For Joseph DeRose, MD, being named Chief, Division of Cardiothoracic Surgery, and Co-Director, TAVR Program for Montefiore Einstein Center for Heart and Vascular Care, brings not just responsibility but also tremendous opportunity.
“Montefiore is unique in that we have this assemblage of world-class surgeons who choose to focus their efforts on caring for patients in the Bronx,” says Dr. DeRose. “My job is to work with many of these doctors to identify and pursue new clinical avenues for Montefiore that will both further our mission to the community and solidify our position as a national leader.”
More than this, however, Dr. DeRose is also responsible for heralding the word of Montefiore’s advances in cardiac and thoracic surgery to local physicians.
“Dr. DeRose is going to play a very important role in reaching out to internists, primary care specialists and cardiologists in the tri-state area to help them understand the depth and breadth of our programs in adult cardiac and thoracic surgery,” explains Robert E. Michler, MD, Surgeon-in-Chief, Professor and Chairman, Department of Cardiovascular and Thoracic Surgery and Department of Surgery, and Co-Director, Montefiore Einstein Center for Heart and Vascular Care. “This is a position of leadership, development and mentorship that I believe he is ideally suited to hold considering his expertise and accomplishments in these clinical areas.”
It’s been just a few months since Dr. DeRose’s appointment, and already he is driving an impressive list of initiatives in both cardiac and thoracic surgery.
“We have several new programs that we’re implementing in the area of aortic surgery,” he says. “One of these focuses on reducing the mortality rates of individuals with acute aortic dissection. These patients need to be transferred quickly to a center, such as Montefiore, that specializes in the treatment of this condition. To help streamline this process we’ll be publishing a dedicated phone number that referring hospitals can use in these cases.”
Another program focuses on the treatment of individuals with thoracic aortic aneurysms using a stent graft instead of traditional medical therapy.
“We were recently selected as one of just 23 centers in the nation to participate in a prospective randomized trial studying the safety and effectiveness of a new endovascular graft for the treatment of this condition,” explains Dr. DeRose. “This is an exciting trial that has the potential to offer these patients a greatly enhanced quality of life.”
Dovetailing on its successful pediatric extracorporeal membrane oxygenation (ECMO) program, Montefiore has instituted an adult ECMO service that is available to referring centers in the region. “We are using ECMO anytime a patient is in extremis, requires left ventricular assist device (LVAD) surgery or isn’t getting enough oxygen – as in the case of chronic obstructive pulmonary disease or lung infection,” says Dr. DeRose. “This is a very busy service, and we are getting referrals from all over the area. In grave situations we will even go out with the ambulance to implement ECMO on-site.”
Robotic heart surgery continues to play a dominant role at Montefiore, and Dr. DeRose is a driving factor in its success. Over the past five years he has performed more than 160 robotic coronary artery bypass grafts (CABG) and pioneered the use of this technology in a procedure called hybrid CABG. The primary benefit of this approach is that it brings both cardiac and vascular surgeons into the same operating room simultaneously to treat patients who have blockages in several vessels.
“During this procedure—which is offered at fewer than 30 centers nationally—a CABG is performed, and then the vascular surgeon steps in to deliver drug eluding-stents to other vessels that present significant risk,” Dr. DeRose explains. “We are currently participating in a national, NIHfunded, prospective randomized trial to compare hybrid CABG to other methods of revascularizing the heart. So far, the results we’ve achieved have been great, particularly for people who are too sick for traditional open procedures.”
Now, Dr. DeRose is drawing upon his expertise and expanding his practice to include robotic thoracic surgery. “We started offering robotic lung resections in August for individuals with early-stage or resectable cancers,” he says. “Typically, lung resections are open procedures that can be quite stressful for people who are very ill or smoke. The robotic approach reduces the physical strain and improves their recovery.”
Under Dr. DeRose’s watch, Montefiore is also building its minimally invasive esophageal program to include both thorascopic and robotic options for patients with esophageal cancer and benign conditions such as reflux. He anticipates that this program will be up and running by early fall.
“I think it’s safe to say that Montefiore is on the threshold of something really great,” says Dr. DeRose. “We already have a successful heart transplant and LVAD program, and our notoriety in the treatment of complex valve disease continues to grow with the recent launch of our transcatheter aortic valve replacement program, which I co-direct. As these new programs take hold, Montefiore will truly be able to deliver on our pledge to bring world-class care to the community.”