Second Opinions for Docs, Second Chances for Patients
The Jefferson Angioplasty Center helps cardiac patients avoid open heart surgery
Jefferson alumni and surgeons Michael Savage, MD '80, F' 86, Nicholas Ruggiero, II, MD '66 F'74, and David Fischman, MD F'91, established the Jefferson Angioplasty Center in 2014.
BY EUGENE MYERS
Richard Kacprowicz, a retired educator from New Jersey, had just suffered a heart attack, and his options seemed limited. A doctor at a local hospital told him he needed open heart surgery for multiple blockages, but when your heart is on the line, it’s worth getting a second opinion. Kacprowicz’s primary care physician referred him to interventional cardiologist Michael Savage, MD ’80 F’86, the Ralph J. Roberts Professor of Cardiology and director of the Jefferson Angioplasty Center and the Cardiac Catheterization Lab.
“Dr. Savage believed he could fix it,” Kacprowicz says.
Instead of bypass surgery to reroute blood flow around the blockage in Kacprowicz’s arteries, Savage recommended angioplasty, a procedure in which a balloon would be inserted into the artery via a small incision in the wrist.
“The artery is like a clogged pipe,” Savage says. “To open the pipe, we put in a balloon that expands and pushes the plaque that’s obstructing the artery to the side, kind of like a snow-plow effect. And then the artery gets stretched out and expanded.”
The process expands the artery to create a larger channel for blood to flow through. Then, a stent, a small mesh tube, is inserted to keep the artery propped open.
The procedure was a success. Then, about a decade later, Kacprowicz suffered a second heart attack; a different artery was completely blocked. Doctors at his local hospital attempted balloon angioplasty, but the procedure failed to clear the artery. They again recommended bypass surgery, but Kacprowicz returned to Savage at Jefferson. And again, Savage and his team came through for him with the same procedure.
Savage and his fellow Jefferson alumni and colleagues Nicholas J. Ruggiero, II, MD ’66 F’74, and David L. Fischman, MD F’91, established the Jefferson Angioplasty Center in 2014 to meet what they perceived to be a growing need for a center that could handle complex cardiac cases like Kacprowicz’s.
“They may be very high-risk patients, and they want a second opinion. Sometimes they’re told the only option is to go to the operating room and have heart surgery. Or sometimes they may be told that nothing can be done,” Savage says. The Center gives patients like these another chance they otherwise may never have known about—often a nonsurgical alternative.
Michael P. Savage, MD reviews a patient’s case in the Cardiac Catheterization Lab.
The Center’s individualized, patient-focused care and expertise make it a unique regional resource for healthcare providers and their patients with complex cardiac diseases—and it has one of the lowest mortality rates in the country, at rates 71 percent lower than the national average. The Angioplasty Center is also the only hospital in the tri-state area and one of only 20 centers nationwide to offer a procedure called coronary brachytherapy.
Brachytherapy is an intervention for stent restenosis, which occurs in less than 10 percent of procedures with the newer medicated stents. In these rare cases, scar tissue forms in the artery after an angioplasty, creating a new blockage.
Jefferson’s cardiologists were among the first in the world to perform brachytherapy. Jefferson was a participating center and the national core angiography laboratory for the Beta-Cath device, a temporary catheter inserted in the coronary artery that delivers short bursts of beta-radiation to an area only a few millimeters long. When Beta-Cath became available, Savage, Fischman, and their colleague Richard Valicente, MD, performed a brachytherapy procedure via a live stream online—a groundbreaking, awardwinning webcast.
Elaine Paparella Vandeputte, a 73-year-old woman from South Philadelphia, was one of these infrequent cases of recurring restenosis. After a heart attack in 2014, she experienced stent restenosis three times over the next few years, in each instance receiving angioplasty and additional stents. After she underwent a fourth round of treatment in May 2016, her doctors recommended that instead of another stent, she try brachytherapy, in which the injured tissue walls of the artery are exposed to a small dose of radiation to inhibit scarring.
Nearly a year after receiving the treatment at Jefferson, Vandeputte is doing well, and her artery remains clear of blockages. The Jefferson Angioplasty Center plays a vital role as a dependable, experienced second opinion center, but it is also much more. It offers an array of diagnostic services and treatments, including transcatheter aortic valve replacement, a minimally invasive alternative to traditional heart valve replacement which requires open heart surgery. Education and research are also high priorities for the Center. “We give an annual conference at Jefferson, and most of us give presentations, both regionally and around the country, at various meetings during the course of the year,” Savage says. The 4th Annual Symposium, on the topic of “Current Issues in Coronary and Structural Heart Disease: A Multidisciplinary Approach,” will be held at Jefferson on May 18, 2018.
“We like to innovate. Clinical research is a big piece of our mission,” Savage says. The Center’s current research focus is on nicardipine, a drug used to treat high blood pressure that Savage and his team hope to demonstrate can also be delivered prophylactically to prevent complications during angioplasty. They just received IRB approval for a randomized blinded trial to measure nicardipine’s effect on the heart’s microcirculation—a study that wouldn’t be possible without philanthropy.
“We’ve been wanting to do this study for a decade,” Savage says. “Now, thanks to the generosity of grateful patients Stanley Ginsburg and the Roberts family, we can finally start it.”