Hearts and Minds

The future of cardiovascular surgery is being performed today at Baptist Health’s Miami Cardiac & Vascular Institute

By John D. Adams

Niberto L. Moreno, M.D.

Niberto L. Moreno, M.D.

Imagine for a moment that the days of invasive cardiovascular surgeries, like opening a patient’s chest and putting them on a heart/lung machine, might soon come to an end. Could you conceive of a heart valve surgery where you wouldn’t need stitches to attach the valve? “If you had told me 20 years ago that type of procedure would have been possible, I never would have believed it,” says Dr. Niberto Moreno, medical director of cardiac surgery at Baptist Health’s Miami Cardiac & Vascular Institute. Well, the future is NOW.

Tomorrow’s innovations today
It wasn’t long ago that cardiac patients in their 80s or 90s would not be considered viable candidates for many medical procedures. But at the Miami Cardiac & Vascular Institute, patients in that age range now have opportunities for greater health and longevity thanks to a number of innovative procedures and a unique team approach to heart surgery. “We have been able to acquire all of the latest technology that is available,” begins Dr. Moreno. “We have sutureless valves and stentless valves, which are used for different types of disease of the heart valves. We still do our beating heart work, and we do the normal, conventional heart surgeries. And all of this is dedicated to the proposition of getting patients quickly back to their daily lives with much less risk for the patient.”

Endovascular-SuiteTo that end, the Institute is currently involved in more than 100 clinical trials. “From a cardiac surgery perspective, we were a trial facility for the sutureless surgical valve, a new valve device that eliminates clots,” says Dr. Moreno. Another benefit is the lack of invasiveness. The procedure follows the same basic principle as an angioplasty, where the surgeons go through a small incision in the groin to reach the heart. This eliminates the necessity of a heart/lung machine so that patients recover more quickly with no inflammatory response. “The heart/lung machine has been the friend of the heart surgeon for many years,” remarks Dr. Moreno. “But if we don’t have to use it, that is certainly the ideal course for the future.”

Before the use of this procedure, higher risk, older patients simply could not be considered for this type of surgery. “We are performing these procedures on patients with an average age in their mid-80s. The wonderful thing about medicine in the United States, and I hope it stays this way, is that we don’t restrict healthcare to someone on the basis of their age. There are folks in their 90s who are just as deserving of the benefits to surgery as a younger patient is.”

A team approach
Beyond the “nuts and bolts” of cardiac medicine, the Institute has also worked to develop a unique team approach to patient care. “Perhaps our most important innovation is the team concept to cardiovascular medicine,” emphasizes Dr. Moreno. “Especially in valve surgery, the patient used to first see their primary care doctor, then they would go to a cardiologist. The cardiologist sees the patient, makes the diagnosis, and then sends the patient to the surgeon. Then the
surgeon decides if he would operate on the patient or not.”

Endovascular-SuiteAt the Institute, patients are presented with a team comprised of surgeons, interventional radiologists, cardiologists, interventional cardiologists, and the advanced nursing staff. The team, as a whole, sit down and discuss patients in an open forum to determine the best forms of treatment for each particular patient. “At the end of the day, we come to a consensus for the best possible therapy we can give to that patient. That’s really the most important thing we have done in the last few years.”

Between this dynamic team approach and the advent of newer, less invasive procedures, the landscape of cardiovascular medicine is evolving. Dr. Moreno agrees. “Ten years from now, who knows how we will do heart surgery? We are reaching toward the latest technology and innovation to help a greater population of people.
Ultimately, younger patients will benefit too. We are in a great place to help develop, then institute, these new procedures. I’m very proud of what we are accomplishing for our patients.”

To learn more about Baptist Health’s Miami Cardiac & Vascular Institute, visit them online at BaptistHealth.net/Heart.

Hearts and Minds