Structural Program Spotlight

The Structural Heart and Valve Center at Brookwood Baptist Medical Center

Birmingham, Alabama

Birmingham, Alabama

Can you tell us about the structural heart program at Brookwood Baptist Medical Center?

At Brookwood Baptist Medical Center, we offer a comprehensive assessment of valvular and structural heart disease in a multidisciplinary setting. Services are coordinated by a team of physicians and our valve coordinators. The physicians of the Structural Heart and Valve Center partner with clinicians and patients to deliver individualized care plans while offering advanced diagnostic testing and endovascular therapies.

Our Structural Heart and Valve Center performs all FDA-approved structural heart procedures, including transcatheter aortic valve replacement (TAVR), MitraClip (Abbott Vascular), transcatheter mitral valve repair (TMVR), Watchman (Boston Scientific) left atrial appendage (LAA) occlusion procedures, and patent foramen ovale/atrial septal defect (PFO/ASD) closures. Our state-of-the-art hybrid multimodality imaging capabilities are also ideal for percutaneous closure of paravalvular leaks and stenting of pulmonary veins.

We also perform a full range of endovascular peripheral interventions, including endovascular aneurysm repair (EVAR), transcarotid artery revascularization (TCAR) (Silk Road Medical), and the TAG Conformable Thoracic Stent Graft (Gore), and we are a leading enroller in the carotid revascularization for primary prevention of stroke (CREST-2) carotid stenting trial.

With years of experience in curative therapies and the appropriate use of innovative technology, our team of experts has a unique capability to deliver high-quality care while placing our patient at the center of every decision.

Can you tell us about your clinical team?

Our structural heart and valve team employs a patient-centric model of care. Two structural coordinators guide patients through an efficient pre-procedural workup, including all necessary preparatory studies. The patients are then discussed in our weekly CME-accredited multidisciplinary conference. We are able to remotely view imaging and records from our outlying hospitals in our central conference, which facilitates true collaboration, with the ability to review all source data.

Team members include:

• Steve Bakir, MD, Interventional Cardiology Director of the Structural Heart & Valve Program;

• Russ Ronson, MD, Cardiothoracic and Vascular Surgery Director and Chief of Staff;

• Dave Cox, MD, Interventional Cardiology;

• William McAlexander, MD, Cardiothoracic and Vascular Surgery;

• Luiz Pinheiro, MD, Advanced Cardiac Imaging;

• Matthew Sample, MD, Interventional Cardiology;

• Jan Skowronski, MD, Interventional Cardiology;

• Sonia Scalf, Structural Heart Program Coordinator;

• Cathy Smith, Structural Heart Program Coordinator.

What our team offers:

• Comprehensive evaluation and consultation by our Structural Heart & Vascular Center Team;

• Patients are seen by a cardiologist and a surgeon on the same day;

• A Personal Clinic Coordinator helps to navigate patients through their journey;

• One-on-one education and support to patients, families and caregivers;

• The latest up-to-date echocardiography and computed tomographic angiography to evaluate the most complicated heart valve conditions;

• Bundled testing to minimize visits;

• Treatment options for valve intervention:

  • TAVR
  • Minimally invasive valve surgery
  • Traditional valve surgery
  • Percutaneous MitraClip
  • Transcatheter mitral valve replacement;

• A collaborative relationship with referring physicians.

How does your team determine what therapy is best for each patient?

During our weekly conferences, which are limited to team members only, we are able to objectively decide which therapies we feel are most appropriate and best suited to each patient. The team consists of cardiologists, cardiac surgeons, echocardiography experts, and operating room and cath lab personnel, as well as nurses specifically trained in structural heart disease. This approach allows expertise and collaboration from every point of care the patient may touch or be involved with.

Can you tell us about your procedure rooms, scheduling and volume?

We perform the majority of our structural procedures in our new state-of-the-art hybrid OR suite, but we are also able to utilize our cardiac cath labs for structural procedures, including TAVR when necessary. The hybrid OR, a 2,123 square foot surgical theater that is among the largest in the Southeast, opened in 2018. It includes an elevated observation room that enables viewers to have an ideal viewpoint of the OR table and is also instrumental as a teaching platform. Equipment includes the most comprehensive suite of Philips equipment available, including an Allura Clarity extended travel C-arm (Philips), and intravascular ultrasound (IVUS), fractional flow reserve (FFR), and instant wave-free ratio (iFR) (all Philips Volcano), as well as a Mac-Lab hemodynamic recording system (GE Healthcare). In addition, the advanced observation deck and communications room allow onsite and remote interaction with physicians for both education and treatment planning. Both the observation deck and communications room are elevated for ideal visualization.

An investment of nearly $10 million is underway to construct three new state-of-the-art cardiac catheterization labs, which will further establish Brookwood as a cardiovascular program of excellence. The new labs will complement the hospital’s new hybrid OR and are in proximity to the main OR, emergency department, and radiology department for highest efficiency and throughput.

How has the program evolved over the past few years?

With our increased capability to treat patients in the most comprehensive and expeditious manner, our program has been able to treat a greater volume of patients. This has necessitated we expand our electrophysiology (EP) and cath lab facilities to meet this need. This volume increase led to a capital investment of nearly 20 million dollars in order to install the most advanced equipment and expand services to better treat patients in an extremely efficient fashion.

Are you involved with any clinical research?

We are involved in many research protocols. We are active enrollers in the CREST-2 study, the TRANSCEND study (the pivotal clinical trial for the Surmodics SurVeil drug-coated balloon), and a variety of other studies.

Can you share more about your TAVR program?

Our structural program has actively employed cutting-edge procedures. We have been an early adopter of percutaneous access for TAVR with a minimally invasive approach. We employ a variety of alternative access techniques for patients with difficult peripheral vasculature, including transcarotid and percutaneous axillary approaches. We use a full suite of complementary equipment available, including transesophageal echocardiography (TEE), transthoracic echocardiography (TTE), and intracardiac echocardiography (ICE). We have also become a center for difficult cases unable to be performed the traditional way through the groin. We can access the heart through the carotid, subclavian, or axillary arteries, as well as a direct aortic puncture, enabling us to perform on all patients who are eligible.

What about percutaneous mitral valve repair procedures?

We perform both MitraClip procedures and transcatheter mitral valve replacement. These procedures are especially helpful in candidates at high risk for conventional surgery, but indications are expanding as the technology improves.

How does your facility handle pre-procedural testing for potential TAVR patients and mitral valve disease patients?

For patients with valvular heart disease, we utilize our valve clinic and staff to coordinate and expeditiously arrange testing needed in preparation for percutaneous aortic and mitral interventions. All patients undergo a complete exam by a cardiologist and cardiac surgeon. The TTE or TEE is reviewed, as well as computed tomography (CT) imaging performed. This is done through one combined clinic visit to minimize patient inconvenience. This information is then discussed at our weekly team meeting to ensure proper planning as to device, anesthesia, imaging, and access.

We work to minimize the number of trips to the facility patients are required to make. Perhaps most importantly, our valve clinic staff and coordinators help provide easy access to our clinic physicians. Our dedicated valve clinic line is answered outside of clinic hours, which helps with patient and family communication.

What are some of the supplemental diagnostic and/or support technologies in use?

We are able to perform advanced structural heart procedures with relative ease and expedience due to our dedicated structural heart imager and integrated imaging software in our hybrid OR. Furthermore, our structural heart team has expertise in interpretation and reconstruction of computed tomography imaging. We employ the use of hemodynamic support through extracorporeal membrane oxygenation (ECMO) in high risk patients during selected TAVR procedures. This decision is made in advance during our valve conference.    

What do you see as the future of the structural heart program?

As our population ages, valvular heart disease will become even more prevalent. Our procedural techniques, technologies, and volume will necessarily rise to meet this demand. Our abilities to offer minimally invasive therapies for valvular heart disease, including repair and replacement of aortic and mitral valves, will allow us to treat even more patients with less morbidity, expediting patients’ return to a healthy, active lifestyle. 

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Brookwood Baptist’s Structural Heart Team Performs Live Cases at 2019 Chicago Endovascular Conference

Brookwood Baptist Medical Center’s Structural Heart Team recently performed several live cases from the hospital’s hybrid OR to the more than 500 medical professionals attending the Chicago Endovascular Conference (CVC), July 10th-12th.

For more information, contact Laura Clark at laurag.clark@tenethealth.com.