Interventional cardiology is a subspecialty of cardiology that involves treating heart conditions with catheters, rather than open surgery. At the Montefiore Einstein Center for Heart and Vascular Care, our award-winning interventional cardiologists have been at the forefront of this field for nearly 20 years and have greatly impacted modern cardiology, particularly with the treatment of heart attacks. They are dedicated to the proper diagnosis and nonsurgical treatment of coronary artery, valvular and congenital heart disease. Their dedication not only offers patients more options for managing cardiovascular complications, but also provides significant benefits, including less scarring and an ability to return to daily activities more quickly than with open heart surgery.
Patients of all ages come to the Heart and Vascular Center for its distinguished expertise. The Interventional Cardiology staff is composed of 12 interventionalists, two of whom are wholly dedicated to pediatrics, as well as specially trained nurses and technicians. Between Mark Greenberg, MD, Chief of Clinical Cardiology, and Mark Menegus, MD, Director of the Coronary Care Unit, the team has nearly 60 years of combined experience.
"Our philosophy is: we work for the patients," Dr. Greenberg explains. "They come to us because we are very careful about giving the best opinion we can to them. We have mature clinical judgment and years of experience. Not every pain in the chest is coronary disease, and we pride ourselves on delivering proper diagnoses and determining the best course of treatment."
Montefiore has a high volume of patients, with more than 7,000 interventional cardiology procedures performed each year and an extremely low complication rate. Our team works closely with other departments, including radiology, vascular interventional radiology, pediatrics, emergency and anesthesia, to ensure that each patient receives the highest quality care.
Interventional cardiologists perform the entire range of advanced procedures, from coronary angioplasty to complex coronary stenting, including:
Coronary angioplasty/percutaneous coronary intervention (PCI): opening stenotic, or narrowed heart arteries with a balloon to improve blood flow
Balloon-catheter angioplasty: placing a catheter with small balloon around it in the coronary artery
Stenting and intracoronary stent placement: inserting a hollow, mesh tube into the artery to keep it open
Rotational atherectomy: breaking up solid, calcium-plaque buildup in the artery into tiny pieces
Coronary thrombectomy (acute myocardial infarction or heart attack): performing a catheterization to remove thrombus, or blood clot from blood vessels
Valvuloplasty: opening a narrow value in the heart using X-ray and dye injected into the blood stream
Balloon valvuloplasty: using a balloon catheter to stretch a narrowed heart valve
Re-embolizing coils: opening the vessel with steel coils
TAVR (Transcatheter Aortic Valve Replacement ) is the procedure in which a replacement aortic valve is threaded through a catheter and placed into position within the heart. If conventional valve repair or replacement is not an option for a patient with severe aortic stenosis, the TAVR procedure was approved by federal regulators last November and is now available at Montefiore. During TAVR, a bioprosthetic valve is threaded through the femoral artery via a catheter and then into the heart. Once in position, balloon valvuloplasty is performed to deploy the replacement valve and its frame within the diseased native aortic valve. The procedure is performed in a hybrid catheterization lab and, once perfected, often takes less than an hour. Montefiore Medical Center is among the first wave of sites selected nationwide to launch a TAVR program in 2012. Patients are actively being evaluated for inclusion in Montefiore’s TAVR program. For additional information about the program, visit www.montefiore.org/tavr or call 718-920-7000.
Montefiore ushered in the era of using catheters to treat artery blockages nearly 20 years ago. Since then, we have been at the forefront of advanced treatments and protocols for coronary disease. Additionally, we house one of the first catheterization facilities in the United States with the most advanced equipment.
The first transvenous pacemaker was implanted here in 1958, and we established an electrophysiology program in the late 1960s for treating rapid heart rhythms. In 1992 we led efforts with the Emergency Department (ED) to establish a program to review cases together. We also implemented teaching sessions, enabling the ED team to treat acute myocardial infarction or heart attacks and conduct EKGs on patients immediately, before processing hospital paperwork.
Recently, the Heart and Vascular Center worked with the New York City Fire Department to limit to 90 minutes or less the time between placing of a call to 911 for a heart attack and opening of that patient's blood vessel. After we receive the prenotification from the fire department, we assemble a team quickly to stop the heart attack as soon as possible.
Our innovative solutions stem from our ongoing research endeavors. Currently, we are conducting a cardiogenic shock trial, studying how to improve the inadequate circulation of blood due to malfunctioning ventricles of the heart, as well as several electrophysiology trials. We are also developing new stents and evaluating several drug therapies, including different options to replace Plavix®. We have been exploring pharmacological agents that have a shorter duration of efficacy so that patients do not have to wait long periods of time for Plavix to wear off in order to undergo surgery. Our research has translated into various breakthroughs for nearly two decades, making Montefiore a healthcare destination that not only offers cutting-edge treatments but also invents them.