Exciting new technological advances in treating end-stage cardiac conditions have been developed, and the Medical College and NewYork-Presbyterian/Weill Cornell are offering more options to fight these diseases.
To keep an already healthy heart in good working order, diet, exercise and regular check-ups will usually get the job done. However, for an increasing number of older Americans, a healthy diet and regular walks around the block alone aren't enough to reverse the damage of advanced heart disease.
According to the American Heart Association, as of 2009, 37.9 percent of American men aged 40 to 59 suffer from cardiovascular disease. For women in that age group, it is 38.5 percent. For the 60-to-79-year-old male demographic — the baby boomer generation — the rate jumps to 73.3 percent, and 72.6 percent for women.
"With the population of Americans over the age of 65 increasing dramatically over the next 10 to 20 years, there is going to be a significant number of patients developing end-stage cardiac conditions, such as valvular heart disease or congestive heart failure," said Dr. Arash Salemi, assistant professor of cardiothoracic surgery at Weill Cornell Medical College and a cardiothoracic surgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. "Until recently, the options have been very limited."
But in the past five years, exciting new technological advances in treating end-stage cardiac conditions have been developed, and the Medical College and NewYork-Presbyterian/Weill Cornell are offering more options to fight these diseases.
For 40 years, the standard of care for patients suffering from aortic valve stenosis — a tightening of the aortic valve that causes decreased blood flow — has been valve replacement surgery using cardiopulmonary bypass. The procedure involves four to six hours of open-heart surgery, where the surgeon cuts through the breastbone, stops the heart, removes the valve and replaces it. Although the surgery has been perfected over time, and is performed with excellent results, it can be traumatic for some patients to withstand.
Even a successful open-heart procedure may require six to eight weeks of recovery time.
However, a new procedure developed through the PARTNER Trial — a study that is available at only a handful of institutions across the country — is now being performed by surgeons at NewYork-Presbyterian/Weill Cornell.
For these patients, the valve is replaced via catheterization, which is inserted through a small incision in either the patient's groin or between the ribs. The transcatheter valve procedure takes about 90 minutes and does not require use of the heart-lung machine. It has a recovery period of only a few days.
"This is a revolutionary technology that will change the scope of how aortic valve stenosis is managed in the very near future," Dr. Salemi said. He believes that within the next decade, the majority of patients with this disease will be eligible for this procedure.
For many patients with advanced heart failure, their hearts aren't strong enough to pump sufficient blood for normal activities, leaving them greatly fatigued and frequently bedridden with difficulty breathing; heart failure is the number one reason for hospitalization. In 2009, doctors at NewYork-Presbyterian/Weill Cornell began implanting a new generation of left ventricular assist devices (LVADs) that are designed to help the heart pump blood from the left ventricle to the aorta, increasing flow throughout the body. Research has shown the approach can help alleviate symptoms and improve survival.
These mechanical pump devices have existed for more than 20 years, but recent advances in their design now make them easier to implant, more durable and better tolerated by the body.
"Where we once had patients with end-stage heart disease who had limited options, we now have those patients receiving assist devices that either serve as a bridge to transplantation or as the final-destination therapy. Either way, survival and quality of life are dramatically improved," said Dr. Salemi. "We have been able to achieve amazing results with advanced therapies for patients who, besides their failing hearts, are otherwise in good health.
"Our overall goal is to be able to provide the best and safest therapies to as many patients as possible," said Dr. Salemi. "These new treatments allow us to fulfill that goal."