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Technology is transforming heart care. It’s uncovering problems sooner, administering treatments less invasively and saving more lives in emergencies.
Donavan Harbison, a 34-year- old recreational runner and former N.C. Central University football player, began feeling bad in late 2023. The young father from Graham thought he had pneumonia. His doctors diagnosed him with heart failure. And technology gave him a new lease on life.
Harbison was the second patient in the world to receive the BiVACOR Total Artificial Heart, according to a Duke Health News report. Duke University Medical Center doctors implanted the device, which kept him alive for 10 days until he underwent a human heart transplant. The device has been implanted into five patients as part of an FDA Feasibility Study since then. The FDA recently added 15 patient slots to the study.
About the size of a coffee mug and sporting a power cord that connects to external rechargeable lithium batteries, BiVACOR takes over for a patient’s heart until a donor heart becomes available.
“In performing the transplant, we cut out the patient’s diseased heart that wasn’t working, then we sewed in this product,” says Dr. Carmelo Milano, Duke transplant surgeon and Division of Cardiothoracic Surgery chief. “Two pumps are built into the artificial heart, pumping blood into the lungs and the whole body.”
BiVACOR is suitable for all ages and sizes of patients. That’s an improvement over previous artificial hearts, which were much larger. “The artificial heart is designed to have great durability,” Milano says. “And although this initial trial serves as a bridge for patients until they can receive a natural heart transplant, the product is being designed as a long-term treatment for heart failure and someday will be used in place of a permanent transplant.”
Doctors and patients are excited and hopeful, imagining a day soon when BiVACOR will save more lives. That time has already arrived for other pieces of technology. Whether deploying artificial intelligence to diagnose underlying heart disease or wearable devices that detect blood pressure and heart-rate abnormalities, they’re improving the ways doctors diagnose, treat and prevent heart disease. And patients are better off for it.
Stopping Leaks
Death may not be imminent for most patients suffering from faulty heart valves. But their condition robs them of quality of life. And it can lead to more serious conditions such as liver or kidney failure.
Tricuspid valve regurgitation is a common type of heart disease. “In many people, the tricuspid valve becomes leaky because of valve or right ventricle dysfunction,” says Dr. John Vavalle, medical director of UNC Health’s Structural Heart Disease Program. “Instead of the blood going out to the lungs like it needs to, it is pumped in the wrong direction — back into the body — which leads to excessive fluid accumulation.”
The only treatment for tricuspid valve regurgitation has been valve replacement. Traditionally that requires open-heart surgery. But the very condition that doctors want to correct makes these patients poor candidates for surgery. “The mortality rate associated with open-heart surgery to fix tricuspid valve regurgitation is higher than the mortality rate of any other valve surgery,” Vavalle says.
New safer options for valve replacement are here. UNC Hospitals’ structural heart team performed a minimally invasive transcatheter tricuspid valve implant in March 2024. It was the first time the newly FDA-approved procedure was done in a clinical setting in North Carolina. The procedure involves replacing a damaged heart valve using a catheter inserted through a blood vessel in the groin. It takes about 90 minutes, and most patients go home the next day. “We’ve been implanting this valve for more than a year, and the results have been nothing but stellar,” Vavalle says. “After I performed my first procedure, I was as excited as I’ve ever been before and knew this valve was going to be a game changer.”
Cardiologists at Novant Health’s Structural Heart Program in Winston-Salem are repairing leaky heart valves with a similar minimally invasive surgical procedure. Like UNC’s implant procedure, it involves running a catheter to the heart through the femoral artery. Once it reaches the faulty valve, the device deploys a clip that reconnects the leaking valve flap, correcting the problem. “When we talk about structural heart disease from a cardiology standpoint, we’re trying to attempt to intervene on problems with the heart at a lower risk to the patient and done in a way that patients don’t need a long recovery time,” says Dr. Robert Preli, a cardiologist who practices at Novant Health Forsyth Medical Center.
Most patients who undergo a valve repair are typically back to their usual activities in about a week. “The best part is that we know right away if the procedure worked,” Preli says. “It’s gratifying for everyone on our care team to be able to bring a brand new heart procedure to our patients here in the Triad.”
Improving Outcomes
After heart surgery, technology-driven monitoring fosters better outcomes for patients. Atrium Health launched its Perfect Care Initiative in 2018, thanks to a three-year, $1.1 million grant from The Duke Endowment. Patients receive a digital health kit that includes a fitness tracker, weight scale and blood-pressure cuff. They allow patients to monitor their vital signs and activity levels at home.
Patient data is collected and transmitted in real-time to care team members through a smartphone app, which also enables scheduling appointments, messaging doctors and other healthcare providers, and attending virtual visits. “This continuous monitoring helps us detect issues early and intervene before they escalate, which is a post-surgery game changer,” says Dr. Kevin Lobdell, a cardiothoracic surgeon at Atrium Health in Charlotte.
Readmission rates have decreased and patient satisfaction has soared since Atrium launched Perfect Care Initiative. Heart surgery patients, who on average had their post-surgery hospital stay reduced by one day, had about 40% fewer readmissions within 30 days of surgery and were able to go directly home from the hospital, bypassing rehabilitation facilities. “In July 2019, we enrolled our first patient, and now we have approximately 3,000 patients in the program,” Lobdell says. “They are engaged in their own care and feel more confident about going home, knowing if they have issues, they can connect with their care team through technology.”
Responding to Emergencies
Even with advances in heart-disease detection, many people are unaware that they’re at risk of sudden cardiac arrest. If the worst happens, their survival chances increase if they receive treatment from an eCPR heart and lung bypass machine. The “e” stands for extracorporeal membrane oxygenation. ECMO removes a patient’s deoxygenated blood through a central vein and passes it through an oxygenator, which removes carbon dioxide and adds oxygen. The blood returns to the patient’s body through the femoral artery.
Atrium Health Wake Forest Baptist Medical Center and Forsyth County EMS use eCPR, improving cardiac arrest outcomes in the communities they serve. In addition to providing traditional CPR and defibrillation on scene and in an ambulance, paramedics are identifying patients who could benefit from eCPR. They are placed on an ECMO machine once they arrive at the medical center in Winston-Salem. “When patients arrive at the emergency department, the ECMO team and emergency team work together to get the blood flow returning to their body,” says Dr. John Gaillard, an emergency medicine specialist at the medical center.
Gaillard says deploying eCPR requires a high level of expertise and a collaborative effort involving many hospital services and specialists. “This is a group effort from EMS, the emergency department, our cardiology team, ICU team and cardiac ICU team,” he says. “The whole cardiac care team at Baptist has done a lot to support this, and we plan to keep doing it and saving lives.”
Detecting Problems
Wearable technology can alert patients to heart disease before they feel symptoms. Donna Finnegan of Winston-Salem can attest to that. She noticed her heart rate was higher than normal, even while sitting, thanks to her $30 smartwatch. While there weren’t any other detectable symptoms, she visited her primary care physician, who immediately sent her to Dr. Jack Xu, a Novant Health cardiologist at Forsyth Medical Center in Winston-Salem.
Xu determined the best treatment was bypass surgery. Novant Health reported that she underwent quintuple bypass surgery to open five blocked arteries she might not have known about until it was too late if she had not used her watch to monitor her vital signs.
Xu employed Computed Tomography-Fractional Flow Reserve, which uses artificial intelligence and other data analyses to show the severity of Finnegan’s blockages. He says CT analysis technology has improved over the past decade and become more widely available. “The scans themselves haven’t changed, but the analysis of the images now uses AI to determine if there is underlying cardiac disease we can’t see with our naked eyes,” he says. “This helps us diagnose and treat cardiac disease at an earlier stage than we were able to do previously.”
American College of Cardiology and American Heart Association studies show that smartwatch data is a promising way to diagnose atrial fibrillation and detect concerning heart-rate trends.
“There’s so much potential with artificial intelligence, especially in cardiology,” Xu says. “The ultimate goal is to better identify patients with heart disease risk factors and diagnose them before their disease progresses.”
Patients are benefiting from advanced diagnostic imaging that comes from the installation of a GE Revolution Apex CT scanner at FirstHealth Moore Regional Hospital in Pinehurst. It leverages smart AI imaging to enhance care by delivering accurate results efficiently.
The GE Revolution Apex CT scanner offers high-definition imaging, fast scan times and advanced capabilities for various clinical applications, including cardiac, stroke and trauma imaging.
It allows radiologists to do a CT workup in less than five minutes and a low radiation chest CT that captures images within one second, important for patients who cannot hold their breath. “The heart’s always moving, causing CT scan images to be blurry,” says Dr. Sean Regner, a cardiologist at FirstHealth Cardiology in Pinehurst. “We can’t exactly stop your heart to take a picture, so the best we can do is slow it down as much as we can, and we aim for 65 beats a minute.”
Moore Regional’s new CT scanner also takes images at set intervals. Artificial intelligence merges them, combing ones from different phases of the heart rate cycle into one version. That creates a 3D image, compared to a 2D X-ray image.
Regner says using CT scanning to detect cardiac disease is a relatively new concept. “Historically, if you wanted to know if you had obstruction in your coronary arteries, you would need a heart catheterization, an invasive procedure, which carries some risk,” he says. “Or you might take a stress test. But with this new CT scan process, we can take a look at your arteries without putting you on a treadmill or risking surgery.”
Keeping Records
New Bern-based CarolinaEast Health System employs a web-based health records system that gives patients access to their health information on demand and in real time“ says Dr. Alex Kirby.
Through CarolinaEast’s MyChart patient portal, patients can view their medical history, test results, medications, vitals and other data via text message, app or website. “Patients can also review their visit notes and request prescription refills any time, even when they are on vacation,” Kirby says.
All healthcare providers using the charting system EPIC can easily exchange patient records, giving providers the ability to coordinate care with clinicians beyond CarolinaEast who also serve their patients and their families. That closes care gaps and reduces duplication. Companion software MyChart aligns patient billing processes to make it easier for patients to pay online. “I believe around three- quarters of the hospitals in the United States are part of the system,” Kirby says. “So, we can easily get patient records from Duke, Chapel Hill and other health systems that are also treating our patients.” ■
— Teri Saylor is a freelance writer in Raleigh.