When Chester County Hospital's new Procedural Suite opened in June, the experience of having surgery and other procedures here transformed—not only for patients and families but also for surgeons, physicians, nurses and clinical staff. Larger operating rooms (OR) promote seamless teamwork and accommodate today's technology, including robotic assistance, equipment mounted on overhead booms, and real-time imaging. Multiple 70-inch monitors in the ORs help the team visualize procedures, share information about the patient anywhere within Penn Medicine, and collaborate more effectively. One room is a hybrid OR, an advanced procedural space that combines a traditional operating room with an image-guided interventional suite. This allows teams from different disciplines to work together as they perform highly complex procedures.
For heart care in particular, the Suite gives patients access to newer, minimally invasive heart procedures that correct structural problems, such as diseased or defective valves. The hybrid OR is key to offering these services, as it combines the technology of an OR with the capabilities of a catheterization lab, which allows teams to access the heart using a catheter inserted through an artery in the chest or upper leg.
The first addition was TAVR—short for Transcatheter Aortic Valve Replacement. This is a procedure that Penn Medicine helped to perfect. Chester County Hospital has had long-standing partnerships with experienced clinical teams who offer structural heart procedures at Penn Medicine's Philadelphia hospitals.
About one in eight people over 75 will develop aortic stenosis, in which the aortic valve—the valve that releases blood from the heart into the body—narrows and can't open fully. As a result, people tire easily and experience shortness of breath. Over time, they can develop heart failure, meaning that the heart is permanently weakened and can't meet the body's need for blood supply. Severe symptomatic aortic valve stenosis can limit a patient's lifestyle and lead to death within a couple of years. This issue has been top of mind for Steven Weiss, MD, Chief of Cardiac Surgery at Chester County Hospital, for several years. He started The Heart Valve Clinic here because he saw many patients with valve problems that weren't being detected and leading to heart failure. "This problem wasn't always recognized," Weiss says. "People just thought, 'Okay, I'm getting older. This is what it feels like to be 80.' Now that we're finding valve disease, we can help them enjoy their 70s and 80s instead of feeling miserable."
TAVR emerged about a decade ago as "a real gamechanger," adds Weiss, by using a catheter-based approach to place a new aortic valve inside the diseased valve. It revolutionized care for the sickest patients for whom open heart surgery—the traditional approach to aortic valve disease—was much too risky. Now it's being used for most patients with aortic valve stenosis. "These patients often feel better right away. They're amazed at the change," he says. Patients will now have access to TAVR right here in Chester County. Weiss, clinical assistant professor of surgery at Penn Medicine Deon Vigilance, MD, and interventional cardiologist Muhammad Raza, MD, are leading the hospital's TAVR program. (Interventional cardiologists specialize in catheter-based heart procedures.) They have formed a physician team that has been performing TAVR at Penn Presbyterian Medical Center and have shifted their operations to Chester County Hospital. "[Aortic valve stenosis] is the most common valve problem in people over 65,” Vigilance notes. "There is a growing number of patients who can benefit from the TAVR approach. They're in the hospital for just one or two days and experience significant improvement in their quality of life. "Our goal is to make the experience as seamless as possible, bringing the highest level of care to you in our community, where you're close to home and have access to your family," he adds. Muhammad Raza, MD, Medical Director and TAVR coleader, is also directing the hospital’s new structural heart program. The vision is to add more structural heart procedures after the TAVR program is up and running. "Put simply, for a patient who has a structural abnormality or valve disease in the heart, we will minimally invasively repair it through a catheter," he says.
One such procedure is the Watchman, a small umbrella-like device implanted in a structure called the left atrial appendage to prevent blood clots from forming there. In selected patients with a type of irregular heartbeat known as atrial fibrillation, it can be used instead of blood thinners to reduce stroke risk. Another offering planned for the future is MitraClip, which is used to fix a faulty and leaky mitral valve. The mitral valve controls blood flow from the top to bottom chamber on the left side of the heart. If it doesn't close tightly enough, the blood leaks back into the left atrium and people can feel out of breath and experience leg swelling. A miniature clip is implanted to help the valve close tightly. "As part of Penn Medicine, Chester County Hospital's program will bring state-of-the-art care for structural heart disease," says Raza.
Another Advancement: Robotic Heart Bypass
In addition to working with the structural heart program, Deon Vigilance, MD, will perform robotic coronary artery bypass surgery, or CABG, in the new Procedural Suite. It allows surgeons to bypass certain blocked arteries in the heart through small incisions in the chest, using highly specialized robotic equipment. For the right candidates, this can mean avoiding the increased risks and recovery times associated with opening the chest and breastbone to access the heart.
The desire to bring more cardiac treatment options here to Chester County is why "we built flexibility into the rooms," says Tim Martin, BS, RCIS, Business/Operations Manager, Invasive Cardiology. "As demand grows and our offerings expand, we can really flex within that space to accommodate many more cases." In the new Procedural Suite, there is a cardiovascular "pod" of six rooms, with one shelled out for future use. "Whatever our needs end up being, we can outfit another OR for those procedures," Martin adds. It's the newest phase of an evolution in care that Janice Baker, MSN, RN, CEPS, NEA-BC, FHRS, Heart and Vascular Clinic Manager, says she's witnessed since joining Chester County Hospital in 2004. "Our goal is to bring services we can safely and appropriately do here so our patients don't have to leave the community—and to be the best place to go for heart and vascular services," she says. "In 2001, Chester County Hospital was the first hospital in the suburbs to offer interventional catheterization and open heart surgery. We were also the first hospital to offer electrophysiology services [procedures to correct irregular heart rhythms]. Now, with the capabilities of our new platform, we will be the first hospital to offer structural heart services to the patients who rely on us for care."
An added benefit: Daily, real-time collaboration among cardiac teams
A more immediate benefit of the new Procedural Suite is how it will bring Chester County Hospital's cardiac specialists together in one place. Although there is already a "culture of collaboration," says Weiss, specialists are housed in different locations throughout the hospital. The heart's vessels, valves, chambers, and electrical activity are all connected, so the experts who treat them should be, too. Working side-by-side in the Procedural Suite, specialists will have immediate access to each other's skills and expertise—a major benefit for any patient being treated for a heart condition. "There are five complementary disciplines involved in the specialty care of heart disease," notes Weiss, referring to noninvasive cardiology, interventional cardiology, electrophysiology, structural heart, and cardiac surgery. "Historically, they kind of grew up separately and now we're moving them all together. When we're all co-located, we'll be able to talk to each other and not just share patients and equipment but ideas. We'll cross-pollinate more. It's an exciting time to be in this specialty."
New Diagnostic Heart Unit and Pre-Procedure Testing
When Chester County Hospital's Pavilion opened in January, a new Diagnostic Heart Unit and Pre-Procedure Testing Area debuted just to the right of the hospital's new Main Entrance. Like the main foyer, this area features a comfortable waiting lounge and ample natural light—along with the most advanced testing equipment in modern, spacious rooms. The benefit, notes Baker, is the co-location of noninvasive heart and vascular testing creating a "one-stop shop" for patients who need to have symptoms checked out or are preparing to undergo surgery or another procedure. There is a nurse on site to assist the clinical leads and technicians performing the tests, which include:
- Echocardiography – uses sound waves to produce live images of the heart
- Stress test – measures the heart's electrical activity during exercise
- Nuclear stress test – uses a radioactive tracer to create an image of how well blood is reaching the heart muscle, during exercise and while at rest
- Pulmonary function testing – measures how well the lungs function
The unit also offers neurodiagnostic testing, which measures brain activity and the electrical activity of muscles and nerves.