MD heart care advances with minimally invasive tech, clinical trials

Increasingly, heart care is leveraging technology for early detection, remote monitoring and minimally invasive treatments. Smart wearables track the heart in real time; artificial intelligence tools assist with diagnosis; and FDA-approved implantable sensors help manage heart failure. Organizations across Maryland are doing their part: exploring new approaches to diagnosis, management and treatment.

Heart disease remains the leading cause of death in the U.S. Combined with stroke, the fourth leading cause, cardiovascular-related deaths were more than 25% of all U.S. deaths in 2023, according to the American Heart Association.

“The average person with heart failure is misdiagnosed four to five times,” says Dr. Albert Hicks, cardiologist and section chief of advanced heart failure and transplant at the University of Maryland Medical Center. “Most of the time they’re diagnosed with pneumonia or a bad cold, asthma or COPD.” Shortness of breath, the characteristic symptom of heart failure, can easily be attributed to other conditions.

University of Maryland Medical System – innovations in heart and aortic care

Hicks, with Dr. Sarah Flint, cardiologist, is implanting CardioMEMS, an FDA-approved device that remotely monitors pulmonary artery pressures. Best for those who have experienced heart failure exacerbation (sudden worsening of chronic heart failure symptoms) in the past year or who have elevated biomarkers that indicate fluid retention and stress on the heart walls, UMMS began using CardioMEMS in 2022.

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Implanted in the pulmonary artery, in a minimally invasive procedure through a vein in the neck or leg in about 45 minutes, patients receive local anesthesia and moderate sedation. Most leave, says Hicks, “with just a Band-Aid.” CardioMEMS detects pressure changes well before patients experience symptoms like weight gain, shortness of breath or swelling in their legs. “Those are late symptoms,” Hicks explains. “The rise in pulmonary pressures occurs between two to four weeks before changes in weight, shortness of breath, edema, etc.”

The device has no moving parts or electronics and is activated remotely via a pillow that patients lie on each morning. Data is transmitted to advanced practice providers at the UM Heart Failure Clinic who monitor it. This monitoring allows for earlier interventions and treatment changes that keep patients out of the hospital.

While devices like CardioMEMS can delay or prevent the need for transplant or mechanical support in some patients, others require more complex, but often also minimally invasive interventions.

Co-directing the UM Center for Aortic Disease, where they tackle complex structural issues in a collaboration between vascular and cardiac surgery, are Dr. Shahab Toursavadkohi, vascular surgeon, University of Maryland School of Medicine associate professor of surgery, and Dr. Aakash Shah, cardiothoracic surgeon and University of Maryland School of Medicine assistant professor of surgery.

Over nearly a decade in the Center, Toursavadkohi has seen an evolution in the treatment of patients not suited for traditional open-heart surgery. They can now complete many procedures through the groin or upper extremity, which helps avoid the difficulties that can accompany large chest incisions; most patients go home the day after surgery.

Other innovations include updates to the TAMBE (Thoracoabdominal Branch Endoprosthesis) procedure, used to treat thoracoabdominal aortic aneurysms (where part of the aorta becomes weak and bulges), which they perform primarily through the groin, and incorporating 3D printing for life-sized replicas of patients’ aortas, including the aneurysm. Using 3D models allows the team to design grafts that precisely match the patient’s anatomy. The graft is collapsed into a small, straw-like delivery device, inserted into the artery and expanded in place to create a precise seal.

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The Center has also begun performing a total endovascular aortic arch repair called Endo-Bentall. As the only U.S. site to successfully complete multiple Endo-Bentall procedures (10 as of this publication), Toursavadkohi and his team train other surgeons while continuing to improve the procedure.

“It becomes really complicated,” he says. “You not only replace the vessel, but the valve and coronaries. If you can execute the surgery, these patients do extremely well. You turn a big surgery that would otherwise require open-heart surgery and carry a high mortality rate into a much less invasive procedure that could be tolerated by older or sicker patients.”

MedStar Health – advancing clinical trials

MedStar Health is advancing cardiovascular innovations through clinical trials and minimally invasive interventions. The Baltimore region of the MedStar Cardiovascular Research Network currently runs over 30 cardiovascular-related trials primarily at MedStar Union Memorial, with several trials at MedStar Good Samaritan and MedStar Franklin Square hospitals.

Dr. John Wang, Director of the Cardiac Catheterization Lab at MedStar Union Memorial and MedStar Franklin Square and Scientific Director of Baltimore Cardiovascular Research, is the principal investigator for the Abbott Envision trial, studying the Abbott Navitor™ Vision TAVR (Transcatheter Aortic Valve Replacement) valve. TAVR is a minimally invasive procedure that allows replacement of an aortic valve without open-heart surgery. Already FDA-approved for high-risk patients, the team is evaluating it in intermediate- and low-risk patients, hoping to expand access to this latest FDA approved transcatheter valve.

MedStar is also home to the Proactive HF2 trial. Led by Dr. Erika Feller, advanced heart failure specialist and the Director of Heart Failure Outreach for the Baltimore region, they are testing the Endotronix Cordella™ Pulmonary Artery Sensor System, recently FDA approved for patients with NYHA class III congestive heart failure, where less than ordinary activity causes fatigue. Implanted in about 20 minutes, the device wirelessly transmits pulmonary artery pressure data to providers, with the goal of earlier interventions and reduced hospital readmissions.

“People may not know the amount and the quality of clinical research being conducted at MedStar Health,” Wang says. “Our depth and breadth of clinical research along with our extensive clinical experience and exceptional outcomes makes MedStar very attractive to sponsors of clinical trials and patients seeking the latest technologies.”

Wang emphasizes the importance of clinical trials in cardiology: “More than any other field in medicine, cardiology has utilized large randomized clinical trials to practice evidence-based medicine. Ultimately, these trials offer great advantages and benefits to our patients,” including earlier access to lifesaving technologies and closer clinical follow-up.

From remotely monitored pulmonary artery pressures to minimally invasive heart valve replacements and groundbreaking clinical trials, innovation is expanding the possibilities, showing that heart care isn’t just about treatment; it’s about anticipating disease, customizing treatment and giving patients the best chance to live longer and healthier.