Heart Surgery | UM St. Joseph Medical Center

The UM St. Joseph Medical Center team of cardiac surgeons, who are faculty at theUniversity of Maryland School of Medicine Division of Cardiac Surgery,have earned a distinguished three-star rating from The Society ofThoracic Surgeons (STS) for outstanding patient care and outcomes incoronary artery bypass grafting (CABG) and aortic valve replacement(AVR).

The three-star rating is earned by only 10-15% of cardiac surgeryprograms in the U.S., according to the STS.

Patients in need of cardiac surgery benefit from the joint programbetween surgeons from UM St. Joseph Medical Center and the Universityof Maryland Medical Center. Together, the University of MarylandCardiac Surgery Program is bringing the most advanced cardiac surgeryoptions and life-saving research to more patients than ever inMaryland.

At University of Maryland St. Joseph Medical Center's Valve Clinic, ourmission is simple: to restore function to a diseased heart valve. We striveto provide each patient with a comprehensive, multi-disciplinary evaluationof their heart valve disease and the most advanced treatment optionsavailable. Our Valve Clinic includes cardiologists, heart surgeons,echocardiographers, intensive care physicians, pulmonologists, and othermedical specialists. One of the doctors from our Valve Clinic will take thetime to fully explain how the valves in your heart are functioning. Iftreatment is needed, we will explain all of the treatment options and guideyou to an individualized plan. For each patient the complete evaluation andtreatment can occur in one location and be scheduled conveniently. We oftenfind that patients can be managed without surgery, or with a less-invasiveoption. If valve surgery is needed, you will receive the most advanced careavailable in the hands of our heart surgery team.

The Valve Clinic sees patients with all types of valve problems includingmitral regurgitation, mitral stenosis, aortic stenosis or insufficiency,bicuspid aortic valve, aortic root dilatation, and tricuspid regurgitation.Patients with mitral valve disease, particularly mitral regurgitation, arecommonly referred to determine the need for surgery. Often patients can befollowed closely with serial echocardiograms and an optimal medicalregimen. For patients with severe regurgitation and symptoms, impaired leftventricular function, elevated pulmonary artery pressures, or atrialfibrillation surgery is usually indicated. At UM SJMC, our goal forpatients who require surgery is to restore the function of the mitral valveand preserve the native valve whenever possible. We believe that awell-functioning native valve is the ideal outcome. This is bestaccomplished with a mitral valve repair. In some cases, the native valvecannot be restored to function and a replacement is necessary with a tissueor mechanical valve. In this case, we still strive to preserve thepatient's native sub-valvular apparatus which maintains natural connectionsbetween the valve and the heart, and has been shown to improve cardiacfunction.

Aortic stenosis is the most common heart valve disease in adults, and itsprevalence is expected to double in the next 20 years. This disease cancause chest pain, difficulty breathing, light-headedness, and fatigue. Formost patients, the optimal treatment is open heart surgery with valvereplacement. Aortic valve replacement can provide relief from symptoms anda longer life. For older and higher risk patients we are able to place anew valve using a transcatheter aortic valve replacement (TAVR). Thisprocedure can be done through a blood vessel, without opening the chest.The procedure is minimally invasive and delivers a new valve inside the oldone, housed on a stent which anchors the valve in position. Recovery can beas short as 1-2 days in the hospital following this procedure.

Aneurysms represent a risk of sudden catastrophe in the form of aorticdissection or rupture. Surgical replacement with a synthetic aortic graftcan provide treatment before that occurs. Studies from large centers showthat in the general population the hinge point for increased risk of anaortic catastrophe is over 5.5cm. When the aorta reaches this size, itshould be replaced, because the risk of surgery is lower than the risk ofan aortic catastrophe. Conversely, for smaller-sized aortas, the risk ofsurgery is generally higher than that of a catastrophe. Certain subsets ofpatients such as those with Marfan disorder, Ehlers Danlos, Loeys Dietz,and a strong family history are at higher risk of an aortic catastrophe,and should be considered for surgery sooner.

Some ascending aortic aneurysms involve the root of the aorta and requirereplacement with re-implantation of the coronary arteries into the newlyfashioned aortic root. Often, an aortic root aneurysm causes the aorticvalve to become insufficient and leak. Increasingly, in appropriatepatients, we are able to re-implant the patient's own valve into the newaortic root. This helps preserve natural valve tissue can avoid theimplantation of a prosthetic heart valve.

Heart disease is the number one killer in the US and coronary arterydisease (CAD) is the most common form of heart disease in this country.Common risk factors for developing CAD are high blood pressure, highcholesterol, family history of CAD, smoking, diabetes, obesity, andphysical inactivity. CAD is characterized by a build-up of plaque insidethe arteries of the heart. These plaques can narrow arteries and restrictblood flow causing chest pain, shortness of breath, fatigue, or othersymptoms. The plaques can also rupture and completely block the artery,causing a heart attack. Some patients with CAD can be ideally treated withmedications alone or medications plus intra-coronary stents placed in thecardiac catheterization lab. For some patients with a heavy distribution ofblockages, open heart coronary artery bypass surgery is the best option.

Coronary bypass surgery involves taking arteries from behind the chestwall, the forearm, or a vein from the leg to re-route blood around theblocked segments of the arteries on the heart. For selected patients thissurgery can be the most effective way to alleviate symptoms, avoid a heartattack, and live longer. The outcomes for coronary bypass surgery haveimproved nationwide over the last 20 years. Our survival rate for coronarybypass surgery for the last 2 years is over 99.7%, one of the best in theregion.

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Heart Surgery | UM St. Joseph Medical Center