For many years Broward Health Coral Springs (BHCS) provided cardiac care services to the community, but one key component was missing—a cardiac catheterization lab for emergency catheterizations. Subsequently, patients were transported to other facilities, but that’s no longer the case.
Last June, a new state-of-the-art cath lab became operational at BHCS. “We now have the ability to care for specifi c patients with ST Elevation Myocardial Infarctions (STEMI),” said Mohamed Osman, M.D., director of the Cardiac Catheterization Laboratory and specialist in Interventional Cardiology at BHCS. “This is a unique opportunity to provide an even higher level of care through angioplasty procedures.”
Designated as a Level 1 Heart Program by the Agency for Healthcare Administration, the new cath lab was termed a “milestone” by hospital CEO Jared Smith, one that “increases our ability to provide a high level of care and uphold our recognition (per Our City Magazine) as the area’s best hospital and Emergency Department.”
Gary Lai, D.O., and chief of Emergency Medicine says the addition of the STEMI heart program makes it possible for EMS to pre-alert the ER and send electrocardiograms prior to a patient’s arrival. “We can prepare immediately to stabilize, medicate, and expedite patients to the in-house cath lab,” he said. “This saves lives and maximizes outcomes.”
The new catheterization lab allows BHCS specialists to perform invasive cardiac procedures and utilize advanced imaging for diagnoses by using contrast dye to determine the severity of the arterial blockage. Once identified, a balloon angioplasty is performed, or a stent is inserted to clear the artery and save as much of the heart muscle as possible. Pacemakers and defibrillator implant procedures are also performed.
Generally speaking, the last 20 years has seen a rapid transformation of new techniques focusing on minimally invasive procedures, rapid care, and shorter hospital stays, according to Dr. Osman. “Although open heart surgery is certainly an option, the major shift has been toward less invasive, less traumatic procedures that obtain excellent results.” People with severe heart valve problems always required open heart surgery. A significant number are now treated with stents to reduce the risk of a major heart event.
Surgical progress in cardiology can be defi ned by an alphabet soup of acronyms: SAVR (Surgical Aortic Valve Replacement); CABG (Coronary Artery Bypass Graft); BAG (Bilateral Arterial Grafting); PCI (Percutaneous Coronary Intervention); TAVR (Transcatheter Aortic Valve Replacement); EVAR (Endovascular Abdominal Aneurysm Repair): and ICD (Implantable Cardioverter Defi brillator). The term Electrophysiology refers to leadless pacemakers and remote monitoring devices. “Because of these techniques, patients spend less time in the hospital, recover faster, and there’s less trauma to the body,” said Dr. Osman. “An aortic valve replacement once required open heart surgery, but now the TAVR procedure accomplishes the same goal by inserting a transcatheter through a small incision in the groin.”
Surgical complications
Any medical procedure has the potential for complications such as excessive bleeding, stroke, and even death, but the key is how often complications occur as a result of surgery. “Both minor and major complications are possible, but keep in mind that no patient is the same,” said Dr. Osman. “If a younger patient requires open heart surgery the only problem is the heart and nothing else, so the focus is isolated, but older patients—especially those with underlying conditions such as diabetes, kidney problems, or a previous stroke, are in a high- risk category for complications,” the specialist said.
To show that one size doesn’t fit all, Dr. Osman uses the example of two patients with the same high percentage of blockage that would be treated differently. “The one who is asymptomatic can be treated with medications and dietary changes, while the other who has difficulty breathing and may have underlying medical conditions is a prime candidate for a stent.” He reminds us that everyone is different, and each patient requires a different mode of treatment depending on general health and underlying conditions. “The key is a full evaluation to create a treatment plan with the best benefit.”
Dr. Osman refers to the doctor-patient relationship as “the art of medicine.” The unique relationship includes listening, evaluating, diagnosing, and treating. “At the end of the day when pieces of the ‘puzzle’ come together it’s the collaboration between the surgeon and interventional cardiologist that makes it happen,” he said. He recently saw a patient with a 90-percent blockage of the artery. CABG open heart surgery was performed, and the person is expected to make a full recovery. Choosing the right therapy is the goal.
The COVID consequence
When COVID’s first wave peaked in March 2020, it impacted cardiology services.
With a focus on caring for acute COVID patients, the shift was away from elective cardiac procedures. “Many patients feared coming to the hospital out of fear of COVID and that posed a huge problem,” said Dr. Osman. “In cardiology, time is a big factor and the longer treatment is delayed the worse a condition can become.” He cited a patient who suffered a heart attack yet remained at home for two days. They were able to save his life, but the heart muscle was significantly damaged and he’s now living with a very weak heart muscle. “Things like this are still happening but not to such a high degree. Remember that the margin of error is much less with age,” he said.
The medical facility keeps a log on how long it takes after arrival in the ER to when a clogged artery is opened in the cath lab. According to Dr. Osman the best time to date has been 23 minutes.