Patient Transport Expands Heart Team’s Reach
In July of last year, Rick Vick, 60, entered the cardiac catheterization lab at St. Francis Hospital in Cape Girardeau, Missouri, for a procedure to treat his heart arrhythmia. During the procedure, his blood pressure dropped, and his heart stopped. The fast-acting heart team brought Vick to the operating room and connected him to a cardiopulmonary bypass machine. Then one of Vick’s physicians called Barnes-Jewish Hospital: Do you have any resources to help?
Washington University cardiac surgeon Keki Balsara, MD, received the call. He flew immediately by helicopter to Cape Girardeau, 99 air miles south, carrying with him a specialized life-support device called an extracorporeal membrane oxygenation (ECMO) machine. When Balsara arrived at St. Francis, Vick was in heart failure. Balsara connected him to ECMO, which temporarily supported his heart function and breathing, and together they took the helicopter back to Barnes-Jewish. Nine days later, Vick underwent an operation to implant a ventricular assist device (VAD), a small, internal mechanical pump that would support heart function long-term. By February 2016, he was back to work as a farmhand.
“I don’t try to restrict myself,” says Vick. “I just pace it.”
Word got out; as care providers at other hospitals heard about the ECMO patient transfer capability, they called Barnes-Jewish Hospital regarding patients with acute respiratory problems or cardiogenic shock, in which the heart is not adequately supplying blood to vital organs. Heart transplant and VAD surgeons — Balsara, director Akinobu Itoh, MD, PhD, and Faraz Masood, MD — are on call to respond to these urgent requests. One travels alone by helicopter or ambulance to set up the patient on ECMO and bring him or her back for further treatment. A team of intensive-care specialists, cardiologists and pulmonologists stands ready to manage the patient.
Since treating Vick, they have brought back 11 patients, and the majority survived. “We are analyzing data on about 360 ECMO patients treated during the last five years to determine who can best be served by this novel approach,” says Itoh.
The division has one of the largest ECMO programs in the world.
Clinical researchers recently began enrollment in the third PARTNER (Placement of AoRTic traNscathetER) clinical trial. Previous PARTNER trials have evaluated the use of minimally invasive surgical techniques to place aortic valve devices in various patient populations. Washington University was a leading enroller for the first PARTNER Trial, which studied high-risk patients who were not candidates for open valve replacement; the second PARTNER Trial studied intermediate-risk patients. PARTNER III will study low-risk patients, who will be randomly assigned to transcatheter aortic valve replacement or open-heart aortic valve replacement.
Washington University cardiac surgeons and interventional cardiologists are participating in a multicenter trial evaluating transcatheter mitral valve repair in patients with functional mitral regurgitation, a condition that occurs when the left ventricle is enlarged or distorted, leaving an otherwise healthy mitral valve unable to close properly. The trial, called COAPT, is evaluating the use of the MitraClip valve device vs. medical therapy.
Women historically have been underrepresented in cardiothoracic surgery. Since Marc Moon, MD, became program director of the cardiothoracic surgery residency in 2003, the division has been working hard to break this trend. During the program’s first 74 years, only one woman completed training (Mary Gregg in 1987). However, by 2020, 20 percent of the 55 individuals who have graduated from the program since 2003 will be women — far above the national average of 5 percent.