Tags Posts tagged with "Dr. Henry Tannous"

Dr. Henry Tannous

Stony Brook Heart Institute has expanded its current array of TAVR treatment approaches, providing new options for patients with severe aortic stenosis. Photo by Jim Lennon/Stony Brook Medicine
Includes valve technology used for the first time on LI and NYC

Physicians at the Stony Brook Heart Institute Valve Center have expanded the array of transcatheter aortic valve replacement (TAVR) approaches with two innovative techniques for treating patients with severe aortic stenosis (AS). Aortic stenosis, a narrowing of the aortic valve opening, affects up to 20 percent of older Americans. AS can lead to significant heart problems. For those with symptomatic severe aortic stenosis, the mortality rate within a year can go as high as 50 percent if left untreated.

Stony Brook Heart Institute’s new treatment options offer these potential benefits to patients:

  • More precise procedures. Building on the existing family of TAVR treatment approaches, Evolut FX, the fourth and latest-generation of the Evolut™ TAVR System Medtronic self-expanding valve technology, is designed to provide physicians with greater ease of use, precision and control throughout the procedure—leading to overall more predictable, deliverable and precise TAVR procedures. On October 5, 2022, the specially-trained Stony Brook TAVR team completed their first FX system procedure.
  • Reduced wear of the valve. A new type of transcatheter tissue valve, the Edwards SAPIEN 3 Ultra RESILIA™ valve, has the potential to improve valve longevity and reduce the need for reintervention by using enhanced calcium-blocking technology to help reduce calcification and the wear of the valve. On November 2, 2022, the first procedure using the SAPIEN 3 Ultra RESILIA™ valve for an aortic valve replacement was performed by the Stony Brook TAVR team. On the same day, the SAPIEN 3 Ultra RESILIA™ valve was used in an intervention procedure to replace a failed surgical mitral valve. Procedures using the SAPIEN 3 Ultra RESILIA™ valve at Stony Brook were the first on Long Island and in NYC to be performed using this type of valve technology.

For three years in a row (2021-2023), Stony Brook has been named a Five-Star Recipient for Valve Surgery by Healthgrades, the first organization in the country to rate hospital quality based on actual clinical outcomes. The TAVR team is led by cardiovascular surgeon, Henry Tannous, MD, Co-Director, Stony Brook Heart Institute, Chief of Cardiothoracic Surgery and Surgical Director, Structural Heart Program; Smadar Kort, MD, Director, Valve Center and Director, Interventional Echocardiography; and interventional cardiologists Robert Pyo, MD, Director, Cardiac Catheterization Laboratory and Director, Structural Heart Disease Program, and Puja Parikh, MD, Director, Transcatheter Aortic Valve Replacement (TAVR) Program.

“Many of our patients diagnosed with severe aortic stenosis will, now, based on their individual preferences and discussion with their heart team, be able to opt for the most innovative, minimally invasive method of aortic valve replacement that best ensures their safety and outcomes,” shares Dr. Tannous. “It is an exciting and transformative time both for patients and the medical community, alike.”

“Our TAVR clinicians now have more ways to provide quality care that is customizable to the patient’s needs,” says Dr. Pyo. “Our ever-growing TAVR program continues to raise the bar for cardiac care on Long Island and we are proud to provide our community with the full array of the most comprehensive aortic stenosis diagnostics and treatments under one roof.”

“Our TAVR program is patient-focused in every aspect, from patient selection to procedure planning to treatment and postoperative care,” advises Dr. Kort. “The treatment provided at the Stony Brook Heart Institute Valve Center is distinguished by easy access to our entire team of specialists and our wonderful and dedicated nurse navigator who acts as a liaison between the medical team and the patient and family.”

“The combined expertise of our multidisciplinary teams allows us to bring the best approach to each patient, treating our cardiovascular patients with some of the most advanced technological breakthroughs for optimal outcomes and quality of life,” says Dr. Parikh.

The TAVR procedure involves placing a replacement valve into the aortic valve’s location through a catheter. For those with severe AS who are considered high-risk for conventional open-heart surgery, the minimally-invasive alternative provides a viable option that eliminates the need for traditional open-heart surgery. TAVR is also a surgical treatment option for patients with severe AS who are considered low-or intermediate-risk for conventional open heart surgery. Stony Brook was the first in Suffolk County and among the first in the nation to offer transcatheter aortic valve replacement or TAVR.

For more information about innovative heart treatment at Stony Brook Heart Institute, visit heart.stonybrookmedicine.edu.

About Stony Brook Heart Institute:

Stony Brook Heart Institute is located within Stony Brook University Hospital as part of Long Island’s premier university-based medical center. The Heart Institute offers a comprehensive, multidisciplinary program for the prevention, diagnosis and treatment of cardiovascular disease. The staff includes full-time and community-based, board-certified cardiologists and cardiothoracic surgeons, as well as specially trained anesthesiologists, nurses, physician assistants, nurse practitioners, respiratory therapists, surgical technologists, perfusionists, and other support staff. Their combined expertise provides state-of-the-art interventional and surgical capabilities in 24-hour cardiac catheterization labs and surgical suites. And while the Heart Institute clinical staff offers the latest advances in medicine, its physician-scientists are also actively enhancing knowledge of the heart and blood vessels through basic biomedical studies and clinical research. To learn more, visit www.heart.stonybrookmedicine.edu.

Jim and Jacqueline Olsen

By Daniel Dunaief

When Jacqueline Olsen learned the day before her birthday last November that she needed surgery for lung cancer, she felt anxious about a procedure she knew could be painful and could involve a lengthy recovery.

“It’s not only my birthday, it’s Thanksgiving,” said Olsen, who is a resident of St. James and is an agent for personal insurance such as home, auto and umbrella insurance. “Everybody was real tense. It was not a pleasant holiday.”

Olsen’s father, William Leonard, and father-in-law, James Olsen, had died of lung cancer after having open chest surgeries. The pain of what her father went through 48 years ago and father-in-law over 20 years ago was fresh in her mind as she readied herself for her own procedure.

Dr. Ankit Dhamija

Speaking with doctors at Stony Brook University Hospital, Olsen heard about newer, better options.

Dr. Ankit Dhamija, Cardiothoracic Surgeon and Director of Thoracic Robotic Surgery at Stony Brook Medicine, suggested to Olsen that she was a candidate for a robot-assist surgery called the da Vinci Surgical System. 

Olsen and her family gathered considerable information about the procedure.

“I did some research on it and it said it would be a faster recovery and I would be up and back to my normal self pretty soon afterward,” said Olsen. “It seemed like a less invasive surgery.”

The robotic surgery does not involve turning over the procedure to a machine, Dr. Dhamija explained.

Instead, the process involves making considerably smaller incisions and guiding the robot through the body to remove the cancerous tissue.

“The robot is a machine that is an extension of our hands,” said Dr. Dhamija, who has performed about 500 such procedures with the help of a robot, including around 70 since he arrived at Stony Brook.

The robotic system allows surgeons like Dr. Dhamija and Dr. Henry Tannous, Cardiothoracic Surgeon and Chief of the Cardiothoracic Surgery Division at Stony Brook Medicine, among others, to sit in the operating room with the patient while the robot enters through an incision. The robot provides a three dimensional view of the inside of the body, magnifying cells by ten times.

The robot assist can also improve the ability of surgeons to perform fine operations.

The system “does have a machine algorithm associated with it that actually is known to reduce tremors in surgeons that have tremors,” said Dr. Dhamija. “Someone that may not be able to do a certain portion of the operation due to their technical limitations can subsequently do it with the robot.”

Dr. Henry Tannous

In the procedure, the surgeon can see and maneuver through the body effectively, searching for the specific cells to remove.

An interventional radiologist can inject a dye which under CT guidance allows the surgeon to “see where the lesion is and to verify that you have adequate margins” or the border between cancerous and non-cancerous cells, Dr. Dhamija said. “Having the dye in there to identify [the cancer] is helpful,” he added.

By using the robot instead of creating a large incision, doctors can reduce the time patients spend in a hospital down to as little as one to three days from the four to eight days after an open chest lobectomy.

“There’s so much to be said about someone [recovering] in their own home,” said Dr. Dhamija. They “get to sleep properly, their bowel habits are more normal, and they get to reengage in their daily life functions sooner. I’m a big proponent of a patient taking charge of their own postoperative care.”

Indeed, Stony Brook doctors have become so confident and comfortable with the robot assist that it has become the main platform for thoracic oncology patients at Stony Brook Medicine, explained Dr. Tannous. Tannous estimates that 90 percent of the lobectomies will be performed robotically in 2022, up from 10 to 20 percent in 2021.

In an email, Dr. Tannous wrote that other specialties that have adopted the robotic platform include gynecology, urology, colorectal, bariatrics, and general surgery.

Stony Brook is also expanding robotic surgery to include cardiac procedures in 2023.

Dr. Tannous said robotic procedures that cut down on recovery time means less risk of hospital-acquired infections, lower extremities blood clots, and numerous other benefits.

Some day, theoretically, the robot may enable remote procedures, with surgeons operating the robot with the help of an on-site local medical team. That could be helpful for astronauts who develop a medical problem far from home where they need emergency surgery.

An important caveat with that, Dr. Dhamija said, is that the staff on site would need to be able to complete a procedure if an open chest surgery became necessary.

Olsen, who was out of the hospital less than 24 hours after she had surgery in late May, has become a fan of the technology and of the team at Stony Brook.

Olsen, who has three scars on her back and two on her side, felt pain for about a week. As she recovered, she never felt the need to fill a prescription for a stronger painkiller, choosing to treat the pain with Motrin. She plans to continue to take blood tests every three months and to get CAT scans every six months.

Olsen was thrilled with the quality of care she received and is pleased she can look forward to sharing quality summer time during the family’s annual beach trip. “It’s heaven to me,” she said, where she can “spoil my grandchildren.

As for a perspective on her surgery, she said the difference between 20 years ago and now is “unbelievable. It was such an awful experience” for her father and father in law. “This was a million times better.”

Dr. Henry Tannous during surgery. Photo from SBU

By Daniel Dunaief

While she hasn’t resolved the debate about two approaches to a type of heart surgery, Laurie Shroyer, Professor and Vice Chair for Research in the Department of Surgery at Stony Brook University’s Renaissance School of Medicine, has contributed considerable information over a long period of time.

Laurie Shroyer. Photo from SBU

In a recent study released in JAMA Surgery, Shroyer, who is the principal investigator and co-PIs Fred Grover and Brack Hattler of the Rocky Mountain Regional Affairs Medical Center, revealed that coronary artery bypass grafting had similar post-surgical death rates for the veterans in their study whether the surgeon used a heart-lung machine, called “on pump,” or performed the surgery without the machine, called “off pump.”

Using long-term results from 2,203 mostly men at 18 VA Centers in the Department of Veterans Affairs Randomized On/Off Bypass (ROOBY) trial, Shroyer determined that the death rate at 10 years was 34.2 percent for off-pump, compared with 31.1 percent for on-pump.

Patients typically need bypass graft surgery when they have a narrowing of their coronary arteries, which comes from fatty material accumulating in the walls of the arteries. Doctors take a part of a healthy blood vessel from the leg, wrist or elsewhere and bypass the blockage, building a detour for the blood and enabling better circulation in the heart.

Using the “off pump” procedure means doctors operate on a heart that’s still pumping blood through the body. The “on pump” procedure uses a heart lung machine to pump blood while the heart remains still.

While the results of this study don’t end the debate over whether one procedure is superior to another, doctors welcomed the data as a well-researched and detailed analysis.

“There’s always going to be this ever-last question of whether off versus on pump bypass surgery is better,” said Dr. Henry Tannous, Chief of Cardiothoracic Surgery at the Renaissance School of Medicine at Stony Brook University. “There’s always going to be very little nuances with different patients that will make us pick one or the other.”

Dr. Tannous who has performed the majority of all bypass surgeries at Stony Brook over the last five years, said the hospital offers surgeries with and without the pump. SB has doctors who specialize in each kind of bypass in case of a change in the expected procedure.

Doctors typically get a clear sense of whether a patient might benefit from on or off pump procedures before starting surgeries. In the great majority of cases, doctors perform the surgery according to their pre-planned expectations for the use of the pump.

Rarely, they convert to the other procedure based on inter operative findings that dictate the switch, Dr. Tannous explained.

Dr. Jorge Balauger, Associate Chief of Cardiothoracic Surgery and Director of Advanced Coronary Surgery, has performed 4,000 CABG procedures, including about 1,000 without the heart lung machine, or “off pump.”

In his considerable experience, he suggested that an 80-year old, who has renal or liver dysfunction and/or arteries in his or her neck that are partially blocked or had another type of comorbidity, such as something in the bone marrow, would not tolerate a heart lung machine well. A person with cirrhosis also would likely be better served with an off pump operation.

“Avoiding the heart lung machine on the older, sick patients is beneficial,” Dr. Balauger said, adding that he looks at the CABG procedure as being akin to a “tailor made suit” that has to fit the patient specifically.

In cases where patients need a second bypass procedure, Dr. Balauger also recommends off pump efforts because a second operation on pump is “way more complex” and requires “dissection of all the scar tissue around the heart, which makes it not only time consuming, but also risky.”

Dr. Henry Tannous. Photo from SBU

Dr. Tannous appreciates the perspective Shroyer brings to the discussion. “Sometimes, it’s an asset to have a researcher and statistician with a very scientifically oriented mind lead the study,” he said, adding that when surgeons meet with patients, they will discuss the use of the pump.

Dr. Baulager described the trial conducted by Shroyer as having an “excellent design” from a scientific standpoint.

He believed, however, that the study didn’t include surgeons who had sufficient expertise in off pump procedures. Dr. Baulager thought more experienced surgeons likely ensured better outcomes for off pump procedures.

One aspect of the study that was “refreshing” to Shroyer was how durable the surgical procedure is, with about 70 percent of patients who received this procedure, both on and off pump, still experiencing improvements in their pre-surgical chest pain symptoms after 10 years.

“We never expected the high proportion of patients would do so well longer term in terms of freedom from events, and in terms of symptoms,” she said. “The fact that the symptoms weren’t different between on and off pump is good news.”

After this type of study, Shroyer will work with several other trials to identify if certain sub-groups of high risk patients may have benefits from an off pump procedure.

To be sure, Shroyer cautioned that these results couldn’t be extrapolated to the general population, especially to women, as almost all of those the study followed were men.“Veterans are a unique population,” she said. “Many received cigarettes as part of their rations, and hypertension is quite high. They are a different population in terms of their [health care] complexities and their [underlying] illnesses.”

While the 10 year outcomes were similar, Shroyer found a shorter revascularization-free survival period among off pump patients. 

Dr. Tannous said this kind of study would generate considerable interest among cardiac surgeons.

“Everything [Shroyer] has written about bypass surgery from the ROOBY trials will catch any cardiac surgeon’s attention nationwide,” he said. “This paper is not any different. It has the extra long-term follow up that makes it more relevant.”