Surgeon Spotlight: 47 Patients Offer Praise for Dr. Patrick McCarthy!
As the practice of heart valve surgery continues to evolve at an ever-faster pace, Chicago-based Northwestern Medicine is at the forefront of efforts to streamline procedures, improve patient outcomes, and create innovations in technology that offer value to patients and healthcare institutions.
Patrick M. McCarthy, MD is executive director of Northwestern Medicine’s Bluhm Cardiovascular Institute. Both a clinician and a researcher, McCarthy takes a hands-on approach to managing the institute, including administration of staff and programs as well as leading research efforts.
“I take an approach that’s unique to our field, one that allows me to oversee the entire Bluhm Cardiovascular Institute with a big-picture perspective, but still personally take care of individual patients,” says McCarthy. Under his guidance, Bluhm Cardiovascular Institute keeps a plethora of programs and research projects in motion. To see 47 patient testimonials for Dr. McCarthy, click here.
The Art & Science of Mitral Valve Repair
Most surgeons perform only a handful of mitral valve repairs each year. McCarthy performs hundreds each year—and works with an equally experienced team at the Bluhm Cardiovascular Institute’s Center for Heart Valve Disease. “Mitral valve repair has been more art than science,” he says. The problem with that, he explains, is that many surgeons don’t have the experience to handle complex repairs, and often opt instead to replace the mitral valve.
To help shift the focus toward more repairs, McCarthy and his team developed a set of quantitative data designed to take some of the guesswork out of mitral valve repair procedures. The resulting paper, A Simple Approach to Mitral Valve Repair: Posterior Leaflet Height Adjustment Using a Partial Fold of the Free Edge, is the first in a series of manuscripts designed to educate colleagues.
“With a quantitative approach, we can offer rules to guide their approach,” he explains. “We’re trying to evolve mitral valve repair into more of a science, so even those surgeons who perform only 10 a year can use replicable techniques for successful repairs.”
Bluhm Cardiovascular Institute champions a focus on valve repair: between January 2012 and June 2014, 83% of its mitral valve cases used valve repair, compared to a Society of Thoracic Surgeons (STS) benchmark of 60%. With this focus, the hospital is able to achieve not only the largest heart valve surgery volume in Illinois, but a 0% mitral valve repair risk adjusted operative mortality rate, compared to the STS benchmark of 1.28%.
Northwestern Medicine is working to spread knowledge about heart valve disease best practices on other fronts, as well. Robert O. Bonow, MD, director of the Center for Cardiovascular Quality and Outcomes at Northwestern, was one of the lead authors of the 2014 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Management of Patients with Valvular Heart Disease.
Bicuspid Aortic Valve Program: Validating and Advancing
Another research effort at Bluhm Cardiovascular Institute led to validation of ACC/AHA guidelines for treatment of bicuspid aortic valve (BAV) and aortic aneurysm. McCarthy and colleagues reviewed data from 456 Bluhm Cardiovascular Institute patients with BAV and found 98% compliance with the 2006 ACC/AHA guidelines, and those who underwent aortic valve replacement with the addition of aortic aneurysm replacement experienced no increase in morbidity (disease) or mortality (death).
The team’s full findings can be found in Effect of Aortic Aneurysm Replacement on Outcomes After Bicuspid Aortic Valve Surgery: Validation of Contemporary Guidelines.
McCarthy adds that Bluhm Cardiovascular Institute is also focusing on advanced imaging techniques for treatment of BAV. Imaging experts Michael Markl, PhD and Alex Jonathan Barker, PhD are exploring the use of 4D flow MRI, both in research and in novel clinical applications.
TAVR and ABLATE: Next-Generation Technology
McCarthy is also serving as national principal surgical investigator for the Transcatheter Aortic Valve Replacement System U.S. Feasibility Trial, an interventional study that seeks to make technical refinements of the original device design.
Transcatheter Aortic Valve Replacement (TAVR) is a minimally invasive surgical technique used to treat patients with aortic stenosis who are too high-risk for open-heart surgery. The procedure preserves the patient’s own tissue; instead of replacing the faulty valve, surgeons implant an artificial heart valve inside the patient’s stenotic aortic valve.
“A shortcoming of the first generation TAVR technology was leaks, which increased patient mortality,” says McCarthy. The new technology seeks to avoid the problems with the first generation devices, and ensure correct positioning of the replacement valve with no regurgitation.
Bluhm Cardiovascular Institute is rapidly growing its TAVR program with volume on pace to exceed 120 cases in fiscal year 2015 (September 2014 – August 2015) compared to 67 cases in the previous fiscal year (September 2013 – August 2014). The TAVR program at Bluhm Cardiovascular Institute remains the most experienced TAVR program in Illinois.
Another project occupying McCarthy is the ABLATE Post Approval Study – Synergy Ablation Lesions for Non-Paroxysmal Atrial Fibrillation, for which he serves as national principal investigator. The trial, which began about five years ago, examines outcomes for patients who have atrial fibrillation.
Trial participants are treated with the Maze procedure, a surgical treatment using ablation that creates electrical barriers that redirect abnormal electrical signals that cause atrial fibrillation, restoring the heart rhythm and normal blood flow. McCarthy reports that enrollment was just completed, and the team plans to report the one-year results and follow approximately 350 patients out to three years.
MitraClip Offers Hope for High-Risk Patients with Mitral Valve Regurgitation
Bluhm Cardiovascular Institute is heading up research and implementation of a new treatment for mitral valve regurgitation, one that may offer a minimally invasive option for patients who are too high-risk for open-heart surgery. During the procedure, the MitraClip is inserted percutaneously (minimally invasive approach through the skin) and joins the mitral valve leaflets, reducing backward blood flow.
Bluhm Cardiovascular Institute’s Mark J. Ricciardi, MD leads a team of experts using the technology, which recently received FDA approval for commercial use. (McCarthy presented to the FDA panel.) Bluhm Cardiovascular Institute is also participating in an ongoing trial, COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation), which examines the benefit for patients with heart failure who are not improving through medication.
“In a group of patients who are that sick, there’s never a zero risk situation. But MitraClip, in the right patient, is much safer than heart surgery,” says McCarthy.
Excellent outcomes and continued growth
As Bluhm Cardiovascular Institute continues to expand its cardiac surgery program (over the last 10 years, the hospital has seen 648% growth in complex cardiac surgeries and 238% growth overall in cardiac surgery), Dr. McCarthy stresses the focus on valve surgery. Currently, 69% of Bluhm Cardiovascular Institute’s cardiac surgery procedures are valve-related, compared to the STS benchmark of 20%.
“We continue to focus on achieving great outcomes at Bluhm Cardiovascular Institute,” says Dr. McCarthy “Our mortality is low, our morbidity is low, our patient length of stay in the hospital is low, and our “likely to recommend” patient satisfaction scores are in the top 1% compared to peer institutions. All of this together exemplifies enormous value to the patient and to our institution.”