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A New Leader to Take Heart Care to the Next Level IN SEP TEMBER 2015, Daniel O'Dea, MD, FACC, became Vice President of Cardiovascular Services at Health Quest after serving as Chief of Cardiology at Vassar Brothers Medical Center and President of The Heart Center, a division of Hudson Valley Cardiovascular Practice, P.C. In his new role, Dr. O'Dea is tasked with integrating, enhancing and expanding Health Quest's cardiology, cardiovascular and vascular surgery services, as well as overseeing The Heart Center's operations. He is excited about building on the health system's strengths and developing new ones. "Diagnosing and treating ischemic heart disease is our strongest, most mature area," Dr. O'Dea says. "We have been doing cardiac catheterizations since the early 1990s and surgery, angioplasty and stenting since 2000. We have 16 years of experience in caring for patients with heart attacks, angina, chest discomfort and acute coronary syndromes. Our cardiothoracic surgery program has some of the best outcomes in New York state. "We recently added heart failure care to our reper- toire," Dr. O'Dea continues. "We have one of the only board-certified heart failure specialists between New York City and Albany, and our heart failure clinic offers a variety of therapies, including the CardioMEMS heart failure monitoring system. Our electrophysiology program collaborates with the heart failure clinic to provide resyn- chronization therapy, in addition to offering device therapy and other treatments for arrhythmias and cardiac arrest." Dr. O'Dea sees heart failure as a key area of growth for Health Quest. "We are expanding our structural heart services," he says. "Offering transcatheter aortic valve replacement was the first step in this effort. We intend to add place- ment of WATCHMAN devices for patients with atrial fibrillation who cannot take anticoagulants, as well as minimally invasive catheter-based mitral valve clipping." "Further testing may be recommended based on the results of the first battery of tests," Dr. Jafar says. "Once the second round of tests is finished, the evalu- ation process concludes with the multidisciplinary valve conference, which meets every two weeks. At this meeting, all of the clinicians involved in valve replace- ment discuss each patient case at leng th and come to a consensus on the optima l treatment approach." VERSATILE PROCEDURE TAV R procedures ta ke place in a hybrid ca rdiac catheterization laboratory at Vassar Brothers Medical Center. Most patients receive genera l a nesthesia and are intubated during the procedure. Those who cannot have intubation receive conscious sedation or monitored anesthesia care. One of the advantages of TAV R is clinicians can access the diseased aortic valve using several dierent avenues as dictated by the patient's anatomy. "Most of these procedures are performed transfemorally, but certain patients aren't candidates for this approach because they have very sma ll, tortuous or heavily ca lcified femora l or iliac arteries, an abdomina l aortic aneur ysm, or a tortuous abdominal aorta," Dr. Sarabu says. "If any of these are the case, we look at a lternate ways of performing TAVR , including the transaortic, trans-subclavian and transapica l approaches. The patient's anatomy and our choice of approach determine which prost hesis we use — eit her a ba l loon-ex pa ndable Edwards Lifesciences va lve or a self-expanding Medtronic va lve. Only the Medtronic va lve, for example, is approved for the trans-subclavian approach, and the transapica l approach can accommodate only the Edwards Lifesciences va lve." Drs. Jafar and Sarabu perform each procedure, and colleagues assist as needed. Vascular surgeons are available to mitigate bleeding, if an emergency arises. Technicians and nurses are a lways prepared to place the patient on a heart-lung bypass machine, if necessary. "Each person has specific tasks to perform," Dr. Jafar says. "The choice of approach determines which clinician takes the Dr. Gorwara and Dr. Jafar review cath films of a patient post-TAVR procedure. PHOTO © PAUL MOORE, PAUL MOORE STUDIO Geraldine Kenny, RN, and Dr. Jafar visit with a patient after his TAVR procedure. PHOTO © PAUL MOORE, PAUL MOORE STUDIO 0 8❱❱❱❱❱ C O V E R F E A T U R E