Transforming Cardiac Care

Cardiac catheterization is a common way to diagnose and treat heart conditions. A procedure that involves passing a catheter—a thin, flexible tube— through the vessels supplying blood to the heart, it’s a highly effective way for doctors to assess the heart’s function. But the way the procedure has traditionally been approached has its downsides.

“For years, cardiac catheterization has primarily been performed through a blood vessel in the groin known as the femoral artery,” says John Wang, MD, an interventional cardiologist and chief of the Cardiac Catheterization Lab at MedStar Heart & Vascular Institute at MedStar Union Memorial Hospital. “Afterward, patients must lie flat for six to eight hours to avoid the risk of significant bleeding and other complications. This can be very uncomfortable, especially for those who have back issues, congestive heart failure, or respiratory problems.”

A Less Invasive Alternative

Now, there is another option and Dr. Wang and his team are among those leading the charge to make it more accessible. “For many patients, cardiac catheterization can be performed through the radial artery in the wrist instead of using an artery in the groin,” Dr. Wang explains. “Called transradial catheterization, it results in virtually no post-procedure bleeding and the risk of major vascular complications is almost zero. That means fewer additional tests, treatments, or hospital stays.”

Perhaps the most important benefit, he notes, is the enormous increase in patient satisfaction using the transradial method when compared to traditional femoral artery catheterization. “There is a dramatic improvement in comfort, convenience, and recovery time for patients.”

David Neutze, a patient of Dr. Wang’s who has experienced both approaches to catheterization, concurs. “I had a femoral catheterization in 2012 before a bypass graft, and the recovery was worse than the procedure itself. I couldn’t do anything for several hours.”

Then, last year, the 63-year-old, who has a family history of heart disease, had a mini-stroke. He was referred to Dr. Wang for a cardiac catheterization to make sure there were no blockages. This time it was performed through the wrist. “Having it done through the wrist was so much better. The recovery process was much easier, and I was moving around and doing normal things within the hour,” he says.

Today, the interventional cardiologists at MedStar Union Memorial perform almost 90 percent of cardiac catheterizations radially and have taken the concept a step further by creating a radial recovery lounge, the first and only one of its kind in Baltimore.

A Unique Recovery Experience

Created exclusively for patients recovering after the radial catheterization procedure, the radial lounge differs from traditional recovery rooms in that it is intentionally designed to depart from a clinical environment by offering the patient a less stressful atmosphere. Here, they can relax in recliners, have something to eat, or watch television. Patients are not restricted to complete bed rest.

That’s where Neutze recovered after his second procedure. “The radial lounge was great. It has recliner chairs and a refrigerator stocked with food and drinks, which was nice because I had to fast before the procedure. My wife was able to join me and there is a large seating area for visitors in front of a big-screen TV,” he notes. “Once they took my IV out, I could get up and walk around. The nurse who cared for me was wonderful and I felt much more relaxed. It was very comfortable.”

Transradial access is slowly gaining ground in the United States. Currently, about 30 to 40 percent of catheterizations are performed using the radial artery, but more and more physicians are becoming enthusiastic practitioners.

“Some physicians have been less likely to embrace this approach because of the learning curve,” Dr. Wang notes. “But as cardiology programs train new doctors to use the transradial approach, I see it becoming the default for cardiac catheterization. Patients are already seeking out physicians who will do this procedure, and the demand is only going to increase.”

Most patients can undergo a transradial catheterization through the wrist without concern. However, due to prior surgeries or injuries, some patients may have inadequate blood supply to the hand. For this reason, every patient is thoroughly evaluated to first determine their eligibility. If the patient’s condition indicates a need for a stent, this can be done through the wrist as well.

“After a transradial procedure, patients stay in the radial lounge for a few hours in order for the nurses to monitor their vital signs and then they are headed home,” says Dr. Wang, who performs more than 1,000 cardiac catheterizations per year.

“I really see this as the future of cardiac care, not just as an alternative access route for cardiac catheterization, but also to improve the patient experience and reduce hospital stays,” Dr. Wang adds.

Less than a week after his last procedure, Neutze was back at the bowling alley competing in his Wednesday night league. The only evidence that he even underwent the catheterization is a small mark on his wrist. He’s thankful that MedStar Union Memorial offers the alternative approach and made recovery even better with the radial lounge. “It’s a whole lot easier,” he affirms. “It’s definitely the way to go.”

To make an appointment with a specialist at MedStar Heart & Vascular Institute at MedStar Union Memorial Hospital, call 877-74-HEART (877-744-3278).

This article appeared in the winter 2018 issue of Destination: Good Health. Read more articles from this issue.