Technology is constantly evolving, and disruptive innovation is pushing the boundaries of cardiothoracic therapeutics. The growing acceptance of less invasive transcatheter interventions, for example, has made it one of the more explored surgical modalities. This progressive technology in cardiothoracic surgery was underscored in many sessions at this year’s meeting of The Society of Thoracic Surgeons (STS) in San Diego.
Michael DiMaio, MD, Chief of Staff for Baylor Scott & White The Heart Hospital – Plano, participated in the meeting and notes that the evolution of an idea from vision to innovation continues to be driven by research. Clinical trials enable experts to not only test and validate new medications and procedures, but also new medical devices and other emerging technologies to ensure we are continually improving patient outcomes and accelerating patient recovery.
One of the most recent examples of this research evolution in the context of medical devices is Transcatheter Aortic Valve Replacement, or TAVR. In late 2017, the Baylor Scott & White Heart – Plano completed its 1000th TAVR. That year, out of 255 mitral valve replacements, 199 were done with a minimally invasive approach. “It’s been quite revolutionary to replace valves in the heart without opening the chest. This was not a procedure that I learned as a trainee, but as a practicing physician in the last few years,” adds Dr. DiMaio.
As a major center for clinical trials, this type of research has put the site at the forefront of minimally invasive therapies. Dr. DiMaio says, “Among the numerous clinical trials at our institution, Dr. Michael Mack served as the national principal investigator in a key multi-center trial called PARTNER 3 – The Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients with Aortic Stenosis (NCT02675114). We were the highest enrolling site in that trial.” The main objective of this study is to establish the safety and effectiveness of the Edwards SAPIEN 3 Transcatheter Heart Valve in patients with severe, calcific aortic stenosis who are at low operative risk for standard aortic valve replacement (AVR). In this prospective, randomized, controlled trial, patients having a low operative risk for surgical aortic valve replacement are being randomized 1:1 to receive either transcatheter heart valve replacement (TAVR) with the Edwards SAPIEN 3 or aortic valve replacement with a commercially available surgical bioprosthetic valve. Patients are seen for follow-up visits at discharge, 30 days, 6 months, and annually through 10 years. “Results were presented at this year’s American College of Cardiology Meeting and published in the New England Journal of Medicine,” reports Dr. DiMaio.
Robotic-assisted surgery represents another notable area enhanced over the years thanks to research into emerging technologies. “Back in the day, we had to make big cuts to get to the organs, now with robotics, we can make smaller cuts during surgery to accelerate recovery time for patients,” says Dr. DiMaio. In fact, Baylor Scott & White Heart – Plano is among the busiest cardiothoracic robotic surgery programs in the world, ranking seventh last year. With patients seeking minimally invasive interventions, the program continues to grow and since its launch in 2011, these procedures have seen a near 200% growth.
Research into emerging technologies has also brought forward a transformation in standard imaging and ultrasounds. The Intracardiac Echocardiography (ICE), takes an ultrasound from inside the heart and it is one of the newest technological advances currently being used at Baylor Scott & White Heart – Plano. Until now, a catheter on the outside of the heart, such as on the skin or in the esophagus through the stomach, was used to look toward the heart. “ICE, however, is inside the heart allowing physicians to see the valve and function from within,” notes Dr. DiMaio.
The goal of emerging technologies research is to bring key insights and practices to the bedside. It’s important to the team at Baylor Scott & White Heart – Plano that the use and integration of these new technologies brought forward through research follows a heart team approach. To place a transcatheter valve, for example, a cardiologist and two surgeons must see the patient, so patients and their families receive multiple expert opinions at the same time. Patients are thoroughly examined, and the team determines the best modality and technology to treat the problem. Dr. DiMaio explains, “You’ve got everybody in the same room, discussing and debating your problem right in front of you. You can hear the pros and cons. Everyone makes the best decision together.” Even if a patient may not be the right candidate for the latest technology, all the options are available and discussed.
Staying current with emerging technologies, testing and validating them through national-level clinical trials, using the newest vetted procedures and combining it all for an unmatched bedside focus on quality and safety – this is leadership in medicine – consistently placing Baylor Scott & White Heart – Plano among the highest performing hospitals in the country in the U.S. News and World Report.