Clinical Overview
The Section of Cardiothoracic Surgery at Westchester Medical Center is comprised of four cardiothoracic surgeons, Drs. Lansman, Lafaro, Malekan, and Spielvogel, who are committed to providing the best results with the most reliable of current therapies in this specialty.
CORONARY BYPASS GRAFTING (CABG) remains a large part of our practice. The age range, acuity, spectrum of severity and co-morbidities in this group truly constitute "high risk," tertiary referral patients, yet the outcomes have been excellent. In fact, the results have consistently compared very favorably with those reported by the New York State Department of Health Cardiac Surgery Advisory Committee (see chart below).
VALVE AND CABG/VALVE AND MULTIPLE VALVE PROCEDURES, often including arrhythmia procedures and aneurysm surgery, made up most of the remaining cases. Here too, the WMC results have compared very favorable for with available statewide data (see chart below) and Westchester was one of only three centers whose results were statistically better than the statewide results. Moreover, Drs. Lansman and Spielvogel were two of only six cardiac surgeons statewide whose mortality was statistically better.
In addition, there are a number of subspecialty areas, Mitral Valve Repair, Aortic Aneurysm Surgery and Heart Transplant/Mechanical Assist Device Procedures that the group has expertise in.
MITRAL VALVE REPAIR: The last 100 mitral valve repair procedures were recently reviewed. A repair was successfully performed in 98% of cases in which a repair was intended, with one mortality for the entire group. Many cases required a complex repair, including leaflet resections, leaflet extensions and construction of Gortex "neo-chordae." In appropriate cases, we use a minimal access technique.
Aortic Aneurysm Surgery: We have a large experience, spanning the spectrum of aortic procedures, including valve-sparing root replacements; full arch replacements, using hypothermic circulatory arrest; thoracoabdominal replacements, using somatosensory and motor evoked potential monitoring; and many re-operative procedures. We are rapidly becoming a referral center for acute aortic dissections for the entire region and have performed 86 repairs for acute dissection, with 1.2% mortality. The overall mortality, for all aneurysm procedures, is 2.4%. When appropriate, we are employing a less invasive, endovascular stent approach.
Dr. Spielvogel has lectured at national and international meetings on his method of aortic arch replacement, the trifurcated graft technique (below), which is becoming adopted internationally. For preoperative and postoperative aneurysm patients, we inaugurated an Aortic Aneurysm Follow-up Program that includes a nurse practitioner and a custom-developed database to implement surveillance protocols for these patients.
CARDIAC TRANSPLANT - MECHANICAL CIRCULATORY SUPPORT DEVICE PROGRAM: We have performed 40 heart transplants, including 12 mechanical assist "bridges-to-transplant," 2 heart-kidney transplants and 1 heart-liver transplant (the 62nd such case in the world); all patients were successfully discharged from the hospital. We have also implanted over 80 assist devices, including the Impella, Tandem Heart, ABIOMED Ventricle, JARVIK 2000 rotary device and the HeartMate I and HeartMate II devices. The heart transplant program has CMS certification, which means that Medicare has recognized us as a center of excellence, and recently, the Joint Commission awarded Disease Specific Certification status to our Mechanical Circulatory Support program. While WMC has implanted many assist devices as a "bridge," for patients awaiting cardiac transplant, the significance of Joint Commission certification is that we can now implant devices for long-term support, also known as "destination therapy." Through this designation, WMC can offer many more heart failure patients an alternative for end-stage cardiac disease.
Make an appointment at one of our Westchester Heart & Vascular locations. For physician information or to find a physician, call (866) WMC-HEART (866-962-4327).