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Cardiovascular Institute

Programs

 

Heart Failure Program

The Cardiovascular Institute provides patients with the full range of tools and services to help control heart failure. Our state-of-the-art facility supports a multidisciplinary approach to the care of patients with heart failure. Patients meet heart failure specialists, nurse coordinators and have access to all of the necessary testing and collaborative specialists who participate in heart failure care. Patients referred to the Heart Failure Program receive close monitoring with care individualized to meet each patient’s unique needs.  

AGH established the region’s only Advanced Heart Failure Unit, which is dedicated to and specifically designed for advanced heart failure patients who require complex medical management. Specialized nurses staff the unit, and patients have around-the-clock access to all members of the multidisciplinary heart failure team, including physicians, pharmacists, cardiac rehabilitation specialists, dietitians and social workers. An outpatient clinic designed for early follow-up after hospitalization is available for patients to prevent early decompensation and admission to the hospital.

The Heart Failure Disease Management Program consists of a multidisciplinary team that evaluates each hospitalized heart failure patient to ensure delivery of guidelines-based care and adherence to quality process measures. Outcome measures, such as readmission rates, length of stay and mortality are closely monitored. Close coordinaton with visiting nurses and home monitoring systems allow for timely re-engagement with the heart failure team to again identify early decompensation and prevent unncessary hospitalization. Skilled physician extenders are utilized to administer outpatient intravenous diuretics and aquapheresis, if indicated, to maintain clinical stability.

Device Therapy for Heart Failure

Our cardiologists employ a host of sophisticated technologies — combined with novel interventional techniques — to provide patients with optimal, state-of-the-art care. Implantable cardioverter defibrillators, or ICDs, are small devices implanted in the chest of a patient with a severe abnormal heart rhythm that continually monitor the heart’s rhythm. Cardiac resynchronization therapy devices are also used for some patients with heart failure. These devices deliver electrical impulses to both the right and left ventricles of the heart, restore the coordination between the two sides of the heart and often improve its function, providing a better quality of life for the heart failure patient. Newer, more advanced devices, which are capable of remote monitoring or specialized heart failure monitoring, are available and tested as part of our clinical research program. These devices allow 24/7 monitoring of intra-cardiac pressures and help identify early trends of decompensation, allowing optimization of fluids or vasodilators to prevent clinical worsening.

Complex Interventions in Heart Failure

Cardiologists at the Cardiovascular Institute are some of the region's most experienced interventionalists at treating complex coronary lesions in the heart failure patient. In select patients, percutaneous ventricular assist devices are a less invasive option for left ventricular support. Percutaneous valve repair — a technically advanced investigational procedure requiring the most experienced interventionalists — is available at the Cardiovascular Institute. For some patients with severe heart failure that is not helped by medical therapy, advanced options are available, such as transplantation or support of the heart with implantable heart-assist devices.

Surgical Therapy for Heart Failure

The Cardiovascular Institute is recognized as one of the region’s preeminent resources for the most complex, high-risk heart surgery.

Ventricular Assist Program

For a patient with severe heart failure, a ventricular-assist device, or VAD, may be surgically implanted to assist the heart in circulating blood. A VAD assists with blood circulation, but does not replace the patient’s heart. The Cardiovascular Institute was among the nation’s first cardiac centers to use a left-ventricular assist system as a long-term, permanent treatment for end-stage congestive heart failure patients who do not qualify for heart transplantation. The surgeon implants a mechanical device that helps the heart pump more effectively.

VADs are typically used for one of the following reasons:

  • As a “bridge to transplantation,” helping to support circulation while awaiting transplantation.
  • As “Destination Therapy,” providing heart support to patients who are not candidates for heart transplantation
  • As emergency support for patients with cardiogenic shock after a heart attack or with fulminant myocarditis (inflammation of the heart muscle), for example, from a heart attack.

The Allegheny General Hospital VAD Program was Pittsburgh's first JACHO-certified center. Our survival rates continue to exceed national standards with low perioperative complications. A multi-transplant team is led by highly trained cardiothoracic surgeons and cardiologists, coupled with experienced nurse coordinators. Practitioners follow patients to the outpatient setting to assure continuity and high quality of care.

Left-ventricular Remodeling Surgery

The Institute’s surgeons are also skilled in the use of left ventricular remodeling techniques, designed to improve heart function in failing hearts by surgically restoring the heart to its normal shape and size for more efficient pumping action.

Coronary Artery Bypass Grafting

During coronary artery bypass surgery, healthy artery or vein grafts are used to bypass diseased sections of the coronary arteries, in order to improve blood flow to the heart. Allegheny General’s cardiac surgeons are experienced in performing both traditional (on-pump) and off-pump coronary artery bypass surgery. Off-pump coronary artery bypass surgery is performed on a beating heart (as opposed to stopping the heart and using a heart-lung machine during the surgery). Benefits of off-pump heart surgery include reduced risk of complications and decreased hospital stay.

Mitral Valve Repair

Dilation of the left ventricle in heart failure can lead to mitral regurgitation, or the leaking or backflow of blood through the valve between the left upper heart chamber and the left lower heart chamber. Our surgeons are skilled in performing mitral valve procedures in these high-risk patients, reducing the symptoms associated with mitral dysfunction.

Heart Transplantation

Transplantation is still the treatment of choice for those whose end-stage heart failure does not respond to other medical or surgical treatment. Our cardiothoracic surgeons have performed more than 250 procedures with short- and long-term survival rates that exceed the national average (In 2010, AGH was ranked as the nation's 15th busiest heart transplant center). Enhanced operative techniques, improved anti-rejection drugs and the use of bridge-to-transplant devices have contributed to the success of the program. Our physician leaders are also leaders regionally and nationally in UNOS (United Network of Organ Sharing) and have contributed significantly to recent implemented changes aimed at improving access to transplants for those most in need.

All patients referred for an evaluation receive a thorough interview with various members of the multidisciplinary team. Specialized nurse coordinators work closely with each patient to provide individualized care that meets the needs of each unique patient.

A Heart Transplantation Evaluation aims to answer three questions:

  • Is the patient’s heart sick enough to need transplantation?
  • Are there other options available to help the heart besides transplantation?
  • Is the rest of the body well enough to withstand a transplantation?

The Heart Transplantation Team works collaboratively to evaluate each patient and tailor treatment to their individual needs. Our post-transplant patient satisfaction and quality of life is excellent.
 

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