BROOKLYN, NY (February 24, 2011) – During the past century, Maimonides Medical Center has built a reputation as one of the nation’s best hospitals for the treatment of heart disease. From pioneering “firsts” that have saved countless lives, to groundbreaking clinical research, Maimonides continues to be a center of innovation in cardiology and cardiothoracic surgery.
“The 100th Anniversary of the founding of Maimonides Medical Center is the perfect time for cardiac experts at Maimonides to review our legendary past,” said Dr. Jacob Shani, Chair of The Cardiac Institute and Director of Cardiology. “We can’t help but be inspired by the stunning achievements in our history.”
Among the most important milestones in cardiac care at Maimonides are: the first successful human heart transplant in the nation in 1967; the NIH sponsored clinical trial of a new class of cardiac medications in 1977, and the first coronary atherectomy in the tri-state region in 1991.
Pioneers in Cardiac Care
The importance of cardiac care was emphasized at Maimonides from its earliest years. In fact, the Trustees established a separate Cardiac Clinic for patients in 1930, when the institution was known as United Israel Zion Hospital. This was the era during which many subspecialties began to emerge in the practice of medicine, and several distinguished physicians at Maimonides were among the nation’s first “cardiologists.”
Dr. Rudolph Nissen became Chair of Surgery in 1945 and encouraged the exploration of new surgical techniques for cardiovascular problems. He was, himself, the leading expert at that time in the repair of aortic aneurysms.
In 1950, Dr. Charles B. Ripstein became the first Chief of Cardiac Surgery at Maimonides. His body of research included groundbreaking work on pericarditis and postcardiotomy syndrome.
Dr. David Dresdale established the Cardiac Catheterization Laboratory 1952, ushering in the new era of Interventional Cardiology – an approach that allowed sophisticated diagnoses to be obtained by threading a catheter into coronary arteries to detect blockages and narrowing of blood vessels.
In 1956, post-heart attack syndrome was identified by and named for Maimonides cardiologist Dr. William Dressler (Dressler Syndrome). And by 1960, Maimonides had established a Residency Program in Cardiology, providing advanced training in this rapidly evolving specialty.
Dr. Adrian Kantrowitz began making medical headlines in 1966 when he performed the first implantation of a partial mechanical heart. The following year he successfully performed the nation’s first heart transplant. Despite the public accolades for these accomplishments, Dr. Kantrowitz often remarked that it was his work with heart assist devices that truly improved and saved the most lives. He developed the world’s first Intra-Aortic Balloon Pump at Maimonides – a device still in use today at hospitals around the globe.
The Modern Era
In 1976, Dr. Edgar Lichstein became Director of Cardiology at Maimonides and helped continue the tradition of expanding the boundaries of medical knowledge. Dr. Lichstein was a chief investigator for the historic BHAT (Beta-blocker Heart Attack Trial) that established the efficacy of a new class of cardiac medications. The public may be familiar with the most commonly prescribed of these drugs by such names as Metoprolol, Inderal and Lopressor.
As the BHAT results were being published in the early 1980’s, Dr. Joseph N. Cunningham became Chief of Cardiothoracic Surgery at Maimonides. After training in several of the best US programs, Dr. Cunningham brought to Maimonides a zeal for innovation coupled with outstanding clinical expertise. He developed a surgical technique that improved the safety of aortic aneurysm repair, and established one of the nation’s most highly regarded training programs for cardiothoracic surgeons.
“During those exciting years at Maimonides, I was here doing my residency,” said Dr. Shani. “Then I left for a fellowship in Interventional Cardiology at Harvard. I was delighted to be recruited back to Maimonides in 1983 to head-up the Cardiac Catheterization Laboratory.”
That very year, Maimonides was designated a 911 Cardiac Center – the only such hospital in the borough. By this time, Interventional Cardiology had evolved beyond a mere diagnostic tool. Skilled experts were exploring ways to remove blockages via catheter, and allow certain patients to avoid open-heart surgery. Dr. Shani, in fact, performed the first coronary atherectomy in the tri-state region in 1991. A year later, a specialized catheter was invented by and named for him – the “Shani Right.” He performed the nation’s first catheterization during a heart attack, stabilizing the patient and minimizing the damaging effects of the attack.
Under Dr. Shani’s leadership, the Cardiac Catheterization Lab at Maimonides became the first in the nation to become filmless, storing sophisticated radiologic images digitally. In 1997, Dr. Shani added a wrist clamp for radial artery catheterization to his list of inventions. And in 2001, the cardiac units at Maimonides became the first in the nation to employ fully-automatic external cardiac defibrillators.
Advances in Interventional Cardiology continued to improve the treatment options for cardiac patients with a variety of conditions. Even troublesome heart arrhythmias became easier to diagnose and treat with the growth of a new interventional subspecialty – ElectroPhysiology (EP). The EP Lab at Maimonides is renowned for its excellence in a number of therapeutic procedures, including: utilizing the technology of implanted pacemakers and defibrillators; performing studies that pinpoint the source of heart malfunctions; and employing laser treatments – or ablations – to eliminate certain types of tachycardia.
Meantime, advances in cardiac surgical techniques began to reduce the risks and complications associated with those major operations. The harvesting of veins for use in bypass surgery became minimally-invasive, eliminating a significant source of post-operative complications. Laparoscopic approaches to heart surgery also became a reality, allowing skilled surgeons to repair hearts without cracking-open the ribcage. “Beating heart surgery” – which eliminates the need for the heart-lung machine – also became a reality and is now available for the correction of certain heart maladies.
According to the current Chief of Cardiothoracic Surgery, Dr. Greg Ribakove, “There are so many safe surgical options today for heart patients. Conditions that once were inoperable can now be surgically corrected. Other patients learn, to their amazement and relief, that they might not need surgery at all.”
Dr. Shani concurred. “The team approach at The Cardiac Institute ensures that each patient is evaluated by multiple specialists, and a treatment plan is established that best meets the individual patient’s needs. Some can be treated with medication and lifestyle changes, some with interventional procedures, and others with sophisticated and minimally-invasive surgical approaches.”
An example of a serious condition that may have multiple treatment options is Atrial Fibrillation. The Maimonides Cardiac Institute created a unique multi-disciplinary Center of Excellence for evaluating and treating this disorder. Cardiologists and Cardiothoracic Surgeons collaborate on the evaluation to ensure that patients receive the treatments best suited to their particular cases.
“The patients are the primary concern,” said Dr. Ribakove. “We rely on evidence-based medicine to create optimal treatment plans. The patient outcomes for cardiac care at Maimonides are outstanding precisely because of this approach.”
The Center for Minimally Invasive Valve Surgery – rare among cardiothoracic centers – routinely performs valve procedures using less invasive, more patient friendly techniques. Many of these techniques were developed or refined by Dr. Ribakove and his colleague, Dr. Gregory Crooke. Along with the established expertise of other cardiac surgeons, the Maimonides Cardiac Institute now has an array of surgical services that rivals the best in the region.
The federal government’s Centers for Medicare and Medicaid Services (CMS) began publishing comparative data on cardiac care four years ago. In its first such “report card” for hospitals, patient outcomes for two diagnoses were rated: heart attack and heart failure. Only a handful of the nation’s 6,000 hospitals received top grades for one or the other category in that report, and only three took top honors in both categories: the Cleveland Clinic, New York Presbyterian – and Maimonides Medical Center. The Cardiac Institute at Maimonides has retained those top scores in each subsequent report.
Today, the Maimonides Cardiac Institute is one of the most comprehensive cardiac centers in the nation, performing more than 10,000 noninvasive procedures; more than 5,000 interventional procedures in the Cath and EP Labs; and 700 heart surgeries each year.
Cardiac Institute Leadership – Cardiologists
Dr. Jacob Shani, Chair, Cardiac Institute and Director, Cardiology
Dr. Edgar Lichstein, Chair, Medicine
Dr. Gerald Hollander, Director, Clinical Cardiology
Dr. Yisachar Greenberg, Director, Electrophysiology
Dr. Robert Frankel, Director, Interventional Cardiology
Dr. Norbert Moskovits, Director, Heart Failure Program
Dr. Alvin Greengart, Director, Non-Invasive Cardiology
Dr. Joshua Kerstein, Associate Director, Clinical Cardiology
Cardiac Institute Leadership – Cardiothoracic Surgeons
Dr. Greg Ribakove, Chief, Cardiothoracic Surgery
Dr. Sunil Abrol
Dr. Gregory Crooke
Dr. Israel Jacobowitz
Dr. Stephen Lahey
Dr. Gary Stephens
Dr. Mikhail Vaynblat
Dr. Igor Brichkov
Dr. Jason Shaw
Cardiovascular disease continues to be the leading cause of death in the United States. According to Dr. Shani, evolving technologies will continue to drive key advancements in diagnosing and treating cardiovascular disease. In addition to its own clinical research initiatives, Maimonides continues to take part in multi-institution medical and surgical studies.
“The field of cardiac medicine is changing rapidly, as we continually discover new technologies and strategies that enable patients to overcome the challenges of coronary disease and live longer, healthier lives,” explained Dr. Shani. “Maimonides is committed to being at the forefront of the effort to develop and implement these advances, all in the name of giving our patients access to the very best care.”
For more information about the Maimonides Cardiac Institute, visit the website at http://www.maimonidesmed.org/CardiacInstitute.
Photo 1: Dr. Adrian Kantrowitz used a heart-lung machine with an improved design by him, at Maimonides Medical Center. In 1959, the machine was put on display in Moscow, Russia, as part of an exhibition demonstrating the success of medicine and public health in the U.S.
Photo 2: Dr. Robert Frankel, Director of Interventional Cardiology (left) and Dr. Jacob Shani, Chair of The Cardiac Institute and Director of Cardiology (right) perform a patient procedure in a state-of-the art Cardiac Catheterization Laboratory at Maimonides Medical Center.