Historic Heart Care at St. Joseph’s Health Cardiovascular Institute

By Allison Gorman
Monday, April 27, 2020

With a growing team of specialists, the most advanced treatments and state-of-the-art facilities, St. Joseph’s Health Cardiovascular Institute continues to make history as a top regional and national cardiac program.

From performing the first successful open-heart surgery in Syracuse to helping pioneer new protocols for transcatheter aortic valve replacement (TAVR), St. Joseph’s Health has been at the forefront of cardiac care, both regionally and nationally, for decades. In the past 10 years, St. Joseph’s has reinforced that position, expanding its team of highly trained cardiac specialists and adding to its menu of advanced interventional procedures, minimally invasive surgeries and mechanical supports to treat even the most complex cases.

The heart of St. Joseph’s cardiac program is its flagship hospital in Syracuse, which capped off $400 million in renovations with the addition of a state-of-the-art surgical tower in 2014 and a 45,000-square-foot Cardiovascular Institute in 2018. The program serves a 15-county area that extends from Canada to Pennsylvania and the Finger Lakes to Utica.

St. Joseph’s has also invested in meeting people where they live to fight heart disease — the leading cause of death in New York and the United States. With the addition of CareFlight, a medical helipad on its Syracuse campus, and more satellite locations opening throughout Central New York, St. Joseph’s ensures that distance is no obstacle for treatment at one of the nation’s top cardiac programs.

A team, including vascular surgeon Syed Zaman, MD, performs surgery in one of St. Joseph’s state-of-the-art surgical suites. The St. Joseph vascular team has more experience performing a full range of services than any other hospital in the region. The hospital’s exceptional outcomes earned them a High Performing rating in abdominal aortic aneurysm repair by U.S. News and World Report.

Cycle of Success

The axiom “success breeds success” is especially true when failure can have fatal consequences. In other words, it’s no coincidence that St. Joseph’s performs about 1,000 cardiac surgeries a year (including the most open-heart procedures in the region, with the lowest risk-adjusted mortality rates) — and that it was named one of the top six hospitals in the nation for heart surgery by The Society of Thoracic Surgeons.

“There are many heart surgery programs in Central New York, but there’s only one that does more than a thousand cases a year,” says Joseph Spinale, DO, MBA, Chief Medical Officer (CMO) for St. Joseph’s Health. “That’s how we get the outcomes we do.”

It’s a self-perpetuating cycle: More heart valve surgeries than any other provider in the region and more coronary artery bypass grafting (CABG) procedures means more patients referred to St. Joseph’s or sent there from places like Watertown, Ogdensburg and Binghamton.

Expert providers are key players at St. Joseph’s, too, according Ahmad Nazem, MD, FACS, Chief of Cardiac Surgery at St. Joseph’s.

“The only way you have more cases is to obtain good outcomes — those go hand in hand,” Dr. Nazem says. “With that kind of volume, you end up attracting better talent at all levels.”

Dr. Russell Silverman, MD, FACC, Director of Medical Cardiology for St. Joseph’s, sees the same dynamic at work on the interventional side. St. Joseph’s is one of the top five producers in the state, with four times more volume than any other hospital is Syracuse.

“Our cath lab is available 24/7 for patients with acute problems that we can address,” Dr. Silverman says. “It’s even available for elective procedures seven days a week, which means we perform inpatient elective procedures on the weekends.”

The medical helicopter also keeps the cath lab busy.

“We transport critically ill patients and perform necessary procedures,” Dr. Silverman says. “We have some of the best interventional physicians in the state.”

James Connelly, MD
“It’s a given: When you do more cases, you end up with more experience, and more experience translates into better outcomes.”
— Ahmad Nazem, MD, FACS, Chief of Cardiac Surgery at St. Joseph’s Health

Becoming an Institute

Dr. Spinale, an invasive cardiologist, suspects his medical specialty is part of what led St. Joseph’s to offer him the newly created position of CMO in 2017. He admits that St. Joseph’s renowned cardiovascular program, including its impressive new surgical tower, was part of what inspired him to accept the offer.

His first goal as CMO was to unite the competing cardiovascular groups upon which the program was built, to create a single enterprise: the Cardiovascular Institute.

“One of the biggest sources of waste in health care is clinical variation,” Dr. Spinale says. “By pulling everyone together and having one way of managing treatments that are based on best practices and clinical research, we can eliminate that waste and provide quality care with better outcomes at a lower cost.”

Since then, the Institute has steadily grown. Its team of specialists now includes five cardiac surgeons, 11 cardiac anesthesiologists, five vascular surgeons, six interventional cardiologists, two cardiac electrophysiologists, 16 medical cardiologists, and 22 physician assistants and nurse practitioners.

The ultramodern cardiac facilities at St. Joseph’s Health in Syracuse were built to accommodate a burgeoning caseload. The $63 million Christina M. Nappi Surgical Tower includes an expansive waiting area and 110 spacious, private rooms that are primarily used by cardiac inpatients.

“When the patient feels better in a space, that affects their improvement, and the family feels more at ease with the patient staying there,” Dr. Spinale says.

The tower’s design also enhances the progress of patient care. When communication is easier and transfer times are shorter, outcomes improve.

Similarly, the $32 million Merola Center for Cardiac Care, which houses catheterization, electrophysiology, interventional radiology facilities, 40 patient bays and a hybrid OR, was designed both for patient comfort and for the delivery of safer, more coordinated care.

Care Flight Helicopter
“Our goal is to do what’s right for the patient. Not necessarily what any one individual wants to do, but what the group thinks is best, based upon best practices and guidelines in the cardiology and cardiovascular surgery literature.”
— Russell Silverman, MD, FACC, Director of Medical Cardiology at St. Joseph’s Health

Advanced Surgical Treatments

St. Joseph’s cardiac surgical program provides a full menu of advanced treatments, including robotic and minimally invasive procedures, for valvular disease, stenosis and insufficiency, as well as aortic pathologies.

“A large part of our procedures is minimally invasive,” Dr. Nazem says. “For example, we go through the right side of the chest with a small incision and do mitral valve surgery, aortic valve surgery and tricuspid valve surgery. Almost all the incisions are, at most, 7 to 8 centimeters in length.”

Some of the surgical techniques offered at St. Joseph’s, like the valve-saving “David Procedure,” aren’t available elsewhere in Central New York. Other surgical options offered there are less about a specific technique than the surgeons’ comfort and experience treating complex cases in a minimally invasive way.

“We do triple valve replacements through a right-side, thoracotomy, minimally invasive incision,” Dr. Nazem says. “That wouldn’t happen many other places.”

For CABG, St. Joseph’s surgeons offer both robotic surgery and open bypass, including an off-pump procedure for patients at high risk for embolization or stroke.

“Because St. Joseph’s has the largest cardiac and critical care anesthesiology team in Central New York, it can safely offer procedures for patients who wouldn’t otherwise be cleared for them,” says Courtney Maxey-Jones, MD, a cardiac anesthesiologist and intensivist at St. Joseph’s and its Medical Director for extracorporeal membrane oxygenation (ECMO) and mechanical support.

The Institute added ECMO in 2018, to better support “the sickest of the sick,” according to Dr. Maxey-Jones. She’s part of a smaller team of critical care cardiac anesthesiologists that provides 24/7 evaluation of eligibility for ECMO for cardiac or respiratory etiology. The team also works closely with the cardiologists and cardiac surgeons to manage day-to-day operation and then removal of mechanical support devices.

“The program has really taken off,” Dr. Maxey-Jones says. “It has allowed us to have some patients who either come in having an acute MI or otherwise would die of cardiogenic shock and to recover some of them and return them to independent daily living.”

Dr. Nazem says St. Joseph’s cardiac surgeons often use Impella heart pumps independently or in combination with ECMO to support patients in heart failure.

Nelly Kazzaz, MD
“Once you get out of New York City, St. Joseph’s is the premier cardiac program in the state.”
— Joseph Spinale, DO, MBA, Chief Medical Officer at St. Joseph’s Health

Advanced Structural Techniques

As the relatively young subspecialty of structural cardiology continues to evolve, St. Joseph’s has stayed ahead of the field by sending its providers to receive training from high-volume providers of advanced procedures, such as TAVR and MitraClip, and by hiring new physicians from strong interventional and structural heart programs.

St. Joseph’s is known for helping advance the use of TAVR, a minimally invasive procedure for severe aortic stenosis. The American Heart Association compares the down time and recovery of a TAVR procedure to that of a balloon treatment or angiogram.

St. Joseph’s participated in clinical trials for the use of TAVR in low-risk patients, and it’s still the major provider of TAVR in Central New York.

“We do a lot of minimally invasive surgeries that other hospitals in the area wouldn’t be able to do,” Dr. Nazem says. “We are ahead with TAVR in this area, and we’re definitely the only robotic center that has done it for years and has great experience with it. The fact that the Merola Center for Cardiac Care has a hybrid OR for TAVR procedures helps us enormously.”

A situation like TAVR failing is extremely fatal. The shorter time between patients getting CPR and getting their chest opened, the better the outcomes and the more lives get saved.

In addition to structural procedures, St. Joseph’s interventionalists offer the WATCHMAN procedure for atrial fibrillation; emergency interventions, such as EkoSonic Endovascular System (EKOS) for acute pulmonary embolism; cryoablations and radio frequency ablations; and implantation of pacemakers and defibrillators.

St. Joseph’s Health anesthesiologists work in the Electrophysiology Lab, studying the electrical activity of a patient’s heart to find where an arrhythmia is coming from. St. Joseph’s performs more than 1,700 electrophysiology procedures, 250 radio frequency ablations and 350 implantable cardioverter defibrillators annually.
“The most critically ill patients are those undergoing cardiac surgery, so having additional training in either critical care or cardiac anesthesia is very important to safety as well as having good outcomes in the cardiac surgery world.”
— Courtney Maxey-Jones, MD, Cardiac Anesthesiologist and Intensivist, Medical Director for extracorporeal membrane oxygenation and Mechanical Support at St. Joseph’s Health

Clinical Care

Structural and surgical cardiology might make headlines, but therapeutic management of heart disease is critical to a robust cardiology program. St. Joseph’s cardiologists have long been known for their clinical excellence, which they extend to patients across Central New York through the hospital’s many satellite locations.

In April, St. Joseph’s opened its 11th location: a heart failure clinic operated in conjunction with Strong Memorial Hospital in Rochester. Both hospitals work together to provide remote monitoring of patients with implanted devices.

A 12th location, which will be the Cardiovascular Institute, is set to open in Fayetteville in June.

The Institute is built on a service line model that begins with the medical cardiologist. If more specialized treatment is required, the best approach is determined by a full team of cardiac physicians, in consultation with the patient and often the primary care physician.

“It takes a committee, not a doctor, to make these decisions,” Dr. Silverman says.

He cites the recent example of a 78-year-old patient who came to him with shortness of breath. The patient, a smoker, had significant pulmonary and coronary disease. He’d had a heart attack and a number of coronary interventions, including bypass, and Dr. Silverman had followed the patient’s aortal stenosis for years. The question was whether this new symptom was related to a diseased valve or diseased lungs.

After a battery of tests and evaluations by pulmonary, surgical and interventional specialists, the team determined that TAVR was the correct approach. Two weeks after the valve replacement, Dr. Silverman watched his longtime patient walk up and down the hall, breathing easier.

“We made the best decision in that case,” Dr. Silverman says. “The patient’s longevity is more than a year, despite his lungs, and the life that he will have now will be better than the life he had prior to the intervention.”

With all the awards St. Joseph’s cardiac program has earned, its physicians ultimately measure success by moments like this.

“I’ve seen patients in dire situations: If they move, they can have a heart attack, fibrillate and die,” Dr. Nazem says. “But I take them to the OR and complete the necessary procedure, and the next day they’re sitting up in bed, and the next day they’re walking. There’s nothing more rewarding than those results for my patients.”

To learn more about St. Joseph’s Health heart care, visit everybeatmatterssjh.org.