LAUNCHING THE C4 
 
 
 
 

SLU HOSPITAL IS REVOLUTIONIZING THE COMPREHENSIVE CARDIAC CARE EXPERIENCE

    

Patients shouldn’t have to bounce around from one doctor to the next in search of the best treatment options for their cardiac care. What if these cardiac specialists – specifically cardiologists and cardiac surgeons – were housed in one area, regularly working together to offer optimal treatment plans for patients?

Late last year, Saint Louis University Hospital launched the Center for Comprehensive Cardio-vascular Care – also known as the C4 – offering patients an individualized approach to cardiac care through collaboration between cardiologists and surgeons. A disease-based center, the C4 offers a menu of treatment options in one place for patients experiencing heart issues.

This all-in-one, patient-focused center is a bonus for patients who are typically shuffled around to various doctors before settling on a specific treatment. Housed on SLU Hospital’s main campus, the C4 has plans for a remodeled cardiac catheterization lab and a new hybrid operating room that combines cardiac surgery and intervention.

“This center starts with the patient and ends with the patient, because we believe they should have choices when it comes to their treatment options,” says Michael Lim, MD, a cardiologist, center co-director, and director of SLU Hospital’s cardiology division. “From catheterization and open surgery to thoracoscopic surgery, medical therapy, and ablation, we work together to make these care decisions with our patients, while reducing their risk for stroke. This is not a common approach at most centers around the country.”

The launch of the C4 was highlighted by the return of one of St. Louis’ most prominent cardiac surgeons, Richard Lee, MD, center co-director, professor, and vice-chairman of the department of surgery. Dr. Lee has partnered with Dr. Lim to run the center.

“The reason I came to join Dr. Lim is the opportunity to fuse cardiology and cardiac surgery,” says Dr. Lee. “For these patients, we will be able to offer new procedures to the region as well as improvements of traditional ones.”

For example, in treating the heart rhythm problem atrial fibrillation (AFib), Dr. Lim, Dr. Lee and Ali Mehdirad, MD, electrophysiology director at SLU Hospital, have partnered to offer the full spectrum of procedures and therapies customized to the patient’s circumstances.

Dr. Lee helped pioneer the Hybrid Maze Procedure, a minimally-invasive option performed in two stages. In the first stage, Dr. Lee creates a “maze,” or scar, on a beating heart without opening a patient’s chest. In the second stage, Dr. Mehdirad performs catheter ablation to create more scars inside the heart. This cures a patient’s AFib by putting it back into rhythm (without a sternotomy) and promoting a faster recovery.

“When we talk about the fusion of specialties, the Hybrid Maze Procedure is a perfect example,” says Dr. Lee. “We’ve combined minimally-invasive surgery with catheter-based techniques to offer patients better outcomes and improved recovery time.”

In June 2013, the C4 team performed a new procedure on a 70-year-old AFib patient who was unable to take blood thinners, putting her at increased stroke risk. The C4 was among the first in the region to perform this procedure that reduces stroke risk for patients with AFib, while eliminating their need for prescription blood thinners. Traditionally, patients have been treated with anti-coagulants such as warfarin to reduce stroke risks, but these blood thinners carry side effects.

This new procedure ties off the heart’s left atrial appendage (LAA) using a pre-tied suture loop that is threaded through the body via catheter in a procedure called an occlusion. For patients with AFib, an occlusion is an option as blood clots arise from the LAA in more than 90 percent of cases. If a blood clot dislodges and travels into the brain, the risk for ischemic stroke is very high.

“We are able to do this minimally invasively without opening up a patient’s chest,” says Dr. Lim. “We want to give patients options and this allows them to have choices beyond warfarin.”

Using the LARIAT® Suture Delivery Device, Drs. Lim and Mehdirad accessed the LAA by inserting a catheter under the rib cage. Another catheter is inserted through a vein in the groin up into the heart, and positioned inside the LAA. From both angles, Dr. Lim then used the loop to suture over the LAA.

“This lowers a significant stroke risk in a high-risk patient population,” says Dr. Lim. “By having an interventionalist, electrophysiologist and cardiac surgeon all in the cath lab during the case, we are able to provide a true team approach for our patients.”