a combination of medications that Dr. Wohler described as “woefully in-sufficient” in many cases as a long-term solution. “Patients with long-standing symptoms can still be at risk of stroke from A-Fib, even if they’ve had good results from medications,” Dr. Wohler explained. “In addition to medications that treat the heart rhythm, patients must take blood thinners, which have to be monitored closely and come with their own set of risks.”
Hybrid A-Fib Ablation combines minimally invasive surgery and a catheter-based approach to block or “ablate” the irregular rhythm using epicardial and endocardial catheters to freeze and cauterize the heart muscle on the areas from which A-Fib typically arises. Dr. Wohler makes tiny incisions in the abdomen, and then uses a videoscope to gain access to the affected area of the heart. It is then treated with radio frequency energy that essentially shuts down the abnormal impulses in that section of the heart. Next, Dr. Kowalski uses a balloon-tipped catheter, inserted through a blood vessel in the groin area, to ablate additional areas from inside the heart. Hybrid A-Fib Ablation restores the heart’s natural electrical impulses. “With just three small incisions in the abdomen, it is much less invasive than the open-heart surgery of the gold standard Cox Maze IV procedure,” said Dr. Wohler. “The hybrid procedure gives patients the best bang for their buck, especially for people who are hard to treat, be-cause it has results comparable to Maze while being minimally invasive.”
While Hybrid A-Fib Ablation procedures can differ from hospital to hospital, success rates are up to 85% and patients can usually go home within 48 hours and get back to their normal routine within a few days. You may be a good candidate for this ground-breaking procedure if you have chronic or hard-to-treat A-Fib, tried prior catheter ablations without success, have had problems taking blood thinners.
A Therapy That Treats Persistent Irregular Heartbeats Without Open Heart Surgery
New York Daily News
Healthy hearts are easy to forget about. Short of sprinting up the stairs or being suddenly startled, most of us forget about all of the work our hearts do pumping blood around our bodies on a daily basis.
Artrial fibrillation, or Afib as it’s commonly called, can turn your heartbeat from a reassuring, steady constant into daily stress that causes anxiety, fatigue and shortness of breath, making it difficult to exercise and function normally. The telltale signs are an irregular heartbeat, including an elevated heart rate or the sensation that your heart is racing or pounding uncontrollably, as well as persistent fatigue, lightheadedness, dizziness and difficulty breathing. Often though, there are no symptoms at, which is problematic says Alexander M. Wohler, MD, FACS Attending, Cardiothoracic Surgeon from The Heart Institute of Staten Island University Hospital, because over time repeated episodes of Afib can damage the heart.
Afib occurs when the atria, the top two of the heart’s four chambers, stop beating in sync with the ventricles, the lower two chambers, and quiver or palpitate at an irregular, and often very fast pace. This makes the heart far less efficient at pumping blood through the body. Over time it can damage the heart, leading to heart failure. Blood pools in the atria during Afib, which can cause blood clots to form, which may lead to a stroke.
Despite those serious risks, “Afib is largely underappreciated by both doctors and patients and put on back burner for treatment,” says Dr. Wohler. He says that often, “There are not necessarily great options in terms of therapy.” While there are some medications that can attempt to normalize the heart’s rhythm, or to lower the rate at which it beats, as well as blood thinners that can help prevent blood clots and strokes, they all have fairly significant limitations and drawbacks.
The Heart Institute of SIUH offers a therapy called Convergent Procedure for Afib that is not available at all cardiac care centers, which has been shown to be more effective than medications, particularly in difficult cases. It’s minimally invasive and patients recover quickly. The only more comprehensive treatment requires open heart surgery.
“Patients who respond well to this treatment find it extremely effective, they’re ecstatic,” says Dr. Wohler.
The Convergent Procedure marries two different disciplines, a cardiothoracic surgery and electrophysiology. Faulty electrical signals in the heart are what cause the atria to beat irregularly. Dr. Wohler and his colleagues are able to map those abnormal electrical impulses, and then treat the heart tissue with radio frequencies that stop them.
An electrophysiologist inserts a catheter through a vein in the leg, and then uses radio frequency ablation to treat the affected heart tissue. Because the tools are inserted through a vein they are quite small and can only address small, but crucial, areas inside the heart itself. Dr. Wohlen then makes three very small incisions in the abdomen and treats the outside of the heart with the same type of therapy, but using a larger tool that covers more ground. That combination, or convergent approach in incredibly effective compared to a catheter alone, which is standard treatment in many hospitals.
“This is the gold standard,” say Dr. Wohler. “The vast majority of the areas that are abnormal are treated effectively with this approach with a much less painful and invasive process. You get nearly equivalent results, with having your chest opened.”
While Afib is more likely in anyone with prior heart disease, it’s not specifically related to lifestyle, says Dr. Wohler. “It’s not like a disease like colon cancer, where you can get screened for it or other types of heart disease where you can take steps to prevent it.” Many otherwise healthy people develop Afib, which can be exacerbated by drinking caffeine or using nicotine or other stimulants.
“Anyone who feels heart palpitations should go to the doctor for an ekg,” or electrocardiogram, he says. “Or, if you have a high heart rate, it’s consistently above 100, it’s quite possible there’s something abnormal.” He said to be alarmed by a heartbeat that feels, “irregularly irregular,” meaning it’s not related to your level of activity.