Innovations in Review 2024

Cardiology and Heart Surgery

Over the past year, NewYork‑Presbyterian made significant strides in cardiology and heart surgery innovations. From the approval of new transcatheter devices to the integration of robotics into cardiac surgery to the use of artificial intelligence to improve cardiac care, our experts at Columbia and Weill Cornell Medicine are pushing the boundaries of modern medicine to achieve the best outcomes possible for our patients. Our multidisciplinary approach allows us to provide optimal care tailored to each individual patient and their unique needs.

Cardiology and Heart Surgery
Cardiology and Heart Surgery

Machine Learning Model Advances Early Heart Failure Diagnosis

A novel AI tool trained to analyze chest X-rays outperformed radiologists and could lead to earlier diagnosis of heart failure in the future, according to a study led by Pierre Elias, MD, a cardiologist at NewYork‑Presbyterian and Columbia and medical director for artificial intelligence at NewYork‑Presbyterian. The AI tool accurately detected if a patient has severe left ventricular hypertrophy or dilated left ventricle. After being validated using more than 8,000 external cases and compared against 15 boardcertified radiologists, the study’s results showed that the AI tool is, on average, 7% more accurate than radiologists.

The deep learning model takes as input a pre-processed chest X-ray of dimension 224- by-224, age, and sex; the model outputs a probability for dilated left ventricle, severe left ventricular hypertrophy, and a composite label indicating the presence of either structural abnormality. (Graphical abstract from the European Heart Journal)

Type B Dissections in Marfan Syndrome Linked to Severe Phenotype

At NewYork‑Presbyterian and Weill Cornell Medicine, cardiologist Nupoor Narula, MD, MSc, is leading research looking at Marfan syndrome (MFS) and its related cardiac problems. Last year, she published a pivotal paper assessing risk factors for type B dissections in people with MFS, utilizing clinical and imaging data from the institution’s extensive aortic aneurysm registry. She and her colleagues found that type B dissections are an overall more severe phenotype than type A dissections. Specifically, MFS patients with type B dissections were more likely to undergo aortic root replacement (ARR) and independent mitral valve surgery, to have had a type II dissection, and to have lived longer. Results from this paper are paving the way for future research on the role of genotype in adverse aortic events and the hemodynamic implications of elective ARR.

Individuals with Marfan syndrome are at an increased risk of an aortic dissection.

New Center Offers Advanced Care for Valve Diseases

A newly established Mitral & Tricuspid Center at NewYork‑Presbyterian and Columbia opened in June 2024. Led by interventional cardiologists Susheel Kodali, MD, and Rebecca Hahn, MD, and cardiac surgeons Isaac George, MD, and Arnar Geirsson, MD, the center coordinates a multidisciplinary team of experts across cardiology, interventional cardiology, electrophysiology, cardiothoracic surgery (including robotic surgery), and cardiac imaging to provide personalized, comprehensive solutions for patients with mitral and tricuspid valve disease. This unique multidisciplinary approach to care offers patients access to innovative clinical trials and advanced therapies, including the latest transcatheter devices, as well as cuttingedge pharmacotherapy, like newer sodium-glucose cotransporter 2 (SGLT2) inhibitors, to help treat all stages of valve disease.

Patients seen through the Mitral & Tricuspid Center will receive a thorough workup to match them with the right treatment plan, which may include enrollment in clinical trials for new transcatheter therapies and advances in robotic valve surgery or robotic surgical procedures.

Preop Drug May Reduce Side Effects of Cardiac Surgery

NewYork‑Presbyterian and Weill Cornell Medicine was one of 19 trial centers across the U.S., Australia, and Canada to investigate RBT-1, a preconditioning agent that combines stannic protoporfin (SNPP) and iron sucrose (FeS) to elevate the anti-inflammatory response, and its potential to reduce postoperative complications. Charles A. Mack, MD, vice chair of quality in the Department of Cardiothoracic Surgery at NewYork‑Presbyterian and Weill Cornell Medicine and site principal investigator for the trial at NewYork‑Presbyterian Queens, presented promising findings from the phase II study of RBT-1 at the 2024 annual meeting of the American Association for Thoracic Surgeons. While efficacy was not the primary focus of the phase II trial, Dr. Mack and the other study authors theorized that RBT-1 is not only a source of iron, it also contains components that may stabilize red cells, allowing less blood to be given during surgery.

Preop Drug May Reduce Side Effects of Cardiac Surgery

Drug-Coated Balloon Approved for Coronary In‑Stent Restenosis

In March 2024, the FDA approved a paclitaxel-coated balloon for the treatment of coronary in-stent restenosis (ISR). The approval came at the same time as publication of the positive results of the AGENT IDE trial, the largest randomized clinical trial and first of its kind in the U. S. looking at the safety and efficacy of the drug-coated balloon catheter versus an uncoated balloon for ISR. Ajay Kirtane, MD, director of the Interventional Cardiovascular Care Program at NewYork‑Presbyterian and Columbia and AGENT IDE study chairman, outlined how the new device fills a treatment gap in ISR and highlighted the trial results that clearly showed the drug-coated balloon is superior to conventional balloon angioplasty. This approval could change the standard of care, as it gives interventional cardiologists another tool in their arsenal to address the issue of a restenosed stent.

Angiogram showing coronary in-stent restenosis

Reimagining Research: Enhancing Cardiac Care for Underrepresented Populations

Mario Gaudino, MD, PhD, a cardiothoracic surgeon at NewYork‑Presbyterian and director of the Joint Clinical Trials Office at Weill Cornell Medicine, has been investigating the lack of data for coronary artery bypass graft (CABG) surgery outcomes in women and people of color. Over time, it has been recognized that CABG outcomes are far worse in women but at present there is not enough research to determine why. On the Advances in Care podcast, he shared how he is conducting ongoing improvements to existing clinical infrastructure and leading pivotal research to better understand the effects of CABG on women and people of color. His work has the potential to change how cardiologists and surgeons treat large portions of their patient population and create an enhanced patient-centric approach to cardiac research.

Gaudino

The Surgical Robot: Advancing Medicine with Robot-Assisted Technology

Robotic approaches to surgery are becoming more common as they create opportunities for precise, minimally invasive procedures that allow for improved surgical accuracy and faster recovery times than traditional approaches. On the Advances in Care podcast, Arnar Geirsson, MD, director of the Cardiovascular Institute and the Surgical Heart Valve Program at NewYork‑Presbyterian and Columbia, discussed how surgical robots are advancing cardiac surgery, including robotic-assisted mitral valve repair. He was joined on the podcast by two other surgeons who share their key takeaways on how robotics are enhancing clinical practice across specialties and will play a major role in the evolution of patient care.

Advances in Care podcast featuring Arnar Geirsson

Connecting Cardio & Cancer: Mitigating Cardiotoxicity with Optimized Treatment Strategies

Increased risk for cardiovascular issues is an unfortunate byproduct of many cancer treatments. Stephanie Feldman, MD, a cardiologist at NewYork‑Presbyterian and Weill Cornell Medicine and a leader in the field of cardio-oncology, spoke on the Advances in Care podcast about how clinicians in this emerging field can optimize cancer care plans and improve quality of life for patients who are at risk for cardiovascular issues. Doing so requires advancing cardio-oncological research, taking a multidisciplinary approach to patient care, and ensuring that patients with cardiac dysfunction associated with their cancer or their treatment remedies are treated safely and effectively.

Advance in Care featuring Stephanie Feldman

Transcatheter Therapy for TR Shows Successful Results

For many patients suffering from tricuspid regurgitation (TR), medical therapy is ineffective and surgery has a high rate of morbidity and mortality. Understanding these challenges, Susheel Kodali, MD, director of the Structural Heart and Valve Center at NewYork‑Presbyterian and Columbia, led the TRISCEND II trial, which demonstrated the safety and efficacy of a novel tricuspid valve replacement system. This innovative transcatheter therapy provides a new treatment option that vastly improves quality of life and will revolutionize how tricuspid valve diseases are treated. The device was fast-tracked for FDA approval due to its clear benefit for the vulnerable TR patient population.

This transcatheter therapy system is to be delivered via the femoral artery without any incisions.