Surgeon Spotlight: Patrick M. McCarthy, MD
As the practice of heart valve surgery continues to evolve at an ever-faster pace, Chicago-based Bluhm Cardiovascular Institute at Northwestern Memorial Hospital 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 the executive director of Bluhm Cardiovascular Institute at Northwestern Medicine. Both a clinician and a researcher, McCarthy takes a hands-on approach to managing the Bluhm Cardiovascular Institute on a system level, including administration of staff and programs as well as leading research efforts. McCarthy's overall focus remains with performing heart surgery, specifically heart valve surgery which makes up approximately 90% of his total caseload in the operating room.
“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 over 80 patient testimonials for Dr. McCarthy, click here.
The Art & Science of Mitral Valve Repair
Most cardiac surgeons perform only a handful of mitral valve repairs each year. McCarthy performs hundreds each year—and works with an equally experienced team at Bluhm Cardiovascular Institute’s Center for Heart Valve Disease. “Historically, 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 to mitral valve repair, we can offer rules to guide cardiac surgeons,” he explains. “We’re trying to evolve mitral valve repair into more of a science, so even those cardiac surgeons who perform only 10 a year can use replicable techniques for successful repairs.”
The Bluhm Cardiovascular Institute is committed to repairing rather than replacing diseased mitral valves, as valve repair surgery results in improved survival and lower risk of complications. For the past five years, the cardiac surgeons at Bluhm Cardiovascular Institute opted to repair over 82% of isolated mitral valve cases as compared to a national average of 57% as reported by the Society of Thoracic Surgeons (STS).
With this focus, Bluhm Cardiovascular Institute has achieved not only the largest heart valve surgery volume in Illinois, but also achieved excellent outcomes following isolated mitral valve repair. Over the past five years, isolated mitral valve repair patients have experienced 0% mortality within 30 days of the procedure––when potentially life-threatening complications are most likely to occur––versus the STS national average of 1.1%.
Furthermore, the cardiac physicians at Bluhm Cardiovascular Institute maintain an ongoing role in shaping the valvular heart disease care standards used around the world. Robert O. Bonow, MD, director of the Center for Cardiovascular Innovation at Northwestern University Feinberg School of Medicine, and James D. Thomas, MD, director of the Center for Heart Valve Disease, co-authored the 2014 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Management of Patients with Valvular Heart Disease.
Transcatheter Heart Valve Program
The Transcatheter Heart Valve Program at Bluhm Cardiovascular Institute is expanding the range of heart valves treated with minimally invasive, transcatheter (percutaneous) options. Offering commercially available and clinical trial options that do not require open-heart surgery.
In 2008, Bluhm Cardiovascular Institute was an influential pioneer in the first clinical trial for transcatheter aortic valve replacement (TAVR): PARTNER (Placement of AoRtic TraNscathetER Valves) Trial. Through the involvement in PARTNER, Bluhm Cardiovascular Institute was one of the first programs in Illinois to successfully replace a diseased aortic valve via the transfemoral approach and the first in Illinois to replace a diseased aortic valve via the transapical approach. Today, Bluhm Cardiovascular Institute is one of the highest volume and most experienced TAVR programs in the nation, now treating approximately 250 patients annually with the TAVR procedure.
“The transcatheter heart valve innovations we have seen in the last 10 years are like nothing I have seen before and there is more to come,” says McCarthy. “Our success with TAVR has led to a plethora of percutaneous treatment options being offered at Bluhm Cardiovascular Institute for heart valves—all with excellent clinical outcomes.”
In early 2016, Bluhm Cardiovascular Institute was the first in the Midwest and second in the U.S. to repair the tricuspid heart valve using a percutaneous tricuspid valve annuloplasty system (PTVAS) as part of the SCOUT Trial. We have the same distinction of being the first in the Midwest and second in the U.S. for treating severe mitral regurgitation with the TIARA mitral transcatheter heart valve.
“With access to so many transcatheter valve options, Bluhm Cardiovascular Institute is able to tailor treatment even more precisely for each patient,” says McCarthy.
Current transcatheter heart valve clinical trials at Bluhm Cardiovascular Institute include:
- PARTNER 3: A Prospective, Randomized, Controlled, Multi-Center Study to Establish the Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients Requiring Aortic Valve Replacement who have Severe, Calcific, Symptomatic Aortic Stenosis. For select patients with aortic valve stenosis.
- (SALUS) Transcatheter Aortic Valve Replacement System a US Pivotal Trial. For select patients with aortic valve stenosis.
- SCOUT STUDY: Early Feasibility of the Mitralign Percutaneous Tricuspid Valve Annuloplasty System (PTVAS) For Symptomatic Chronic Functional Tricuspid Regurgitation. For select patients with tricuspid valve regurgitation.
- (COAPT Trial) Clinical Outcomes Assessment of the MitraClip Percutaneous Therapy for High Surgical Risk Patients. For select patients with mitral regurgitation.
- (TIARA-I) Early Feasibility Study of the Neovasc Tiara™ Mitral Transcatheter Heart Valve with the Tiara™ Transapical Delivery System. For select patients with mitral valve regurgitation.
Validating and Advancing Bicuspid Aortic Valve Disease
Another research effort at Bluhm Cardiovascular Institute led to the validation of the ACC/AHA guidelines for the 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). Full findings of this review 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 that help physicians diagnose and treat BAV. Bluhm Cardiovascular Institute imaging experts Michael Markl, PhD and Alex Jonathan Barker, PhD continue to explore the use of 4D MRI, both in research and in novel clinical applications. In addition to the standard 3D (length, width and height) imaging, the fourth dimension comes from the concept of time. 4D MRI heart imaging allows for a more comprehensive picture, helping clinicians better visualize blood flow through the heart and cardiovascular system.
Excellent outcomes and continued growth
As Bluhm Cardiovascular Institute continues to expand its cardiac surgery program (over the last 10 years, Bluhm Cardiovascular Institute has seen a 730% growth in complex cardiac surgeries); Dr. McCarthy stresses the focus on heart valve surgery. Currently, 68% 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 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 in Illinois are in the top 1% compared to peer institutions. All of this together exemplifies enormous value to our patients and healthcare institution.”