Protected PCI, Surgical Applications
Tampa General Heart Team: High-Risk Revascularization
Four physicians from the heart team at Tampa General Hospital, in Tampa, FL, discuss how they assess patients with heart failure and determine the best strategies for high-risk revascularization in these patients.
Hiram Bezerra, MD, an interventional cardiologist at Tampa General, explains that the heart team discusses every heart failure patient they consider for revascularization in, “a very dynamic conversation.” This heart team consists of an interventional cardiologist, cardiothoracic surgeon, heart failure specialist, and referring cardiologist. They discuss treatment pathways ranging from full cardiopulmonary bypass surgery to percutaneous coronary intervention (PCI) to a hybrid approach using both strategies.
Swaroop Bommareddi, MD, a cardiac surgeon on the team, explains, “every patient is seen by an interventional cardiologist and a surgeon, so there’s really no bias in terms of the revascularization strategy.” He explains that heart failure cardiologists are involved early in discussions if the strategy involves mechanical circulatory support (MCS). Heart failure specialists help determine strategies for patients who may fail to wean from MCS.
Dr. Bezerra highlights that a unique feature of the program at Tampa General is that Dr. Bommareddi has extensive experience using Impella 5.5® as mechanical circulatory support in high-risk PCI patients who may require an extended duration of MCS support and have needs beyond what Impella CP® can provide. “Internally, we call it the super-Protected PCI,” Dr. Bommareddi adds. “These are patients often times who are turned down by even other tertiary referral centers.”
Debbie Rinde-Hoffman, MD, one of the heart failure cardiologists at Tampa General, discusses how she has transparent and ongoing conversations with patients about potential pathways for the advanced therapies, if needed. Ioana Dumitru, MD, another heart failure cardiologist, emphasizes, “It’s a multidisciplinary approach for the immediate problem, but also looking long-term as the potential best outcome for the patient and making sure that is what the patient’s expectations are.”