The NewYork-Presbyterian Queens cardiovascular service line offers a full range of cardiothoracic care, providing patients in Queens with a complete local option for advanced treatment.
Gregory Pontone, MD, FACC, Director of Outpatient Cardiovascular Services and Co-director of Inpatient Cardiac Imaging at NewYork-Presbyterian Queens, and Sam Lang, MD, Chair of Cardiothoracic Surgery at NewYork-Presbyterian Queens and professor of clinical cardiothoracic surgery at Weill Cornell Medicine, analyze a coronary angiogram.
The cardiovascular program at NewYork-Presbyterian Queens, in partnership with physicians at Weill Cornell Medicine, unites numerous service lines to provide a full spectrum of cardiovascular care to achieve the best outcomes for cardiac patients. To fulfill the goal, a wide range of screening and diagnostic services offers patients and their cardiologists valuable information about their hearts and heart attack risk. Available services include noninvasive cardiac imaging, cardiac catheterization, electrophysiology and heart surgery. The program’s physicians also strive to raise community awareness of cardiovascular health.
“Our cardiology and cardiac surgery programs are highly rated and excel in creating positive outcomes for patients,” says Sam Lang, MD, Chair of Cardiothoracic Surgery at NewYork-Presbyterian Queens and professor of clinical cardiothoracic surgery at Weill Cornell Medicine. “We have excellent physicians and strong multidisciplinary relationships across all hospital departments.”
Though the program is smaller than some in the city, according to Dr. Lang, the scale allows physicians to coordinate easily and provide close one-on-one care. The hospital also has routinely excellent outcomes, including nationally recognized low complication and mortality rates, Dr. Lang adds. This results in high-quality care and patient satisfaction.
Before surgeons, interventional cardiologists or cardiac electrophysiologists perform any cardiac procedure, each patient undergoes diagnostic services tailored to his or her overall circumstances. NewYork-Presbyterian Queens offers advanced cardiac screening and diagnostic tests, including cardiac CT and MRI, calcium scanning, 3-D transesophageal echocardiogram, nuclear stress testing and the full complement of arrhythmia screening tools.
Imaging and testing systems guide physicians throughout the progression of a patient’s diagnosis, treatment and recovery.
“A primary care physician or cardiologist might hear a heart murmur during examination of the patient, or the patient might experience chest pain or shortness of breath,” says Gregory Pontone, MD, FACC, Director of Outpatient Cardiovascular Services and Co-director of Inpatient Cardiac Imaging at NewYork-Presbyterian Queens. “They might send the patient for further imaging, including an echocardiogram, to determine whether there’s a valve problem or stress testing to identify blockages in the arteries that supply the heart.”
Stress testing may be done via exercise or a medicine that stresses the heart; in either case, imaging taken under stress may help identify areas of decreased blood flow to the heart muscle. To identify structural concerns, cardiac MRI can identify whether the heart muscle has experienced damage, as well as provide further information about the status of the heart valves. Cardiac MRI, cardiac CT and 3-D transesophageal echocardiogram are advanced cardiac imaging modalities that may not otherwise be available nearby, Dr. Pontone adds.
“We are accredited by the Intersocietal Commission for the Accreditation of Nuclear Medicine and Echocardiography Laboratories,” Dr. Pontone says. “This means we meet or exceed the highest quality standards for studies and are recognized as a high-quality site by the board that governs cardiac imaging.”
Cardiac Catheterization Lab
Whether used as an emergent procedure to treat myocardial infarction or an elective operation to open blocked arteries, cardiac catheterization is the centerpiece of NewYork-Presbyterian Queens’ cardiovascular program.
“We have one of the busiest cardiac catheterization labs in the city for patients coming in with acute heart attack,” says David Slotwiner, MD, FACC, FHRS, Chief of the Division of Cardiology at NewYork-Presbyterian Queens and assistant professor of clinical medicine at Weill Cornell Medicine. “We have one of the fastest door-to-balloon times, too. We partner with the Fire Department of the City of New York (FDNY) and their EMS services, which means FDNY ambulances carrying patients with suspected heart attack can notify us ahead of time to prepare the lab and have the physician and catheterization team standing by. The sooner we open a blocked artery, the less heart muscle is damaged.”
The cardiac catheterization lab was recently awarded the Mission: Lifeline Silver Award by the American Heart Association (AHA) for outstanding speed of treatment for patients experiencing heart attacks. For non-urgent patients, the most commonly performed services are elective diagnostic catheterization, percutaneous coronary intervention and stent placement.
“We perform a high volume of diagnostic angiograms and elective interventions, such as stenting,” Dr. Slotwiner says.
Cardiac Electrophysiology Services
NewYork-Presbyterian Queens is the only facility in the borough that provides a complete arrhythmia service line, from pacemakers, to implantable defibrillators, as well as advanced catheter ablations and left atrial appendage closure for patients with atrial fibrillation who are unable to take anticoagulation long term.
“In one innovative procedure, heart surgeons and electrophysiologists partner in a convergent ablation procedure to treat atrial fibrillation. Also known as hybrid ablation, this procedure combines cardiac catheterization and surgical ablation in a single operative setting. This treatment is appropriate for patients who have failed other treatments for atrial fibrillation. The hybrid procedure is performed under general anesthesia.
“The surgeon enters under the sternum and places a thoracoscope in the upper abdomen, tunneling it back to the heart to deliver radiofrequency energy to ablate the back side of the left atrium,” Dr. Slotwiner says. “We also place catheters, entering from the veins in the leg to access the heart. We then perform catheter ablation from inside the left atrium to address other sites that cause fibrillation. In this way, we isolate the triggers of atrial fibrillation, those that initiate fibrillation and those that let the fibrillation sustain itself.”
Dr. Pontone monitors a patient during an exercise stress test.
This procedure has proven highly effective in treating patients with refractory atrial fibrillation.
“Hybrid ablation provides a great opportunity for collaboration with surgeons,” says Dr. Slotwiner, who is an electrophysiologist by training. “We like to break down traditional barriers and have different physicians work together to enhance patient outcomes.”
Advanced Technology: The Leadless Pacemaker
Dr. Slotwiner and his colleagues are also proud to offer the leadless pacemaker, a device that does away with many potential complications of a traditional pacemaker, including infections and broken leads. While a traditional pacemaker is placed in the upper left chest with leads traveling down to the heart, the leadless device is a self-contained unit the size of a pen cap.
Physicians deploy the pacemaker through a vein in the leg into the heart, where it attaches to the heart muscle. The device contains a lithium iodide battery with a 10-year lifespan.
“There’s no wire or scarring,” Dr. Slotwiner says. “Patients hardly know they have it. We are the only institution in Queens to offer the leadless pacemaker.”
Exacting Skill for Open Surgeries
For patients facing open-heart surgery, survival is of the utmost importance, and that is where NewYork-Presbyterian Queens excels. In 2015 and 2016, according to Dr. Lang, the hospital achieved less than 2 percent mortality for coronary artery bypass surgery. High standards and exceptional outcome rates are especially important to patients in the area; they know they can access extremely safe open-heart surgery close to home, with no need to travel outside Queens.
“Queens has a population of more than 2 million people, and we are the only hospital here that can perform open-heart surgery,” Dr. Slotwiner says.
“Our results are excellent — as good as or better than most in the state of New York,” Dr. Lang says. “We have an outstanding cardiac and thoracic surgery program, especially where our outcomes are concerned.”
It takes a team effort to achieve high-quality metrics, year after year. All cardiovascular service lines are involved.
“We work closely with other providers to make sure patients who come to us have been properly evaluated by a cardiologist,” Dr. Lang says. “They typically have undergone a catheterization already. Our core cardiac services are of utmost importance to what we do as surgeons.”
The surgical team consists of experienced physicians who have been at NewYork-Presbyterian Queens for some time. The staff of nurses, physician assistants and surgeons is comfortable working together, know each other’s rhythms and run a closely coordinated program.
Dr. Slotwiner speaks with a patient.
“Dr. Avgerinos [Dimitrios V. Avgerinos, MD, PhD, assistant professor of clinical cardiothoracic surgery] trained and completed a fellowship at Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell Medical Center,” Dr. Lang says. “He is an expert surgeon with an interest in aortic surgery. I’ve been at Weill Cornell Medicine since 1986. Between us we have a wide experience in cardiac surgical procedures.”
The most common open cardiac surgeries performed at NewYork-Presbyterian Queens are coronary artery bypass, valve surgery and aortic surgery, Dr. Lang says. Many cardiac diseases are now addressed in a minimally invasive fashion, including percutaneous cardiac interventions, such as stent placement. This means the patients who do require cardiac bypass surgery tend to have very complicated issues. Now, more than ever, cardiac surgeons must be extremely proficient in a variety of approaches and levels of intervention, as is the case with Dr. Lang and his colleagues.
“There is no substitute for experience,” Dr. Lang says. “One thing we’ve seen in coronary artery bypass surgery is that patients have more extensive and more complex diseases. Since we now have techniques to manage patients without surgery, the challenge is to maintain a high-quality program to address complex cases.”
Here for Queens
NewYork-Presbyterian Queens’ cardiologists understand they are essential care providers in the borough and a much-needed resource to the communities they serve. To better meet that need, they routinely spend time outside of the hospital setting, meeting patients where they are. From teaching appointments and clinic visits to outreach in public settings, these physicians continuously educate their colleagues, patients and neighbors.
The cardiology service’s network of clinics are a vital part of this outreach mission, which allows patients to obtain basic screenings close to home. While advanced tests, such transesophageal echocardiography, CT and MRI, are all performed in-hospital, stress tests, transthoracic echocardiograms, calcium scoring and other screening tests are available throughout the community.
“We have several cardiology sites throughout Queens, so we are convenient to patients where they live, with no need for them to travel, Dr. Pontone says. “Many of these offices have on-site parking, too. We are able to triage patients from location to location, so if a test is not available at one site, we can send the patient to the appropriate clinic.”
Dr. Slotwiner adds, “We have multispecialty practices set up in all the major areas of Queens, and we are opening more. At any site, patients can see a cardiologist the same day, as well as receive testing. They don’t have to travel to Flushing for many services; they can stay right in their own neighborhood.”
Dr. Pontone regularly visits cardiac testing sites; he also goes to senior centers, businesses and other local venues, presenting heart health lectures and teaching people about risk factors for cardiac disease.
“We pride ourselves on being a community based hospital, so most of our patients come to us from private physicians or small groups of cardiologists in the area,” Dr. Slotwiner says. “More than half our patients are cared for by community physicians, so it is very important to provide resources to those doctors. This past year we gave a free Continuing Medical Education (CME) symposium. We also offer interactive sessions and training for allied professionals.”
As Chief of Cardiology, Dr. Slotwiner also makes it a point to visit local physicians in their offices, as he says, “hearing their needs and understanding what we need to do to serve them as best we can is important.” Whether they are in the community or working from the hospital, NewYork-Presbyterian Queens cardiology experts are a driving force for location heart health.
For more information, visit nyhq.org.