Cardiovascular Expertise, Cutting-Edge Technology at UPMC Passavant

Years ago, residents of Pittsburgh’s northern suburbs had to drive into Oakland to receive advanced cardiac care. Over the past few years, however, UPMC Passavant has become a proven center of excellence in the field of cardiac disease.

Not only has it grown from its roots as a community hospital to a tertiary care center where patients can receive the most advanced care available, but UPMC Passavant is now building a reputation as a hospital on the leading edge of international cardiovascular disease care.

“UPMC Passavant has made a quantum leap from providing ‘routine’ cardiac care to very sophisticated management of heart and vascular disease,” explains Ronald Pellegrini, MD, chief of Adult Cardiac Surgery. “We have grown from our role as a tertiary care center to providing an even higher level of care for heart disease.”

“Our vision for the department has been the expansion of high-quality, technically advanced, and patient-friendly cardiac services at UPMC Passavant, encompassing all aspects of cardiovascular disease management,” says director of cardiovascular medicine and preventive cardiology, Daniel Edmundowicz, MD, MS, FACC. “This includes the finest anatomical therapies, such as percutaneous peripheral and coronary artery angioplasty and stenting; surgical revascularization, valvular repair, and replacement; and progressive programs for the medical management of congestive heart failure, pulmonary hypertension, and risk factor management. “We’re pushing the envelope to help patients establish and maintain cardiovascular health and wellness,” he adds. “We’re also bringing more clinical research trials to UPMC Passavant as a way to offer innovative cardiovascular care to our patients in the future.”

The UPMC Passavant Cardiovascular Center

At UPMC Passavant’s Cardiovascular Center, patients can take advantage of a comprehensive network of cardiovascular services including diagnostic testing, advanced imaging, electrophysiology services, catheterization procedures, highly advanced heart surgery, vascular and endovascular surgery, and cardiac rehabilitation services. These services are provided by UPMC Cardiovascular Institute cardiologists, community-based cardiologists, and vascular and cardiac surgeons from the UPMC Heart, Lung, and Esophageal Surgery Institute (HLESI).

“By vertically integrating all of the hospital’s cardiovascular services, we are better able to provide quality patient care and to optimize outcomes,” says Teresa Petrick, president, UPMC Passavant. “At the same time, we are working hard to maintain the personality of UPMC Passavant, integrating the personal care that our patients expect into everything that we do.”

“While all of our patients share a common disease, its causes and manifestations may differ for each person,” says Dr. Edmundowicz. “Patients who come to UPMC Passavant have the advantage of physicians who specialize in each area of the disease working side-by-side, lending their expertise to each other. This not only increases the program’s efficiency, but also improves convenience and outcomes for the patient.”

Combining advanced technology with physician expertise

To determine the cause of cardiac problems, UPMC Passavant cardiologists utilize a range of diagnostic tests which include echocardiography; electrocardiography and clinical electrophysiology; multigated acquisition (MUGA) scanning; exercise stress testing; and radionuclide stress testing. Patients who may be suffering from a critical condition are immediately seen in UPMC Passavant’s Chest Pain Center, where they are placed on cardiac monitors and undergo repeat lab work so that doctors can make a quick and accurate diagnosis. More than 2,000 catheterization procedures are performed in UPMC Passavant’s state-of-the-art laboratories each year through such procedures as balloon angioplasty and intravascular stent placement. “For our patients’ convenience, we try to minimize wait times for these diagnostic tests,” says Marjie Gould, RN, BSN, MBA, director of cardiac imaging.

Through UPMC Passavant’s Vascular Interventional Laboratory and Vascular Surgical Service, patients also benefit from having access to a range of innovative procedures. Advanced and minimally invasive options often are used, including endovascular repair of aortic and thoracic aneurysms. “Because of this newer technology, we are able to do minimally invasive interventions in situations such as complex aortic chest surgery, that would not have been possible as little as five years ago,” says vascular surgeon, Robert Rhee, MD. “We now can offer angioplasty and stenting options for a range of occlusive and aneurysmal vascular disease problems.”

“UPMC Passavant is now one of the busiest hospitals north of Pittsburgh in terms of providing interventional services,” adds Dr. Rhee. “Here, patients have access to most of the technologies and protocols available at UPMC’s urban hospitals, which helps them avoid having to travel into downtown or Oakland.” As one of the few electrophysiology labs north of the city, UPMC Passavant has performed more than 2,000 electrophysiology procedures, with treatments ranging from diagnostic testing to pacemaker and cardiovascular defibrillator implantation. Biventricular pacing devices, also known as cardiac resynchronization therapy, also are available for the treatment of advanced heart failure.

Radiofrequency ablation is performed to treat the most therapy-resistant cases of arrhythmia. “We recently began performing advanced ablation procedures to treat common arrhythmias, which traditionally have been treated with medications or through the implantation of a pacemaker,” explains Sandeep Jain, MD, adding that UPMC Passavant is one of the few hospitals in the region that treats atrial fibrillation with radiofrequency ablation.

A newly expanded electrophysiology laboratory opened this past May, and includes sophisticated mapping system equipment. “Using this new system, we are able to study a body’s electrical conduction system while at the same time integrating a patient’s anatomy, which enables us to better analyze and treat the patient’s condition,” adds Dr. Jain. More complex procedures may require the expertise of UPMC Passavant surgeons who are part of HLESI. These include mitral valve repair, aortic valve repair and replacement, coronary artery revascularization, left-ventricular reconstruction, and endovein harvesting. UPMC Passavant also offers a range of open-heart surgeries including routine coronary bypass grafting (CABG); emergency and repeat CABG and valve procedures; less invasive, off-pump coronary bypass surgery and single- and multiple-valve surgeries for adult congenital heart disorders.

To date, more than 2,800 open-heart procedures have been performed at the hospital, and UPMC Passavant’s share of the market continues to grow, despite a decline in the volume of open-heart surgeries performed throughout the region.

Health and wellness programs

While UPMC Passavant is known for its sophisticated treatment of cardiovascular disease, it is also quickly earning a reputation for its prevention programs. “It’s wonderful to have such high-tech measures available to help patients suffering from heart treat disease, but it’s also important that cardiology care be directed toward preventative measures,” says Kenneth Huber, MD. “If preventative care is in place, you may never need to use those high-tech measures.”

Preventative care can also be used to improve the surgical outcomes of patients, who benefit from support programs that can help them control risk factors. UPMC Passavant has established a Lipid Clinic, designed for patients with difficult-to-manage cholesterol issues. “This program has been in place in Oakland for many years, and was recently brought to UPMC Passavant,” says Dr. Edmundowicz. As part of the program, patients receive nutrition counseling, lifestyle modification, and exercise advice. Patients also are shown how to make heart-healthy choices through the Cardiac and Pulmonary Rehabilitation Program, where they work with specially trained nurses, exercise physiologists, respiratory therapists, and dietitians.

To teach women about their risk factors and possible ways to prevent heart disease, UPMC Passavant created the Women’s Heart Program. Participants in the program receive cholesterol and glucose analysis, as well as blood pressure testing and a body mass index evaluation. Exercise, weight reduction, and nutritional counseling are available, and women can participate in exercise and weight reduction classes through UPMC Passavant’s partnership with the Greater Pittsburgh YMCA.

“Because we have seen quite an upsurge of heart disease in our community, we wanted to provide a way for women to learn more about the risk factors pertaining to heart disease,” says Dr. Suad A. Ismail, co-director of the program. “Women in the program receive a comprehensive cardiac risk factor assessment that enables us to determine their risk of heart problems, refer them to lifestyle modification programs, schedule them for tests, or refer them to qualified physiologists or cardiologists.”

The continuum of care

In addition to working as a team within the Cardiovascular Center, UPMC cardiovascular physicians also work with other specialists in the hospital to ensure that patients receive comprehensive care. “We’ve been involved with the open-heart surgery program since its inception,” says Thomas L. Schauble, MD. “Our role is to manage patient respiratory issues that can arise after surgery, which happen quite often with open-heart patients.

“Dr. Theodore Vuchinich makes rounds with the cardiac surgeons on a daily basis and also interacts with the nurse practitioner in the intensive care unit and cardiac care units each day,” he says. Patients also have access to a number of clinical trials, which could provide even more innovative treatments in the future.

Currently, the cardiovascular physicians at UPMC Passavant have funded trials under way in such areas as novel medications for pulmonary hypertension and congestive heart failure; new drug-eluting stents for the treatment of coronary artery disease; and novel anti-hypertensive and anti-atherosclerotic medications for the prevention and treatment of coronary artery disease. Funded trials in the areas of lower extremity disease and aneurysm repair also got under way last spring, and a study on carotid disease just received approval. “Patients used to have to drive downtown, and in some cases, get on an airplane to receive the types of treatments that they can now receive at UPMC Passavant,”says Dr. Pellegrini. “We have become the destination for patients seeking high-end cardiovascular care closer to home.”

Facilities keeping pace with growth in cardiovascular services

Cardiac patients who require a higher level of treatment and monitoring have always had access to specialized inpatient facilities at UPMC Passavant, including intensive and critical care units, as well as a progressive cardiac care unit where specially trained staff care for fewer patients.

With the addition of the new Patient Tower, which will open in 2010, cardiovascular patients will have access to even more state-of-the-art equipment and technology. “The new tower operating rooms will provide us with the capacity to perform complex angiograms, interventions, and CT scans as well as allow us to work together to perform more complex procedures,” says Dr. Rhee.

The new tower will include six operating rooms—one will serve as a hybrid angiography suite, and another will contain a CT scanner. An additional 16 intensive care beds will be provided for medical and surgical cardiac patients, and private family rooms will be available. Amenities in waiting rooms will include wireless Internet access, blankets, pillows, and food and beverage carts.

Through a unique partnership between UPMC Passavant and La Roche College, families from out of town can take advantage of accommodations in the La Roche Hospitality Rooms. Located close to UPMC Passavant, the rooms are designed for hospital visitors with family members in critical condition. At a cost of $40 per night, the rooms offer convenience and affordability for families planning longer-term stays.