Illinois Medicine

campus news C H I C A G O P E O R I A R O C K F O R D C H A M P A I G N - U R B A N A A ROUTE TO THE HEART T New procedures in angiography and angioplasty are making it safer for patients and improving recovery time HE USUAL PRACTICE for common cardiac proce- dures such as angiograms and clearing blocked arter- ies is to place the catheters through the femoral artery in the groin. The patient needs to lie still on his or her back for four to six hours, which can be uncomfortable for elderly patients with back prob- lems, and walking can be uncomfort- able for days. Although complica- tions from standard catheterization procedures through the groin are low, they can occur in 2 to 9 percent of patients. A new approach, transradial an- giography, threads a catheter through the radial artery in the wrist rather than the larger femoral artery. Cardi- ologists at the University of Illinois and Jesse Brown VA medical centers are among the first in the Chicago area to offer the approach. "It's a simple change that has a dramatic impact on the experience and recovery of the patient," says Adhir Shroff, MD, as- sistant professor of cardiology at UIC. Patients who have the procedure done via the wrist can immediately sit up, eat and walk without pain, Shroff says, and the transradial approach can reduce bleeding—the most com- mon complication, particularly among women and the elderly—to less than 1 percent. The transradial procedure has been widely adopted in Europe, where up to 60 percent of procedures are now done this way. In the U.S., only about 2 percent of coronary interventions use the procedure. At the end of last year, Shroff, Mladen Vidovich, MD, UIC assistant professor of cardiology, and Bernadette Speiser, MSN, nurse manager in cardiology at the Jesse Brown VA Medical Center, led an all-day workshop at UIC in implementing the approach that drew cardiologists and other catheter lab team members from the Chicago area PHOTO: UIC NEWS Adhir Shroff, MD, and his colleagues are local leaders for transradial angiography and use of a new heart pump. and around the country. "The issue is really just the learn- ing curve," Shroff says. "The change requires dozens of small changes—ev- erything from redesigning the sterile drape so that the openings are at the wrist rather than the leg and finding smaller needles, wires and catheters, to the way the table is set up." In another clinical area within cardiology, Shroff, Vidovich and John Kao, MD, UIC assistant professor of medicine, have been leaders in using a new heart pump that can be inserted without the need for surgery, allowing cardiologists to treat high-risk patients with a procedure to unblock their heart arteries. The recently FDA-approved device was used to assist in six angio- plasty procedures at the medical center since October. Patients with the worst block- ages are often the sickest, making it too dangerous to treat their coro- nary artery blockages with standard angioplasty or even with a bypass operation. "Often these patients, who may have complicating conditions like cancer, renal failure, severe lung disease or heart failure, are poor can- didates for more invasive procedures and are left with few options," Shroff says. With the Abiomed Impella 2.5 ventricular assist device, which has been used only about 1,000 times in the country, doctors can offer the less-invasive procedure to high-risk patients. Smaller than a No. 2 pencil eraser, the Impella pumps blood from within the heart into the aorta, supple- menting the weakened pumping of the patient's heart. Although it performs a large portion of the heart's work, it is silent and virtually imperceptible to the patient. The Impella can be regulated dur- ing angioplasty to maintain blood flow, giving the physician the time needed to remove the blockage. If the patient needs further support, the Impella can be continued while the patient moves up to the ICU and until the heart is able to take on the task. "We have created a seamless transition from the cath lab to the ICU," Shroff says. "We could not have done this without the collaboration of every- one who sees these patients as they move through the hospital, from the emergency room to the cath lab to the ICU, especially Nursing Services and the cath lab staff." 4 | SPRING 2 010

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