Wednesday, March 21, 2018

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Heart Care: How Far We Have Come

Written by  Rich Ellis


The evolution of the subspecialty of cardiology is widely considered being responsible for the greatest prolongation of life in industrialized nations. Advancements in science and technology coupled with the expertise of various medical experts in the field have contributed to a significant decrease in heart disease and heart-related conditions. Although heart disease continues to be a leading killer, the death rate by age and impact to population per capita during the 21st century is markedly less than during the 20th century. To learn more about cardiovascular care, OurHealth turned to two Richmond specialists.

Cardiologists versus Cardiovascular Surgeons

Patients often confuse the roles of cardiologists and cardiovascular surgeons, mistakenly believing that there are no discernable differences in the types of services they provide, the conditions they treat or the procedures they perform. It’s a popular misconception and understandably so because both focus on caring for, diagnosing and treating conditions related to the heart and vascular system — but that’s where the similarities end.

“Although cardiologists and cardiovascular surgeons work together as a team to manage cardiac patients, they’re actually completely separate disciplines,” says Christine Browning, MD, a cardiologist with Cardiovascular Associates who also works at St. Mary’s Hospital and Memorial Regional Medical Center, hospitals affiliated with Bon Secours Richmond Health System. “When you finish medical school, you basically make the decision to be a medical doctor or a surgical doctor, and from day one, each is a completely different training track.”

BSHVI 286K left blue-01The separate tracks take about seven years to complete, Dr. Browning says, as both cardiologists and surgeons progress through internships, residencies and fellowships specific to their discipline.

Cardiologists typically manage cardiovascular disease, Dr. Browning explains, while a cardiovascular surgeon has a short episode of care that is limited to the surgical intervention. For example, a patient with high cholesterol, high blood pressure and diabetes might first be referred to a cardiologist for a stress test. Depending on the results, the stress test could be followed by a cardiac catheterization to examine the arteries supplying the heart in order to diagnose whether those arteries are obstructed. If they are, the cardiologist might treat the blockage with a stent. If, on the other hand, the stent isn’t a treatment option, the patient would usually be referred to a cardiovascular surgeon.

What is a stent?

A stent is a tiny wire mesh tube. It props open an artery and is left there permanently. When a coronary artery is narrowed by a buildup of fatty deposits called plaque, it can reduce blood flow, causing chest pain. If a clot forms and completely blocks the blood flow, a heart attack results. Stents help keep coronary arteries open and reduce the chance of heart attack.

The surgeon decides whether the patient is a candidate for surgical intervention and if they are, which approach is right for them. It could be a valve repair performed through a traditional open surgery, a minimally invasive valve repair or even a transcatheter valve replacement, Dr. Browning says. The surgeon manages the patient during the acute pre- and postoperative phases of care and typically for 30 days following surgery, at which point the patient returns to the care of a cardiologist, who follows the patient indefinitely.

Minimally Invasive Procedures

Marc Katz, MD, a cardiac surgeon and the medical director for Bon Secours Heart & Vascular Institute in Richmond, performs many of these surgical procedures using the latest medical technologies.

“Right now it’s a great time for patients because more and more procedures are being done in a less invasive way,” says Dr. Katz. “For example, we’re performing a lot of valve repairs and replacements through a needle stick. This has opened up a whole new opportunity for patients by making this type of care available to patients who would not previously have been considered a candidate for any type of heart surgery.”

Nearly 6 million people in the U.S. are afflicted with congestive heart failure. Of these, more than 250,000 are advanced cases with an annual mortality rate of 80 percent.

Procedures such as transcatheter valve repair or transcatheter valve replacement, in which the catheter is inserted through an artery or vein, are used to repair the heart’s leaking mitral valve or to repair the aortic valve, which tends to narrow. Both conditions increase in incidence with age, and by age 65 to 70, approximately 10 percent of the population experiences a problem with one of these valves.

Before the availability of minimally invasive procedures, a typical mitral valve repair would have included an incision through the breast bone, use of a heart-lung machine to compensate for the heart’s stoppage during the procedure and a lengthy hospital stay and recovery. Dr. Katz shared the example of a 96-year old patient who recently had a mitral valve repair and was able to return home the following day.

“In an article written by the president of the American College of Cardiology and the president of the Society of Thoracic Surgeons, they used analogies to these two technologies being as groundbreaking as the development of anesthesia or the discovery of penicillin,” says Dr. Katz.

"A third area we’re doing a lot of work in is with patients experiencing end-stage heart failure who are either candidates for a heart transplant but a heart isn’t available yet or who have a heart that’s weak, but for one reason or another they’re not a candidate for a heart transplant," continues Dr. Katz. "For those patients, an assist pump called an LVAD, a left ventricular assist device, can be the solution."

Continuing Improvement with LVAD’s

In 1990 Dr. Katz was the first surgeon in Virginia to implant an LVAD in a patient, and 25 years later he was the first surgeon in Virginia to implant the Thoratec HeartMate 3 Left Ventricular Assist Device — a new advance in mechanical circulatory support. The patient was selected as part of the prestigious MOMENTUM 3 clinical trial, with Bon Secours being one of 60 locations in the United States — and the first in Central Virginia — chosen as part of the evaluation for people with advanced heart failure.

The HeartMate 3 LVAD is an implantable mechanical device that helps circulate blood throughout the body. Sometimes called a “heart pump,” it is designed to supplement the heart’s pumping function for patients whose hearts are too weak to pump blood adequately on their own.

"What makes it unique is that the rotor that pumps the blood is magnetically levitated so it has no bearings — there’s nothing to wear out," Dr. Katz explains. For people who aren’t candidates for a heart transplant, the HeartMate becomes their new heart.

“Patients who undergo the LVAD procedure experience a dramatically improved quality of life because an LVAD can pump blood throughout the body as well as a healthy heart can,” says Dr. Katz. “An LVAD restores circulation and improves the efficiency of other organs that had been adversely impacted by diminished blood flow.”

Be Heart Smart

While medical technology is certainly improving cardiac care, avoiding cardiovascular disease through diet, exercise and preventive care and by avoiding tobacco use should be every patient’s primary goal. When that isn’t possible because of genetics or the presence of disease or other conditions, a patient’s primary care physician could refer them to a cardiologist as the next step in the diagnosis and treatment sequence, with a subsequent referral to a cardiovascular surgeon, depending on the diagnosis.


  • Christine Browning, MD with Bon Secours Cardiovascular Associates of Virginia
  • Marc Katz, MD iwth Bon Secours Cardiac Surgery Specialists


American Heart Association –