Dedicated Interventional Services at Munroe Heart Led by Robert L. Feldman, M.D.

At Munroe Regional Medical Center, Munroe Heart’s interventional cardiologists provide the latest catheter-based techniques to treat a variety of conditions in a dedicated lab.

Comprised of five interventional cardiologists and one interventional electrophysiologist, the cardiac catheterization lab at Munroe Heart is dedicated to catheter-based procedures. Munroe Heart, started in 1988, has grown since its inception. Today, specialists perform about 6,000 procedures annually, up from about 1,500 procedures after opening. The lab boasts five cath suites, with one dedicated to electrophysiology procedures. Families of patients undergoing most procedures are invited to watch the procedure, if they choose, to gain a better understanding of it.

“We do a few things differently than other practices,” says Robert L. Feldman, M.D., Director of the Cardiac Catheterization Lab at Munroe Heart. “Beyond having a completely dedicated staff of experienced interventional cardiologists and an interventional electrophysiologist, we’re continuing a history of being involved in a moderate amount of clinically relevant research that looks at bringing new medications and new devices to the community. We’ve had some carotid stenting programs that would not have been available without participating in clinical research. This participation allows us to provide patients with the latest techniques that are continually getting safer, more effective and easier to deliver.”

Treatment for a Systemic Disease

Dr. Feldman brings extensive experience in special carotid interventions with his surgical colleagues for aortic and thoracic aneurysm repairs with endovascular techniques to avoid open surgery in aneurysm patients.

“We’ve been able to specialize in these techniques and have additional niche-type expertise because we’re dedicated to interventional procedures,” says Dr. Feldman.
Gregory O. von Mering, M.D., interventional cardiologist at Munroe Heart, says the team is part of a discipline-wide effort to treat patients with peripheral artery disease and complications of the condition as a systemic illness. The team’s broad and deep experience enables them to complete complicated vascular interventions on a regular basis.

“Our team addresses vascular disease as a systemic illness that not only affects the heart, but also the arterial vessels of the body, everywhere from the neck to the feet,” says 
Dr. von Mering. “As such, we’re available to patients to treat the disease where it’s symptomatic — from nonhealing ulcers or vascular obstructions in the leg to abdominal aortic aneurysms. If patients are candidates for being treated with these techniques, we serve as a one-stop center for treatment of most vascular problems.”

Abdominal aortic aneurysms are silent conditions until a patient experiences a sudden catastrophic expansion of the aneurysm with a rupture, which is associated with high mortality and morbidity. After Munroe Heart interventional cardiologists identify and recognize this condition, and if a patient meets the criteria for intervention, the aneurysm repair can be completed through an open procedure or endovascular treatment.

“Frequently, patients who are candidates for endovascular treatment are chosen because this approach has a reduced burden of recovery,” says Dr. von Mering. “A unique and very positive aspect of our practice is our close relationship and partnership with Munroe Heart surgeons. Dr. Feldman and I work side by side with them and are able to take advantage of the complementary talents of this multidisciplinary team. We’re able to accomplish improved outcomes for these patients.”

A True Team Approach

Collaboration between surgeons and interventional cardiologists includes discussing various treatment options with patients to weigh the risks and benefits of a procedure as a team, which enables physicians to present the best option for treatment to a patient. The team also performs hybrid procedures that utilize endovascular techniques during a lower extremity vascularization that requires angiograph, stenting or an angioplasty as disease is recognized.

“Our team is available to provide a comprehensive approach to the patient that goes beyond the traditional boundaries of surgical venous endovascular care,” says Edward Santoian, M.D., interventional cardiologist at Munroe Heart. “With a focused, dedicated lab, we utilize the latest technology to treat the full spectrum of cardiovascular disease.”

Cardiologists at Munroe Heart employ a variety of the latest devices available for endovascular techniques — and because of the dedicated practice and experience, the physicians are able to custom tailor treatment based on a patient’s disease characteristics. From arthrectomy devices and thrombolitic tools for aspirating clots to a variety of stents and balloons, Munroe Heart endovascular specialists don’t use a single technology on a patient but instead provide comprehensive options.

Advances in Cathertizations

Interventional cardiologists at Munroe Heart perform complex catheterization procedures. John A. Bittl, M.D., interventional cardiologist at Munroe Heart, treats patients who have dialysis accesses and fistulas and grafts.

“When patients who consider these accesses and fistulas to be their lifeline develop narrowing or clots, I have techniques that can make accesses functional again,” says Dr. Bittl. “We also employ a transradial approach for cardiac catheter and stent implantation that reduces the change of bleeding complications, as well as showing a reduced need for blood transfusion or need for surgical repair of the access site.”

Another distinctive procedure of interventional cardiologists at Munroe Heart is the fractional flow reserve. This technique enables physicians to determine whether narrowing arteries truly need a stent.

“Not every narrowing on an angiogram is severe enough to require a stent,” says Dr. Bittl. “We’re very careful about placing stents in patients who really need them, as an increased number of stents translates to a greater chance for future heart attacks.”

Dr. Bittl, who serves on the writing committee for the 2011 PCI guidelines for the American Heart Association and the American College of Cardiology, recently published an editorial review in Circulation that discussed bioresorbable 
stent placement.

“Many patients our practice sees don’t like the thought of a permanently implanted metal stent in their heart,” says Dr. Bittl. “Bioresorbable stents have great potential for reducing the need for taking clopidogrel long term following a stent placement. These stents could be the next major revolution in cardiology — the idea of a temporary scaffold to keep an artery open for a period of time up to about a year or two after treatment is very appealing compared to the current technology.”

Munroe Heart is located at Munroe Regional Medical Center in Ocala, FL. For more information, call (352) 867-8181.




MD News January/February 2011, North Central Florida



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