Maryland Heart Center

Heart of Collaboration

The Heart of Collaboration | Personalized Care | Unique Collaboration | Research Vision | The Future is Bright

Unique Collaboration

Some of the most interesting advances at Maryland in recent years have evolved from collaborations among cardiologists and cardiac surgeons that both leaders say are unique. According to Dr. Mehra, "Heart centers in general try to bring together the cardiologists and cardiac surgeons, but we have gone beyond what many have been able to do. We are integrating surgical and medical treatments to provide the best care for individual patients." This integration contributed to a 25 percent growth in cardiac admissions from 2004 to 2006.

A new hybrid procedure to treat multi-vessel coronary blockages exemplifies this collaboration. The University of Maryland Medical Center is one of the first hospitals in the United States where cardiac surgeons and cardiologists work together to restore normal blood flow to all of a person's blocked coronary arteries while also improving patient recovery and convenience.

A surgeon uses robotic assistance to perform multiple-vessel bypass surgery without opening the chest. In the same operating room, which is both a fully-equipped surgical suite and a state-of-the-art cardiac catheterization laboratory, an interventional cardiologist uses stented angioplasty to open other blocked heart vessels.

The hybrid approach began in 2005; robotic assistance with the da Vinci S Surgical System was added to the mix in 2007.

Another collaboration links a cardiac surgeon who has expertise in the surgical treatment of atrial fibrillation with cardiologists who specialize in the medical management of the condition. The result is a multidisciplinary clinic in which the team will assess whether drugs, non-surgical ablations or surgical procedures are best for a patient.

On another front, cardiologists in the heart rhythm service have joined their colleagues in nuclear medicine and radiology to bring real-time imaging into the electrophysiology laboratory. They have coupled highly detailed PET/CT and MRI images with traditional catheter-based mapping to determine where to apply radiofrequency ablation.

This type of therapy destroys scar tissue on the underside of the heart that may cause the electrical abnormalities in ventricular tachycardia, often associated with sudden cardiac death. The task of locating these multiple points of heart attack-related scar tissue has traditionally been time-consuming and risky: healthy tissue or blood vessels could inadvertently be destroyed; abnormal tissue could be overlooked.

The addition of imaging speeds up the process, enhances accuracy and improves success rates. "Things we thought were not possible before are being done now, thanks to the power of more sophisticated imaging and advanced percutaneous techniques," says Dr. Mehra. He adds that treatment success for ventricular tachycardia using conventional electrical methods hovers at about 50 percent nationally. At the University of Maryland, the imaging component has helped boost the success rate to 80 percent.

Cardiologist Dr. Myung Park is director of the pulmonary hypertension program.

Another strong Heart Center program focuses on pulmonary hypertension, a lung disorder in which blood pressure in the pulmonary artery rises far above normal levels. This collaborative effort, led by Myung H. Park, M.D., assistant professor of medicine, was started shortly after Dr. Mehra arrived and is now the region's largest pulmonary hypertension program. It offers comprehensive diagnostic and treatment services to patients with all forms and stages of pulmonary hypertension.

While collaboration has become a distinguishing characteristic of the Maryland Heart Center, the strength of that collaboration pivots around the expertise of individual team members. Some of that expertise comes from specialization.

Early on, Dr. Griffith decided to focus on making each surgeon a regional and/or national expert in one area in which he or she was particularly gifted and interested in pursuing. "We began to see how we might be able to deliver all the patients with the same problem to one surgeon, so that individual's experience would grow," says Dr. Griffith.

A heart valve program soon began to emerge. James S. Gammie, M.D., associate professor of surgery, began specializing in mitral valves while Jamie M. Brown, M.D., associate professor of surgery, concentrated on aortic valves.

In another example of specialization, Robert S. Poston, Jr., M.D., formerly a Medical Center cardiac surgeon, concentrated on coronary artery bypass grafting (CABG). That specialization led to his novel notion to configure a surgical robot, often used in prostate surgery, to assist in bypass surgery. In September 2006, the University of Maryland Medical Center became the first hospital in Maryland, Delaware, Washington D.C., and Northern Virginia to perform minimally invasive, beating heart, multiple-vessel coronary artery bypass surgery with the assistance of a surgical robot.

"We've seen patients now contact us from out of town for coronary artery bypass surgery because they've read about our robot-assisted procedure, and thats basically the bet paying off," says Dr. Griffith.

Armine Tadewdsyan, R.N. (left), with cardiologist Stephen Gottlieb, M.D., who is director of the heart failure service.

The Heart Center's heart failure service is a major endeavor that illustrates the continuum of medical and surgical treatments available at Maryland. Stephen S. Gottlieb, M.D., heart failure service director and professor of medicine, leads the program, which draws on the talents of a large team of nurses, cardiologists, surgeons and other caregivers who provide therapies that either block or slow the progression of the disease.

On the heart failure research front, a recent landmark genetic study at Maryland's Cardiopulmonary Genomics Laboratory is opening the door for personalized medical treatment. Lab director Stephen B. Liggett, M.D., professor of medicine and physiology, has identified a common genetic variation that predicts a patients response to beta-blockers, frequently used to treat chronic heart failure. A simple genetic test guides physicians as they develop the best treatment for individual patients with heart failure.

Many patients with end-stage heart failure benefit from the Heart Center's mechanical circulatory support program. Heart pumps, also known as ventricular assist devices (VAD), are the main tools of this program. The use of VADs at Maryland has accelerated during the five years since Dr. Griffith's arrival. "We have 11 VADs of all sizes and shapes, some FDA-approved, some experimental," Dr. Griffith says. He is principal investigator on a National Institutes of Health (NIH)-funded project to develop a tiny heart pump for infants.

For many patients, heart transplantation is the next step after a VAD. The heart transplant program at Maryland now leads the region and is another example of effective collaboration among cardiologists, guided by Erika D. Feller, M.D., assistant professor and medical director for heart transplant, and cardiac surgeons.

Please call if you would like to make an appointment or talk to someone about our services. Patients dial 1-800-492-5538 or 410-328-5842, physicians dial 410-328-6622 or 1-800-318-1019.