Elective angioplasty becomes standard procedure at Lawrence + Memorial

New London — Two days after shoveling snow this weekend sent him to his local doctor with chest pains, a local man on Wednesday became the first to undergo elective angioplasty at Lawrence + Memorial Hospital.

"He did great," said Dr. Brian Cambi, the cardiologist who performed the surgery. "He'll be able to go home tomorrow."

Two weeks ago, the patient would have been sent 48 miles west to Yale-New Haven Hospital for the surgery, in which free blood flow is restored by inserting a thin plastic tube and a balloon-tipped catheter into a blocked artery. A Feb. 3 decision by the state Office of Health Care Access allowed L+M to become the first hospital in Connecticut to offer elective angioplasty without also having the in-house capability to perform open heart surgery, a service only available at larger hospitals such as Yale and Hartford Hospital.

"This is personally and professionally rewarding," said Dr. Peter Milstein, chief of cardiology at L+M, who had been working for several years with the hospital and the region's other cardiologists to provide the new service.

Since 2009, about 550 L+M patients have been sent to larger hospitals for elective angioplasty, which is a scheduled procedure typically done within 72 hours of a patient being diagnosed with a blockage. According to projections provided to state regulators, L+M expects to do 73 of the procedures this year, and about 130 or more in each of the next two years. Patients with complications such as other illnesses or particularly challenging blockages still would be sent elsewhere, Cambio said.

Doing the procedure locally, he said, is better for patients and families and reduces the cost of care. The procedure previously was allowed only in hospitals with open-heart capability because of concerns about complications. But angioplasty is no longer a novel procedure, he said, and complication rates have dropped from about 10 percent of all cases to less than 1 percent.

"It is now clear it is safe to offer this procedure at L+M," said Cambio, who will be the lead cardiologist doing the elective angioplasty there. He is medical director of the newly named Lawrence + Memorial Heart and Vascular Center and is an assistant professor at the Yale University School of Medicine.

L+M President and Chief Executive Officer Bruce Cummings announced the new service Wednesday, calling it "a historic day" for the hospital and "kind of a dream come true" both for him and for the hospital's cardiologists.

The new service, he said, is the result of the partnership between Yale and L+M that first brought emergency angioplasty services — done on heart attack patients — to L+M in 2008. More cardiology and vascular surgery services are expected to be added in the future, he said, at the new Heart and Vascular Center in affiliation with Yale.

In its approval of the request, OHCA cited the distance to other hospitals offering the procedure and high rates of heart disease death in New London County in support of its decision. It also noted that the service builds on the emergency angioplasty care currently provided, making use of the same cardiologists, equipment, clinical staff and facilities.

Norwalk Hospital and the Hospital of Central Connecticut, in Southington and New Britain, have applications pending with OHCA to offer elective angioplasty. In January, OHCA rejected a request from Greenwich Hospital to offer the service, citing the availability of the service at Stamford Hospital 5 miles away, among other reasons. OHCA said it would not approve any request for the service that competes with an established program in the same service area.

Dr. Gilead Lancaster, president of the Connecticut Chapter of the American College of Cardiology, said that among key considerations are whether a hospital will have a sufficient volume of patients to ensure high-quality care.

"The quality of the procedure depends on the operator's experience," said Lancaster, who is also director of noninvasive cardiology at the Joel E. Smilow Heart Institute at Bridgeport Hospital and a Yale medical school professor.

He said he believes L+M has met that and other tests, and that the new service will be good both for patients and the hospital, providing it with a new revenue stream and higher status.

"We are very excited about this care being offered in places like L+M," he said.



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