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Be Well, Be Well Informed

Innovations in Cardiovascular Care

Posted on Jul 14, 2015 in Heart Health

Mills-Peninsula heart surgeons Christopher Woods, M.D., Ph.D., Conrad Vial, M.D., Dirk Baumann, M.D. and David Daniels, M.D.


Cardiovascular Surgeons With A Heart For Technology And Patient Care

For most people, the phrase “innovations in cardiovascular care” probably brings to mind high-tech gadgets. And Mills-Peninsula cardiovascular specialists are indeed innovators who partner with Silicon Valley medical tech firms to design and refine the latest devices and software programs.

But more important than their involvement with fancy high-tech equipment is the fact that our cardiovascular specialists are also innovators in terms of how they care for patients, according to Conrad Vial, M.D., Mills-Peninsula cardiothoracic surgeon and medical director of Cardiovascular Services. “Some of the most exciting and valuable innovation in the cardiovascular service at Mills-Peninsula is not necessarily related to a particular novel procedure or new technology,” Dr. Vial says. “Rather, it has more to do with how we organize care, how we form treatment plans and how we carry out follow-up for our patients.”

Dr. Vial and his colleagues have restored the patient to the center of care. They have redesigned the process by asking themselves, from the patient’s point of view, “How can we improve care?”

Team Consultation Benefits Patients
An example of redesigning care from the patient’s perspective is the team consultation within the Mills-Peninsula cardiovascular department. According to Dr. Vial, patients with advanced coronary disease are often scheduled for a team consultation with him and interventional cardiologist David Daniels, M.D., instead of having separate consultations. The advantage of the team approach to consultations for patients is that they hear two specialists’ perspectives while they review and interpret test results and images, discuss how they would approach the problem and weigh the pros and cons of different treatments. “We sit down at the same time and explain to the patient why we’re recommending a certain treatment, whether it’s an intervention procedure or surgery. This way, patients get a strong and consistent message from us. This is important because it can be confusing to a patient to hear from different specialists that they can both treat the problem using very different procedures,” Dr. Daniels says.

During team consultations, patients have the opportunity to ask questions and have a conversation with the specialists about their condition and the treatment each recommends. If there are differences in opinion, patients are able to talk to the physicians immediately and find out why there is disagreement. In short, patients are able to come to a decision on their treatment plan in the most convenient and efficient way possible.

“Dr. Vial and I agree on who should have cardiac surgery and who should have a minimally invasive stenting procedure probably 99 percent of the time, which is unusual,” Dr. Daniels says. “This is because we’re focused not on who’s going to do the procedure, but what’s the right treatment for the patient.”

Together, patients and physicians tailor a treatment plan to best address the patient’s condition: One may be a candidate for a catheter-based intervention; another may require bypass surgery; while a third may benefit most from a combination of surgical and interventional procedures. For patients who require the latter, a surgical team may opt to perform these multiple procedures simultaneously in Mills-Peninsula’s hybrid surgical suite.

This type of simultaneous team consultation empowers patients, reduces confusion and simplifies the decision-making process. This is especially true, Dr. Vial says, of patients who traditionally would have consulted with different specialists at separate appointments, and may have been left on their own to weigh their options and decide which treatment to pursue.

By making this simple change in care planning, “We’ve shifted from what I call the ‘Dr. Marcus Welby’ model of care (in which a trusted doctor lays out a prescription for treatment as if on a stone table) to a mosaic model,” Dr. Vial says. “We’re not giving patients ‘stone tablets’ any more. We are surrounding patients with subspecialists who have related, but different, skill sets, training and perspectives, who come together to offer our patients a treatment plan that is tailored to their needs: a customized mosaic of care.”

Silicon Valley Partnerships Benefit Patients
Delivering top-notch cardiovascular care tailored to patients’ needs is of paramount importance. But Mills-Peninsula’s cardiovascular specialists also partner with Silicon Valley medical device companies to create, design and refine the latest cardiovascular technology.

For example, interventional cardiologist Dirk Baumann, M.D., director of the Heart and Vascular Institute at Mills-Peninsula,is the first to use a new technology called an EKOS catheter developed by a Mountain View start-up to treat pulmonary embolism (a life-threatening condition where a blood clot has traveled to the lungs, usually from a leg). When inserted into a blood vessel, the EKOS catheter allows Dr. Baumann to deliver ultrasound waves through multiple probes directly to a blood clot in the lungs. The ultrasonic waves disperse clot-dissolving medicine more effectively and safely. “Using the EKOS catheter also lowers the risk of bleeding complications because we are able to reduce the quantity of clot-dissolving medicine we use by tenfold,” Dr. Baumann says. “Clot-dissolving medicines carry a risk of bleeding complications. So any time we can reduce the amount we’re using, that’s a direct benefit to our patients.”

Another leading-edge technology pioneered by Dr. Baumann and his colleagues is the Avinger Ocelot catheter. This catheter employs optical technology to create a two-dimensional image of the inside of a blood vessel. The improved image allows our interventional cardiologists to better assess whether they are pushing against the blockage or the artery wall, which helps reduce the incidence of complications from the procedure. As a result, the doctors are able to more safely and effectively maneuver a wire through blockages to remove them. The Avinger Ocelot was fully funded by community philanthropy.

To help patients suffering from arrhythmia (an abnormal electrical current in the heart causing irregular heartbeat), Mills- Peninsula electrophysiologist Christopher Woods, M.D., Ph.D., uses groundbreaking 3D mapping software to create virtual reality images of the heart’s electrical patterns. “Rather than cutting open the chest to get at the heart,” Dr. Woods says, “we’re using new 3D mapping software that enables us to go through a small incision in the patient’s leg vein with a catheter to find and eliminate tiny faulty ‘electrical circuits’ in the heart that are causing the arrhythmia.

“The new technology allows patients to avoid major surgery, so they often go home within a day or two of the procedure,” Dr. Woods continues. “We have, bar none, the best technology to treat arrhythmia in the Bay Area. It’s technology that improves safety and effectiveness tremendously.”

Mills-Peninsula’s location in the heart of Silicon Valley conveys an advantage to our cardiovascular services team, Dr. Woods says. “Working in this environment and having access to all the high-tech businesses is an incredibly fruitful opportunity for innovation and synergy between medicine and people outside of medicine.”

Mills-Peninsula is a highly sought-after clinical trial site for medical technology companies because of the high volume of certain types of procedures we perform, Dr. Baumann says. Higher volume means better data on outcomes is gathered – which further benefits patients because the techniques and equipment that are the most beneficial for patients are identified.

It Begins and Ends With the Patients
“The best way to help patients is to invite them into a structure that is specifically developed around them, rather than around individual departments or physicians,” Dr. Vial says.

“It all goes back to the patient,” he continues. “We don’t adopt technology to be able to boast of the latest and greatest at Mills-Peninsula Medical Center. The focus here is to put the patient at the center of things, to work together to offer the patient more than our individual skills. Our goal is to achieve superb outcomes, combined with a pleasant experience at the most affordable cost.”

Dr. Vial emphasizes that developing and using the latest technology is important, but even more important is to continuously improve the way we deliver care to our patients by always focusing our attention on what is best for them. “We continue to evolve the way we deliver care. In doing so we will improve not only care outcomes, but life outcomes,” he says.