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WellSpan heart specialists can utilize this presurgery planning approach for diagnostic cardiac heart catheterization; coronary intervention, such as stent implantation; chronic total occlusion treatment; and transcatheter aortic valve replacement, among other procedures. Transcatheter aortic valve replacements, which physicians first performed without opening the chest in 2010, will particularly benefit from the use of 4D CT. At first, transcatheter aortic valve replacement was utilized only for the sickest patients, but now it has been proven effective for a greater number of patients. While roughly 15% to 18% of patients who have valves replaced eventually need pacemakers, that is not the case at WellSpan York Hospital. "Our rate [for placing pacemakers after valve replacement] is about 3%," Dr. Harvey says. "We now teach other cardiology departments what we do." Although the new cath lab is expected to enhance patient outcomes, the team at WellSpan had already established that low rate even before the advanced tools were available to them in the cath lab suite. FIX TO AN UNEXPECTED PROBLEM One of the unanticipated benefits of improved heart valve replacement procedures is that patients are outliving their replacement valves, according to Dr. Harvey. Although that is obviously an advantage to patients, it is accompanied by a downside — the risk of occluding an artery is much higher during a second replacement valve procedure, as the second replacement valve can push against the first one and block blood flow. "Our new technologies allow for greater accuracy in placing the valve," Dr. Harvey says. "We realized that, in the next five to 10 years, we were going to be seeing this complication more frequently, so that's the focus of the research we are conducting now." WellSpan continues to lead in cardiovascular care by showing other teams how to accomplish impressive results in valve replacement, providing the most advanced technology to physicians. This results in better outcomes for patients and enhances the collective understanding of what cardiac valve replacement patients are going to require in the future. Other cardiovascular specialty teams at WellSpan are conducting research projects, as well, with the goal of identifying the most effective treatments for a variety of cardiovascular conditions. THE CARDIOVASCULAR AND PRIMARY CARE CONNECTION At WellSpan, the approach to care employs a team methodology. The primary care physician, as well as the heart specialists and an entire network of provid- ers, collaborate to provide outstanding care, promote successful recovery and maintain patient health into the future. Within the Heart & Vascular model at WellSpan, patients have access to programs and specialists ranging from lifestyle intervention to electrophysiology. What's more, even after patients are referred to WellSpan, the team prioritizes maintaining the relationship with primary care physicians. "The first, middle and last advocate for the patient is their primary care physician," Dr. Harvey says. "This new CT scan procedure and everything we are doing is for the longevity of the patient. We want to help primary care physicians take care of their patients for life." To learn more about how WellSpan is advancing cardiovascular care throughout the region, visit WellSpan.org/HV. n " I enjoy practicing at this great institution. W. Jay Nicholson, MD, started the cardiology program here and changed the way things are accessed across the whole state. He was followed by his son William Nicholson, MD, who was a true modern-day pioneer. I came into a program where innovation is the standard, and that is both inspiring and invigorating." — JAMES HARVEY, MD, DIRECTOR OF THE STRUCTURAL HEART PROGRAM AT WELLSPAN This illustration shows the placement of the Edwards SAPIEN Transcatheter Heart Valve through a transfemoral approach. When performed in the cath lab with 4D CT, correct placement of the valve can be easily confirmed before the patient ever leaves the room. M D N E W S . C O M /// M D N E W S S O U T H C E N T R A L P E N N S Y LVA N I A ■ 2 0 2 0 0 5