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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 intervention- alists offer the WATCHMAN procedure for atrial fibrillation; emergency interventions, such as EkoSonic Endovascular System (EKOS) for acute pulmonary embolism; cryoablations and radio fre- quency ablations; and implantation of pacemakers and defibrillators. 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 sig- nificant pulmonary and coronary disease. He'd had a heart attack " 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 " 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 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. n M D N E W S . C O M /// M D N E W S C E N T R A l N E W Y O R K ■ 2 0 2 0 0 9