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COV ER FE AT UR E LASER LEAD REMOVAL When pacemakers or other devices fail to work properly and require replacement, medical intervention is required. Commonly, surgeons extract leads — wires that conduct electricity from the device to the heart — via an invasive procedure performed through an incision in the chest. Southcoast electrophysiologists offer a minimally invasive alternative that approaches the lead through a catheter inserted in the groin. Using laser energy to break up the scar tissue built up around the lead, electrophysiologists can remove the lead and install a new device. Just under the Skin Southcoast Hospitals Group is one of the few facilities recently awarded early allocation for a novel defibrilla- tor device that obviates the need for risky lead removal altogether. The Subcutaneous Implantable Defibrillator (S-ICD) delivers therapeutic doses of electricity to steady a dangerously arrhythmic heart via a lead implanted under the skin at the bottom of the rib cage and breastbone, according to an FDA press release announcing the device's approval. The S-ICD brings hope to patients whose conditions put them at higher risk for standard defibrillator placement, infection or sudden cardiac arrest, as well as those who have diabetes or are on dialysis. After a STEMI patient's arrival at the hospital, the goal should be to take no longer than 90 minutes to remove arterial blockages and restore blood flow. Southcoast is constantly working on ways to improve that timing. "We have fine-tuned our processes for accelerating our STEMI response times over many years and have excellent results. We're now investigating earlier activation of our catheterization team, prior to the patient's arrival at the hospital. This will require partnering with our local EMS services to facilitate communication from the field directly to the ER and cath team as the patient is being transported by EMS," says Dr. Farrell. Innovative Approach To clear blockages and open arteries, interventional cardiologists have traditionally threaded angioplasty balloons or stents through catheters in the femoral artery, but femoral access carries significant bleeding risks. Additionally, patient-specific factors, such as obesity and arterial disease, can make threading a catheter through the femoral artery difficult or unsafe. Although such complications can be anticipated and managed, a new approach eliminates the risks and allows leading-edge treatments for a broader spectrum of patients. "Since we use larger catheters to do more elaborate procedures or use more potent blood thinners to complete a procedure, bleeding risk is associated with femoral access," Dr. Sklar says. "In contrast, the radial artery is smaller and more easily compressed. Radial access minimizes bleeding risk." Approximately 60 percent of all cardiac catheterization procedures performed by Southcoast interventional radiologists use the radial artery. Dr. Sklar notes that the number is growing, but it's not a one-technique-fits-all approach. For example, surgeons can use the radial artery as a conduit during cardiopulmonary bypass, so if physicians suspect a patient will require bypass in the future, they will use the femoral artery for catheterization instead. Excellence in Surgery Since performing the first open-heart surgery at Southcoast in 2002, the cardiac surgery program has been a critical component of its cardiac services. Helmed by world-class surgeons James Fingleton, MD, Chief of Cardiovascular Surgery, and Iraklis Gerogiannis, MD, and enhanced by highly trained nursing and support staffs, the cardiac surgery department offers traditional, open surgical operations, as well as innovative, minimally invasive procedures. There's a significant learning curve to the minimally invasive approach, and five years and nearly 300 cases have given Dr. Fingleton experience equivalent to that of any surgeon in Boston. This provides a less-invasive alternative for patients needing aortic valve replacement, mitral valve repair, congenital lesion removal or even some tumor excisions. "We have state-of-the-art technology at our fingertips," Dr. Fingleton says. "But what's really important is the experience of the surgeon. If patients want someone who has done it all, there's no need to look any further." For more information about the innovative offerings at Southcoast Health System, please visit www.southcoast.org. ■ Anatomical placement of the Subcutaneous Implantable Defibrillator System National Recognition For Southcoast Hospitals Group, the success of 2013 was business as usual. Healthgrades named Southcoast one of America's 100 Best Hospitals for Heart Care and awarded it the Specialty Excellence Awards for both Overall Cardiac Care and for Cardiac Surgery. 8 | Greater Boston MD NEWS ■ M D N E W S . CO M