Hartford Hospital Doctors First in U.S. To Implant Right Ventricular Impella Device

On Oct. 31, 2012, doctors at Hartford Hospital were the first in the United States to place a right ventricular Impella device (a "mini heart") in a patient in shock because of a right ventricular infarction. This device is currently being evaluated by the FDA, and this surgery has been performed only eight times worldwide.

The right heart Impella is designed to support patients with right ventricular dysfunction that is usually associated with an inferior wall marked cardial infarction. The presently available support devices including balloon pumps, Impella, and tandem heart are useful to support a failing left ventricle but provide no right ventricular support.

The right heart Impella is a catheter that is placed from the inferior vena cava through the right atrium, right ventricle and is positioned in the pulmonary artery. There is a pump within this catheter. It withdraws blood from the inferior vena cava and pumps into the pulmonary artery (thus taking over the function of the right ventricle).

The director of Structural Heart Disease, Dr. Ronan Margey, took the lead in procuring the device, receiving approval for implantation by Hartford Hospital's Institutional Review Board (IRB), and implanting the device in this patient. Drs. Dan Fram, Jeff Hirst, Fran Kiernan, Ray McKay, Immad Sadiq, and David Silverman were all involved to support this achievement.

The Hartford Hospital STEMI Team Sets a Record and Saves Lives

On January 17 2011, Alfred Cecchini, a 47 year old barber who lives in South Windsor, experienced a substernal chest pain after working out in the gym. He immediately called 911. Alfred was ultimately successfully treated for acute myocardial infarction in the HH Catheterization Laboratory. His blocked coronary artery was opened with a stent with a record door-to-balloon time of 26 minutes.

STEMI TEAM LEADERSHIP GROUP @ HARTFORD HOSPITAL
STEMI TEAM LEADERSHIP GROUP @ HARTFORD HOSPITAL

From left: Paul Thompson, Chief of Cardiology; Raymond McKay, Director of the Chest Pain Center; Marcin Dada, Associate Director of the Chest Pain Center; A. Jon Smally, Medical Director of Emergency Medicine; and Justin B. Lundbye, Medical Director of Cardiac ICU.

The Hartford Hospital pre-hospital ECG STEMI (ST Elevation Myocardial Infarction) initiative, a multidisciplinary project involving Cardiology, Emergency Department and Emergency Medical Services, was introduced as a pilot initiative at Hartford Hospital in 2008. (Read the press release.)

The original single center and single provider system has evolved into the multicenter, regional STEMI network including 3 major hospitals within Hartford HealthCare (Hartford Hospital, MidState Medical Center and Windham Hospital) and multiple EMS providers. The ultimate goal is to develop a state wide STEMI Network to facilitate rapid diagnosis, triage and timely treatment of STEMI patients in the region.

The Hartford Hospital STEMI Team utilizes an organized response system between the hospital and local paramedics. Hartford Hospital was the first hospital in Connecticut that implemented this advanced technology, which reduces precious time in treatment during the most critical period of a heart attack - when every minute counts.

The pre-hospital ECG, obtained by the first responders, is securely transmitted to Hartford Hospital’s Emergency Department. The pre-hospital ECG data determines whether the patient is suffering from a STEMI (medically known as a ST Elevation Myocardial Infarction).

If the diagnosis is confirmed, the Hospital’s Cardiac Catheterization Laboratory immediately begins preparing for the patient’s arrival so emergency catheter-based intervention can be initiated immediately upon the patient’s arrival, bypassing several delaying steps.

The Hospital’s goal is to minimize the time it takes to treat a patient experiencing a cardiac emergency, as each 15-minute segment saved during this period is associated with 6.3 fewer deaths per 1,000 patients, according to the National Registry of Myocardial Infarction.

See also:



Hypothermia Helps Heart Patients Heal

Doctors perform medical miracles every day, including bringing people back from the dead. Hartford Hospital has even had success bringing back to good health cardiac arrest patients who have been clinically dead for up to 17 minutes.

Watch this NBC 30 News Story as Dr. Justin Lundbye explains this life saving procedure.

View more news videos at: http://www.nbcconnecticut.com/video.


Hearts on the Mend: Robotic Heart Surgery at Hartford Hospital  

Drs.Robert Gallagher (left) and David Underhill are using the da Vinci Robotic System
 for minimally invasive cardiac surgery.
Armed with the tools of technology, Hartford Hospital cardiac surgeons are the first in the region to harness the power of robotics to perform heart operations with speed, safety and smaller scars. Minimally invasive surgical techniques reduce pain, minimize blood loss and shorten recovery times, but the complexity of cardiac surgery—and the inflexibility of the earlier versions of the instrumentation—have previously limited cardiac surgery to the conventional, open method.

Now surgeons at Hartford Hospital are using the da Vinci Robotic Surgical System for minimally invasive cardiac procedures.

“It was clear,” says director of Surgery Orlando Kirton, M.D., “that in addition to being able to perform cardiac procedures with high quality and good outcome, we needed to grow where the technology was going. That’s what patients want. Da Vinci fits in well with that plan.”

The da Vinci System is the first “intuitive” endoscopic robot. It offers surgeons and patients the best of both worlds: it has the benefits of a minimally invasive procedure, but it gives surgeons the ability to see what they’re working with as clearly as if they were performing open surgery.

“The robot offers surgical support to operate deep inside the body without making a large incision,” says Jonathan Hammond, M.D., director of the Division of Cardiovascular Surgery. “We can get deep inside the chest without spreading the ribs, which minimizes pain.”
 
More Surgical Agility

In addition, surgical procedures can be performed with movements that feel natural. “The instruments are extremely flexible and can be introduced more deeply into the body cavity,” says cardiac surgeon Robert Gallagher, M.D. “They give you the same degrees of freedom as your own wrist. Standard endoscopic tools are just straight instruments. You can go in and out or up and down, but you can’t get around corners. The robot is good for technically demanding procedures.” Surgeons also appreciate the visualization and freedom the robotic system offers. Cardiac surgeon David Underhill, M.D., says, “From a technical point of view, da Vinci offers spectacular optics and visualization. The acuity is astounding. We see views inside the chest that we wouldn’t see in conventional surgery.”

Motion scaling is an additional benefit of the system. “Your relatively large movements can be translated into finer motion,” says Dr. Gallagher. “This is as close to real life as we’ve come. The view is three-dimensional, with images magnified to the tenth power.”

Cardiac surgeons do acknowledge some degree of frustration at the loss of tactile sensation, especially when they first began using da Vinci. “Sometimes,” says Dr. Underhill, “I want to reach out and grab the tissue. But it becomes second-nature with use. You can’t feel the tissue or the suture material, or the needle going through, but the optics compensate. They show you how tight to pull on a stitch.”
 
Working on Robotic Skills

Teams of cardiac surgeons are working on different procedures. Drs. Underhill and Gallagher are using the da Vinci robot to dissect out the internal mammary artery (IMA) which is used as the bypass vessel for bypass procedures. The procedure can be done more cleanly with the robot. “This has gone exceptionally well,” says Dr. Underhill. “We’re the only medical center in Connecticut that’s doing this. We harvest the IMA with the robot, and then we perform the rest of the procedure conventionally.”

 “We’re doing takedown of IMA now,” says Dr. Gallagher. “Next will be coronary bypass through small left-side incisions.” Dr. Underhill adds, “We’re also performing mitral valve repair and trial septal defect closure.” Currently Drs. Underhill and Gallagher are the only two surgeons performing the takedown of the IMA for bypass procedures. Dr. Hammond says, “We decided it was best to have one or two individuals develop their skills on these procedures. We concentrate the effort on them, and we don’t have to worry about six different learning curves. These two have figured out what works well and what doesn’t, and this is beneficial for patients in the long run.”
 
Robotics Well Established at Hartford Hospital
 
Although da Vinci represents the very latest in minimally invasive technology, it’s already well established at Hartford Hospital. Joseph Wagner, M.D., urologic surgeon, introduced the da Vinci system to the hospital in 2003. Support from donors helped the hospital underwrite the cost of the million-dollar robot. The cardiac surgeons who’ve been using da Vinci feel as though they’ve had a solid foundation upon which to build. “Hartford Hospital has been a leader in this technology,” says Dr. Underhill. “There’s a commitment to excellence in this on the part of the hospital. The infrastructure needed to perform such intricate procedures using the da Vinci robot is in place. The anesthesia team is excellent. For this type of surgery, you have separate lung ventilation, and the team has that down.”
Those involved with the da Vinci system at Hartford recognize that being the first hospital in the region to offer procedures using the robot carries with it the responsibility to proceed with great caution. “We recognize the importance of proper training and proctoring as we advance along,” says Dr. Gallagher. “We perform our due diligence with respect to our patients.”

“Cardiac surgery,” says Dr. Gallagher, “has been likened to flying a 747. The pilots go down a checklist every single time, even though they’ve flown the plane hundreds of times. Everything is done in sequence to make it a safe flight. Takeoffs and landings are the hardest. You need to have done everything exactly right, and then when you’re ready to land, everything’s been done to give you a safe landing. When you’re sitting at the console, it’s intuitive. Once you’re at the robot, it all falls into place.”

 - Rounds, Spring 2006