Patients with heart disease may benefit from procedures such as cardiac bypass surgery to open blocked arteries and improve blood flow through the heart. However, some patients are considered too “high risk” for such measures, and there are few alternatives to alleviate their symptoms. But cardiac revascularization now offers hope for many of these patients.
At UCLA, the Complete Revascularization in High Risk Indicated Patients (CHIP) program specializes in caring for the growing number of patients who have complex coronary artery disease and heart failure along with other factors that put them at high risk for surgery. The other factors may include advanced age, diabetes, previous cardiac surgeries and peripheral vascular disease, putting them at increased risk for having a heart attack, stroke or dying during a surgical procedure.
“This is a one-stop, multidisciplinary program for patients who would not be candidates for bypass surgery due to the complexity of their disease and their other ailments,” says cardiologist Ali Nsair, MD, director of the CHIP program. “Traditionally, these patients may not receive any treatment. With our aging population, the number of complex heart failure patients is only going to increase.”
While many centers may turn down such patients, UCLA’s CHIP program offers a team approach that includes experts in cardiothoracic surgery, interventional cardiology, electrophysiology, heart failure and mechanical circulatory support to evaluate and treat selected high-risk patients.
Treatment of these high-risk patients is now possible due to several medical advances and treatments, Dr. Nsair says. These well-established procedures include medical therapies, surgery and percutaneous coronary revascularization, a minimally invasive procedure to open arteries by threading a catheter through the leg and into the heart to open blockage with a balloon-like device or by deploying a stent in the artery. In patients with the most severe conditions, heart transplantation is recommended or patients may be put on left-ventricular assist devices. These pumps are implanted in the chests of patients to help their hearts function. Patients also are treated for other cardiac conditions, such as arrhythmias and valvular diseases.
During the evaluation, a team of experts will explore the safest and most effective options with the patient and his or her family, Dr. Nsair says. “Our objective is to make sure we offer these patients the best therapy we can,” he says. “These patients often experience intractable chest pain and are incapacitated by their symptoms. Our objective is to offer the best treatment to improve the quality of life of these patients, so they can live longer and healthier lives.”