University Health System’s Heart and Vascular Institute: Tailoring Treatment to Each Patient, in a Team Approach

Tuesday, February 16, 2016

Joanne Brewer was the proverbial picture of health for most of her life. “I was one of those healthy people who didn’t use any of my health insurance, and I hated like heck to have to pay for it,” the 73-year-old retired educator says. “I wasn’t overweight, did not have high blood pressure and never smoked a day in my life.”

Brewer’s health changed about 10 years ago when she began experiencing severe dizziness and lightheadedness, to the point she would collapse to the floor. Ultimately, she was diagnosed with atrial fibrillation, or AFib — a common disorder that results in an irregular rapid heartbeat and increases the risk of stroke.

Despite treatment, Brewer suffered a stroke in 2014 and was airlifted to University Hospital. While her stroke was successfully treated, the rapid, irregular heartbeat from her AFib was punctuated by a slow heart rate due to a problem with the electrical system of her heart that interfered with the medical treatment of her atrial AFib.

She met with Steven Bailey, MD, Chief of the Division of Cardiology at the University of Texas Health Science Center, who recommended a pacemaker, implanted by Sandeep Sagar, MD, PhD, Assistant Professor of Cardiology and Electrophysiology. Both practice at the Heart and Vascular Institute at University Hospital.

The Heart and Vascular Institute brings together a comprehensive group of specialists dedicated to the care of both adult and pediatric heart patients, including cardiologists, cardiothoracic and vascular surgeons, anesthesiologists, and other specialists and professionals.

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While the pacemaker resolved many of her symptoms, Brewer still experienced palpitations and fatigue. She met again with Dr. Sagar and Chad Stasik, MD, Assistant Professor of Cardiothoracic Surgery at the UT Health Science Center.

They recommended a two-step hybrid ablation procedure now available for patients with persistent or hard-to-treat AFib. It combines two different approaches to ablation, interrupting the misfiring electrical signals that cause Afib by carefully creating scar tissue both outside and inside the heart. Few hospitals perform the procedure.

The first step, called the thoracoscopic maze procedure, is performed by Dr. Stasik, who creates lines of scarring on the left and right atriums of the heart’s outer surface through small incisions in the chest, without traditional open heart surgery. The left atrial appendage, the most common source of stroke in patients with AFib, is clipped during the procedure so it can no longer communicate with the left atrium.

A second procedure, typically completed one to three months later, is done in the electrophysiology laboratory, in this case by Dr. Sagar. It involves testing and touching up the previous scarring from the inner surface of the heart, and creating more scar lines if needed.

Brewer’s second procedure was performed in November. A month later she was once again hiking along the steep trails of Lost Maples State Natural Area.

“They’ve basically given me my life back,” Brewer says.

Including the Patient in the Treatment Plan

Not every AFib patient requires such a complex and advanced treatment, and the Heart and Vascular Institute offers a wide range of options that are tailored to each patient’s unique needs. For patient Todd Beebe, his problem was similar to Brewer’s, yet different.

The 68-year-old commercial real estate broker consulted with John Calhoon, MD, Chair of Cardiothoracic Surgery at the UT Health Science Center, and Manoj Panday, MD, Assistant Professor of Cardiology. They recommended a pacemaker for his difficult-to-manage AFib. Ablation wasn’t needed because Beebe’s symptoms were resolved with medicine and a pacemaker.

“It was miraculous,” Beebe says. “It was like I’d been given a new heart or something. The lightheadedness went away. The dizziness went away. The results were immediate.”

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Adil Husain, MD, Chief of Pediatric Cardiothoracic Surgery at the UT Health Science Center (left), and John Calhoon, MD, Chair of Cardiothoracic Surgery at the UT Health Science Center

Dr. Calhoon, Director of the Heart and Vascular Institute, says advanced technology and innovation — backed by strong evidence — is a hallmark of the program at University Health System. But that’s not what sets it apart.

“Our intent at University Health System is to make sure the doctor talks with you about your problems and concerns, and then formulates a plan with you,” Dr. Calhoon says. “We want to be a team that listens to you, talks with you and explains things plainly. We don’t just want to be specialists who do something to you. If you want to know what makes us different, I think that makes us different.”

University Health System is in the planning process for creating new space for the Heart and Vascular Institute in its new, million-square-foot Sky Tower, combining catheterization labs, noninvasive cardiology suites, imaging, echocardiography and electrophysiology in a single location.

And while surgical specialists and cardiologists, led by Steven Bailey, MD, Chief of the Division of Cardiology at the UT Health Science Center, have long collaborated together, they will soon be located alongside one another in the new Heart and Vascular Institute.

“The plan is to offer the best heart and vascular care for kids and adults,” Dr. Calhoon says. “It will be one-stop shopping. Should you have a congenital heart defect, we can care for you your entire life.”

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UT Health Science Center has a long history of innovation in cardiology and vascular medicine. The intravascular stent was developed in the 1980s by Julio Palmaz, MD, Ashbel Smith Professor of Radiology at the UT Health Science Center, with some of the earliest stents implanted in patients at University Hospital.

Today, a wide array of advanced treatment options are offered at the Heart and Vascular Institute, including transcathether aortic valve replacement, or TAVR; the LARIAT procedure; mitral valve clipping; rheolytic thrombectomy; cardiac resynchronization therapy with bi-ventricular pacemakers or defibrillators; and more.

An equally comprehensive list of diagnostic services is also available, including 3-D EP mapping to pinpoint the source of an irregular heart rhythm; adenosine stress test for those who cannot exercise on a treadmill; diagnostic cardiac catheterization or coronary angiography; nuclear chemical stress testing; hypertrophic cardiomyopathy evaluations; intracoronary Doppler ultrasound; echocardiography; and more.

University Hospital, named best hospital in the San Antonio area five years in a row by U.S. News & World Report, offers dedicated cardiac and vascular “integrated” operating rooms on the second and third floors of the Sky Tower. They include multiple high-resolution video displays and touch-screen controls, accommodating the most complex surgeries. One is a hybrid surgical suite combining the functions of an operating room and cath lab in one room.

FEVAR: A New Treatment for Aortic Aneurysms

Another new procedure offered at University Hospital offers a minimally invasive option for the treatment of patients with aortic aneurysms — a dangerous weakening or ballooning in the wall of the aorta. Typically patients require open surgery and surgical repair of the aneurysm when it’s located near the branch arteries to the kidneys.

The new procedure, called fenestrated endovascular aneurysm repair, or FEVAR, is a newly approved graft that is custom-fitted to the patient’s anatomy, inserted into the femoral arteries in the legs and routed to the aneurysm by catheter.

The graft acts much like a pipe, channeling blood flow past the weakened area. The customized openings in the graft, called fenestrations, allow blood to flow from the heart to the kidneys. Recovery time and return to normal activities is faster, and the procedure can be an option for patients who aren’t good candidates for open surgery.

Georges Haidar, MD, Assistant Professor of Vascular and Endovascular Surgery at the UT Health Science Center, described FEVAR as a real step forward, one that offers fewer complications, faster healing and much less time spent recovering in the hospital.

Dr. Haidar was lead surgeon on the first patient to undergo the procedure at University Hospital in November 2015, and the first at a local nonmilitary hospital.


For more information about the Heart and Vascular Institute at University Health System, call 210-358-2700 or visit universityhealthsystem.com/services/cardiovascular.