The Structural and Valvular Heart Health Center is the latest resource within Tufts Medical Center’s respected CardioVascular Center to offer patients and referring physicians easy access to the most advanced cardiac care. The program, which started in 2012, brings together experts in clinical cardiology, cardiac surgery, valvular disease, interventional cardiology, vascular medicine and cardiovascular imaging to provide a one-stop resource for evaluating, diagnosing and treating adult patients with structural and valvular heart disease (SVHD) – the second-largest category of heart disease after coronary artery disease.
“The complexity of patients with SVHD, along with the evolution of advanced treatments – including innovative surgical and catheter-based approaches – demands a level of insight and expertise that no individual subspecialist has,” says Andrew Weintraub, MD, Director of the Coronary Care Unit, and Associate Director of the Cardiovascular Invasive and Interventional Program and the Vascular Medicine Center. “Through this new Center, we meet regularly and make treatment decisions as a team, which means that each patient has a decision rendered by physicians deeply invested in only one thing: the best outcomes for that person.”
“It’s a broad-based collaboration and a diverse knowledge base that really helps to get the best patient outcomes possible,” adds Carey Kimmelstiel, MD, Director of the Adult Cardiac Catheterization Laboratory and Interventional Cardiology, and Director, Clinical Cardiology.
So what sets Tufts Medical Center apart from other tertiary referral centers offering expertise in these areas?
“A lot of hospitals say they have a so-called heart center and all their specialists work together, but in reality it doesn’t always happen,” says Natesa G. Pandian, MD, Director of the Heart Valve Clinic. “Our strength is in providing services in a real interdisciplinary fashion, not just within the Medical Center but also including the referring physician.”
“We’re partners versus competitors in the care of patients,” Kimmelstiel adds. “We’re good at communicating in real time with the referring physician about what’s happening with their patient, and we’re good about returning patients to their community physician when treatment is completed.”
The clinical expertise at Tufts Medical Center also sets the institution apart.
“We were the first in Boston to perform valvuloplasty twenty-plus years ago, so treating structural heart disease in the cath lab is a very mature subspecialty here,” Kimmelstiel says.
Tufts Medical Center also is world-renowned for its comprehensive treatment of hypertrophic cardiomyopathy (HCM). Of the very few HCM treatment and research facilities of its kind, it is only one of 4 programs, nationwide, to receive a Most Preferred rating from the Hypertrophic Cardiomyopathy Association, and is third-busiest in terms of volume behind only the Mayo Clinic and Cleveland Clinic.
On the surgical front, the Medical Center also remains on the leading edge.
“We perform minimally invasive mitral and aortic valve repair and replacement,” explains Hassan Rastegar, MD, Director of Adult Cardiac Surgery. “Because we do it through a small keyhole incision without dividing the sternum, the patient benefits are significant: minimal risk of infection, minimal blood loss, shorter length of stay and faster recovery. Patients can drive, go to work or play golf within two weeks – versus a six- to eight-week recovery with conventional sternotomy.
“And our outcomes are excellent, based on benchmarks established by the national Society of Thoracic Surgeons,” Rastegar adds.
Trans-catheter aortic valve replacement (TAVR) represents the latest tool in Tufts Medical Center’s extensive armamentarium of options available to treat patients with heart valve abnormalities, advancing minimally-invasive approaches to include ones performed with a catheter, instead of a scalpel.
Research related to SVHD is another arena in which the Medical Center excels. For example:
“We currently are the third-highest enrolling site in the U.S. for a trial focused on stroke prevention through patent foramen ovale (PFO) closure,” Kimmelstiel notes. “An estimated one-third of the 750,000 strokes that occur each year are cryptogenic [without obvious source], and PFOs are present in about half of these. This trial holds tremendous promise for a lot of patients.”
Another distinguishing feature of this new Center is its total focus on the individual patient. Patient-centered services include streamlined scheduling through a single dedicated phone number, consolidation of services in a single, convenient location, same-day diagnostic imaging to reduce the need for multiple visits, careful attention to patient and family education, and a care coordinator to help patients navigate their course of treatment.
“The flow of treatment for SVHD can be complex, but the way we’re organized and the motivation of our staff make it simple,” Weintraub says, noting, “If you think about what patients want from a Boston-area major academic medical center, it includes direct access to superb clinical care and to be treated as an individual in a place where people know them by name. This is what we provide.”
“Each of us has received recognition for the work we do,” adds Pandian, referring to the Center’s physician team and their numerous publications, presentations and “top doc” awards, both nationally and in Boston. “But we never forget that we are not only dealing with a patient with a heart problem, but also with the human being behind the problem and his or her family.”