Innovations in Cardiology

Innovations in
Cardiovascular
Care
A “Heart-to-Heart” with Einstein
Sunday | February 9, 2020
FEATURING
Sumeet Mainigi, MD
Raymond Singer, MD
Sean F. Janzer, MD
Alexandra Tuluca, MD
Christian F. Witzke, MD

Meet Sumeet K. Mainigi, MD
How an Operation for Atrial Fibrillation
Changed His Life
Frank Ryan is a 67-year-old retired truck driver,
grandfather of 18 and great-grandfather of 9.
He had been experiencing atrial fibrillation – an
irregular, often rapid heart rhythm that robbed
him of his energy, leaving him weak, lightheaded
and short of breath.
Sumeet K. Mainigi, MD
Chairman of Cardiology and Director of Electrophysiology at Einstein Medical Center
2
He came to Einstein for help. His doctor was Sumeet
Mainigi, MD, Chairman of Cardiology and Director of
Electrophysiology at Einstein Medical Center. Here is
Frank’s story in his own words:
“Dr. Mainigi told me about a revolutionary procedure –
ablation—as a way to treat my atrial fibrillation. He explained
the procedure and made me feel confident that I was the
perfect candidate. I said “no.” But one night watching TV,
I couldn’t focus on the show or relax at all. My heart was
pumping out of my chest. So I decided to do it.
“I woke up after the surgery and knew
something was different. I felt like a
new person. Dr. Mainigi gave me my
life back!”
“I’m stronger than ever. I can breathe
better, sleep deeper, and walk longer
distances. I’m able to sit still and
read, which I couldn’t do comfortably
before. I’m even planning to take my
wife to Ireland next year to celebrate
our 50th wedding anniversary! Having
ablation to repair my rapid heart rate
was the best thing I could have done.
“The folks at Einstein really went
the extra mile. I had the greatest doc
on earth. I wouldn’t send anyone to
another hospital.”
by Einstein Blog Team
Dr. Mainigi is also an Associate Professor of Medicine at Sidney Kimmel Medical College. He has specific expertise in ablation
of atrial fibrillation, ventricular tachycardia, supraventricular tachycardias, and implantation of pacemakers, defibrillators,
and biventricular-devices.
Dr. Mainigi has presented original research at many national and international scientific meetings and has authored numerous
publications, book chapters and review articles in the fields of cardiology and electrophysiology, including a breakthrough catheter
ablation study that has changed the way doctors often treat heart failure. He also serves on several national committees for the
Heart Rhythm Society and American College of Cardiology. He is a well-regarded physician and educator and is the recipient of the
following awards: Top Doc, Philadelphia Magazine, 2011 – 2019; Top Doctor Cardiac Electrophysiology, U.S. News & World Report,
2011 – 2018; Top Doctor Under Age of 40 / The Next Generation of Great Philly Docs 2009, Philadelphia Magazine; Einstein Hospital
Teaching Award, Einstein Department of Medicine Teaching Award, and Einstein Division of Cardiology Teaching Award.
Dr. Mainigi holds a degree in Biomedical Engineering from Johns Hopkins University. He received his medical degree from New York
University (NYU) School of Medicine. He completed his residency in internal medicine, fellowship in cardiology, and fellowship
in electrophysiology at the Hospital of the University of Pennsylvania. Dr. Mainigi is a Fellow of the Heart Rhythm Society, Fellow of
the American College of Cardiology.
Areas of Interest
Atrial Fibrillation/Atrial Flutter, Defibrillators (ICD’s), Pacemakers, Radiofrequency Ablation, Supraventricular Tachycardia, Syncope,
Ventricular Tachycardia

Meet Raymond L. Singer, MD
Raymond L. Singer, MD, was named Chief of
Cardiac Surgery at Einstein Medical Center
Montgomery in March 2019.
Previously, he was Physician in Chief of the Institute
for Special Surgery at Lehigh Valley Hospital, where he
spent 27 years and performed more than 7,000 surgeries.
Dr. Singer is a fellow of the American College of Surgeons,
the Society of Thoracic Surgery, the American College of
Cardiology, and the American College of Chest Physicians
and a past president of the Pennsylvania Association for
Thoracic Surgery.
Q: How did you decide to become a doctor?
A: Ever since I was young, I wanted to be a physician.
In fact, there are reels of silent 8-millimeter movies
from the 1960s showing me with my play doctor’s kit,
examining everyone in the family.
Q: What drew you to your specialty?
A: Originally, I was interested in being a family physician.
I guess I was influenced by some of the TV shows of
the late 1960s. I had applied to the brand-new medical
school in Hershey because there was a newspaper
article in the Philadelphia Bulletin saying they were
going to be creating country docs. I just pictured
I would live in the country and get a big dog.
I got accepted at Hershey and then, lo and behold,
I got accepted to the University of Pennsylvania.
They didn’t really have a family practice track. Next
thing I know I was hanging out with surgeons and
found it very exhilarating to be able to intervene in
somebody’s life in such a dramatic fashion, particularly
with heart surgery. And so sometimes I think of myself
as being a family doctor on the inside and a surgeon
on the outside.
Q: Where did you receive your training?
A: When I finished medical school, I did my training in
general surgery and cardiothoracic surgery at Thomas
Jefferson University Hospital. That was eight years:
five years in general surgery and three years in cardiac
surgery. I did additional training in Paris with Dr. Alain
Carpentier to learn advanced techniques in mitral valve
repair surgery, as well as in Belgium with Dr. Hugo
Vanermen and in London under Dr. Magdi Yocoub.
Q: You’re a cardiothoracic surgeon. In layman’s terms,
what does that mean? What kind of conditions do
you treat?
A: We are trained to do heart and lung surgery. In fact,
I started a website in 1999 called heartlungdoc.com.
At Einstein Montgomery, my focus is heart surgery.
With heart surgery, we deal with heart valve disease
and coronary artery disease primarily. We also perform
complex aortic aneurysm surgery.
In addition to the conventional valve and bypass
procedures, we also perform less invasive procedures,
ranging from small incision “keyhole” operations using
telescopes, to trans-catheter procedures to repair and/
or replace faulty aortic and mitral valves. It’s exciting
to work at Einstein because of the collaborative efforts
of the cardiologists and surgeons, working together
to get our patients back to their normal lives as soon
as possible.
Q: Can you explain a little bit about the transcatheter
aortic valve replacement procedure, or TAVR?
A: Currently, the TAVR procedure is used for aortic
stenosis, which means that the patient’s aortic
valve is restricted from opening, typically due to the
development of calcium deposits on the valve. In the
TAVR procedure, we do not open the chest and we
do not use the heart-lung machine. We don’t stop the
heart. We’re able to do about 90% of them just from
catheters in the groin, like a cardiac catheterization
procedure. Using x-ray guidance, we can place a new
valve inside the patient’s own valve, pushing aside the
calcium deposits with a stent. Most patients can go
home in just a day or two after a TAVR procedure.
Q: Can anyone with aortic stenosis get the valve
replaced with the TAVR procedure instead of
open-heart surgery?
A: In order to have a TAVR, you need to be either
high risk or what they call intermediate risk patients.
I was among the first in the country to do the TAVR
procedure in 2012, and I was a principal investigator for
what is known as the low-risk TAVR trial. We anticipate
this spring or summer that the FDA will approve this
technology for patients who are low risk.
(continued on next page)
The Sumeet K. Mainigi, MD article on page 2 appeared in Einstein Healthcare Network’s Perspectives blog.
To access the blog and more information about network services, please visit www.einstein.edu.
3

Q: You came to Einstein recently from Lehigh Valley
Hospital. What drew you here?
A: I grew up down here. I went to Cheltenham High
School and my wife went to Plymouth-Whitemarsh. So,
this is home for us. Einstein is an extraordinary place
with excellent care. I’m particularly drawn to Einstein
Montgomery, where there is a feeling of warmth and
caring, along with state-of-the-art technology and highly
trained and experienced doctors and nurses. I feel
that Einstein Montgomery is a real gem and I’m thrilled
to be home and to be able to make a difference in that
community where I grew up. My dream is that in only a
short time, the good people of our community will ask a
simple question, “Why would I go anywhere else for my
care than Einstein Montgomery?”
Q: Do you have a favorite book?
A: I’ve always enjoyed reading Dr. Wayne Dyer’s books
and listening to his lectures on health and wellness.
Two additional books that have great meaning to me
are Tom Brokaw’s The Greatest Generation and Mitch
Albom’s Have a Little Faith.
Q: Favorite hobby?
A: My favorite hobby is playing piano and singing. I’ve
played the piano since I was very young, and I’ve
enjoyed theater and playing keyboard and singing
in bands. My favorite role in a play was Don Quixote
in The Man of La Mancha. I also helped pay my way
through college and medical school by working as a
disc jockey.
Q: Favorite movie?
A: No doubt, it’s Field of Dreams. For one thing, it was the
first date I had with my wife, and I’m also a big baseball
fan. I can remember my father taking me to Connie
Mack Stadium as a boy. My two daughters now love
going to Phillies games with me.
Q: What is something that people might not know
about you?
A: I’ve often said I come from a family of patients, not a
family of doctors. Both my parents worked so hard to
give me the opportunities in life that they never enjoyed.
They survived the Great Depression and World
War II. Both my parents had cancer and heart disease.
I’ve sat in many doctors’ offices and surgical waiting
rooms, praying for their recovery. I know what it feels
like to be on the other side, so I try my best to always
treat my patients and my colleagues as if they were my
own family.
by Lisa Ellis for Einstein Perspectives
Raymond Singer, MD
Chief of Cardiac Surgery at Einstein Medical Center Montgomery
As a board-certified cardiothoracic surgeon, Dr. Singer has
completed more than 7,000 heart and lung operations since
completing his general surgery and cardiothoracic residencies
at Thomas Jefferson University Hospital.
Dr. Singer received his medical degree from the University of
Pennsylvania School of Medicine and a Master’s in Medical
Management from Carnegie Mellon University at the H. John
Heinz III School of Public Policy and Management. He is a
past-president of the Pennsylvania Association for Thoracic
Surgery and is a nationally known healthcare leader. Dr. Singer
has a passion for surgical excellence and is recognized for his
quality outcomes and personalized care.
He is a member of the American College of Surgeons,
American College of Cardiology, American College of Chest
Physicians, American College of Physician Executives and
Society of Thoracic Surgeons.
Originally appeared in Einstein Healthcare Network’s
Perspectives blog. To access the blog and more information
about network services, please visit www.einstein.edu.
4

Meet Sean F. Janzer, MD
Patient Comes From New Zealand for
Procedures to Boost Blood Flow in Legs
In some ways, Simon Willis Webb is a typical
patient of Dr. Sean Janzer – he sought treatment
for painful blocked arteries in his legs that forced
him to curtail his activities.
In some ways, though, Webb is anything but typical – he
came from New Zealand to see Dr. Janzer, an interventional
cardiologist at Einstein Medical Center Philadelphia.
Webb is a successful entrepreneur in his 60s who lives in
the North Island of New Zealand, in Hamilton, and loves
spending time outdoors. But he was struggling to ski, bike
and hike because the major arteries in both of his legs
were clogged.
Peripheral artery disease is a progressive disease that
is the result of plaque buildup in the arteries that supply
blood to the limbs. It affects up to 8.5 million people in
the United States alone.
In New Zealand, Webb had undergone angioplasty, in
which balloons were used to open his femoral arteries,
the main vessels that supply blood to the legs. But that
procedure was unsuccessful.
He continued to exercise to help develop peripheral blood
vessels in his legs to improve circulation. “I worked very
hard at keeping my legs fit and strong,” he says. “I did this
by walking every day as well as riding my bike and skiing as
often as possible. But these activities with blocked arteries
took a lot of effort and a certain amount of suffering.”
One day, while Webb was searching the internet for a better
solution to his health problem, he discovered a technique
called the Avinger Pantheris Lumivascular Atherectomy.
(continued on next page)
5

This form of atherectomy, in which a catheter with a sharp
blade is used to remove plaque from a blood vessel,
wasn’t available in New Zealand. The procedure allows
the surgeon to see inside the artery through a camera,
so that the extraction of the plaque can be more precise.
Webb eventually found a video of Dr. Janzer performing
the procedure. “I already liked the sound of Dr. Janzer
and respected his skill and abilities from his video presentation,”
he says. “After checking his profile on several sites,
I could see that he was greatly respected by his peers and
his patients alike.”
Dr. Janzer has been the primary investigator on research
projects of the devices and trains other physicians on
how to use them. When Webb contacted him and sent
diagnostic studies of his legs, Dr. Janzer gave him hope.
“I said I could do something,” Webb says.
Webb flew to the United States in November in the
company of his son to undergo the first procedure on his
left leg. The improvement was immediate. “I now have a
strong pulse in my foot, which could not be felt prior to
surgery,” he said at the time. “My left leg is way better
than it was.”
Webb and his son then flew to Florida to go sightseeing.
It was his first trip to the United States for medical reasons,
but his third as a tourist. “We loved Miami and its sunshine,”
he says, “but we both believe Philadelphia has way more
character and genuineness. We love its history and friendly
people.”
Then Webb returned to Einstein for the procedure on his
right leg on December 5 and soon returned home. “His
second procedure went well,” Dr. Janzer says. The doctor
and the patient have become friends, and Dr. Janzer is
planning to visit Webb in New Zealand in the next year.
“I wondered at times if I should be doing this,” Webb says
of his trip across the ocean for treatment at Einstein. “But
I just love to be physical and believed that improvement
would be worth it. The surgeries have given me a better
quality of life and made me feel happier about my life.
“I cannot speak highly enough of the people at Einstein,”
he says. “They have welcomed me with open arms and
made sure that my every comfort and need has been met.
They are extremely professional, and I would recommend
them to anyone who asked.”
by Jill Porter for Einstein Perspectives
Originally appeared in Einstein Healthcare Network’s Perspectives
blog. To access the blog and more information about network
services, please visit www.einstein.edu.
Sean F. Janzer, MD
Program Director, Interventional Cardiology Fellowship
Einstein Medical Center Philadelphia
Dr. Sean Janzer is an interventional cardiologist with nearly thirty
years of experience. He completed his medical degree at Drexel
University (then known as Hahnemann Medical College) and internal
medicine internship and residency at Drexel University Hospital
(formerly Hahnemann University Hospital). It was there where he also
completed his fellowship in cardiology and interventional cardiology.
He is board certified by the American Board of Internal Medicine
and Subspecialty Board of Cardiovascular Disease and Interventional
Cardiology and is an Endovascular Diplomat of the
American Board of Vascular Medicine. He has lectured, written and
published nationally and internationally in his area of expertise
which includes advanced, minimally invasive treatments for heart
and vascular conditions, including Peripheral Artery Disease (PAD),
Critical Limb Ischemia, and coronary artery Chronic Total Occlusions
(CTO) and the latest treatments for Peripheral Artery Disease (PAD).
As an educator and Director of Einstein’s Cardiology Fellowship,
he is training the next generation of interventional cardiologists.
As Principal Investigator for national research studies, he is leading
the way in defining the best treatment protocols to improve outcomes
for cardiac patients. He is recipient of numerous professional
accolades including being named a Philadelphia Magazine
“Top Doc” on multiple occasions and a six-year consecutive run
as a “top doc” by U.S. News & World Report and Castle Connolly.
Areas of Interest
Cardiac Catheterization, Cardiovascular Diseases,
Chronic Total Occlusions
6

Meet Alexandra Tuluca, MD
Alexandra Tuluca, MD, the Associate
Chief of Cardiac Surgery, is a busy
attending cardiothoracic surgeon for
Einstein Healthcare Network.
She is one of only a handful of female heart surgeons in
the country and is a recent recipient of a “40 under 40”
award by the Pennsylvania Medical Society. Her interests
include minimally invasive cardiac surgery, the treatment
of aortic disease, and endovascular surgery.
We sat down with her recently to talk about her career,
discovering some of the steps along the way that led to
her time and clinical interests at Einstein.
Q: You’re a cardiothoracic surgeon. In layman’s terms,
what does that mean? What kind of conditions do
you treat?
A: In layman’s terms it means I’m a heart surgeon.
I perform procedures that relate to the heart, such
as coronary artery bypass surgery, valve repair or
replacement, and aortic aneurysm surgery. Of course,
within each of those categories there are further
subtleties. In heart valves, for example, there’s
minimally invasive valve work that can be done
through “mini-incisions” as well as percutaneously.
Specifically, I perform a percutaneous treatment
called TAVR (transcatheter aortic valve replacement)
in high volume here at Einstein.
Q: In a lot of ways, some of that really seems new,
compared to how it was done in the past.
A: Yes, cardiac surgery as a field is rapidly evolving.
I think the traditional thinking about heart surgery is
that all the patients that get surgery are incredibly sick
and stay in the hospital for weeks or even months.
That’s really not the case and is largely a thing of the
past. Many times, heart surgery is actually quite safe.
I would say our success rates are very high. Patients
go home, on average, between four and five days after
surgery. We have also made a lot of advances in the
minimally-invasive realm. At Einstein, we probably do
a lot more minimally-invasive surgery for isolated valve
and bypass procedures than other places in the city.
Not everyone can do it.
Q: What drew you to your specialty?
A: I have wanted to be a surgeon, literally, since I was
about 4 years old. My grandfather was a surgeon in
a small town. He was surgeon-in-chief at one of the
two major hospitals.
I still remember specifically how my grandfather
affected the lives of his patients. As an example,
I remember how we would walk down the street and
people would just stop him and say, “Oh, Dr. Tuluca,
do you remember me? You operated on me and saved
my life!” All of those types of memories just resonate
with me. I always remember them and have not veered
from that. I think my entire life I just wanted to be a
surgeon as I was so inspired by my grandfather.
During my second year of surgery residency,
I remember seeing a complex heart operation and that
was it. I remember saying to myself, “This is what I’m
going to do.” Fast forward years later and I am doing
what I love.
Heart surgery is a very exciting field. We’ve made a
lot of progress in short amount of time. When you put
things in perspective, the field of cardiac surgery itself
didn’t truly start until the 1950s. That means it has
been less than 100 years since we’ve been doing
such complex procedures, even globally! So, to go
from not even having a heart-lung machine at the very
beginning to now doing many operations through
smaller incisions or through catheter and wire-based
percutaneous procedures, it surely is a field that is
constantly evolving.
There’s definitely a technical aspect of these
surgeries that I enjoy, but what is most satisfying for
me is to make such a difference in patients’ quality
of life. I have patients who see me prior to surgery all
the time who are just miserable. They have chest pain
or they haven’t been able to go up a flight of stairs.
They just aren’t able to live their life to the fullest, and
then you do a surgery, guide them safely through,
and often immediately after they say they can breathe
better, feel better, and have more energy. It’s just
incredibly rewarding.
(continued on next page)
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Q: What drew you to Einstein?
A: I trained at Temple University for general surgery. I was
raised in New Jersey, and went to medical school in
New Jersey, so I’ve been in this area for a while. My
husband, Jay Simhan, also works for Einstein as a
surgeon in the Urology department; we both were
recruited to Einstein at the same time. Although we
were recruited nationally to various cities, we always
loved Philadelphia and loved the mission of Einstein.
It just worked out that we both found positions that
we felt would satisfy what we wanted.
Q: What are your clinical interests?
A: I like to focus my practice on aortic surgery in particular.
This includes minimally-invasive aortic valves,
transcatheter aortic valves, aortic roots, aortic aneurysms,
and endovascular aortic surgery. I am one of
the few surgeons in the region with specific training in
aortic conditions and I have a fair amount of experience
performing surgeries within this subspecialty.
Q: So you perform procedures at Einstein Medical
Center Montgomery, and you’re also at Einstein
Medical Center Philadelphia?
A: Yes. This week, I operated at Einstein Philadelphia
on Tuesday and Wednesday, and then I operated at
Einstein Montgomery on Monday and Thursday.
Q: Do you have a favorite book, or books?
A: I like science fiction. Any sort of sci-fi type book,
dystopian, post-apocalyptic, any Isaac Asimov book,
HG Wells, any old-school sci-fi book, I’ve read it, and
loved it.
Q: Favorite movie?
A: Star Wars. Really, the old Star Wars. We’re going to
skip the three episodes (Episodes I, II, and III) that
were totally awful, and then the new Star Wars.
I also really, really like the Marvel Universe movies.
I could just watch those movies, when they’re on TV.
Just turn the TV on, “Oh! Captain America!”
Originally appeared in Einstein Healthcare Network’s
Perspectives blog. To access the blog and more information
about network services, please visit www.einstein.edu.
Q: What is there about you that people might not know?
A: Many people don’t know this, but I was born in
Romania. I came to the United States as a teenager
at the start of my high school education in this
country. Moving here basically uprooted my entire
life in Romania, I came here with my dad to live the
American dream.
by Jeff Meade for Einstein Perspectives
Heart Disease Is as American as Apple Pie*
Heart disease continues to rise in the U.S. Heart surgeon
Dr. Alexandra Tuluca, Associate Chief of Cardiac Surgery
at Einstein Healthcare Network, explains how the American
lifestyle contributes to this public health concern.
Q: Are men at higher risk of heart disease than women?
A: A lot of traditional research studies investigating the
effects of heart disease largely included male patients
only. Since female patients were not often included with
equal representation in these older studies, there was
a misconception by many that women don’t get heart
disease and that is categorically not true. As one of
only a few female heart surgeons in this country, I see
plenty of women with this condition. One in five women
in this country dies of heart disease.
Q: You were born in Romania where your grandfather
was also a surgeon. Did that influence your desire
to become a surgeon?
A: Definitely. For as long as I can remember I’ve always
wanted to be a doctor. Growing up, I was very close
with him and he was a well-regarded surgeon in his
community in Romania. I am living the American
dream: I moved here as a young teenager, worked
hard, and after medical school, I became greatly
interested in cardiac surgery, following in the footsteps
of my grandfather.
Q: Has technology changed how you perform surgery
since the beginning of your career?
A: I’ve seen a shift toward minimally invasive procedures.
For example, nowadays, I routinely perform catheterbased
procedures that can be done without making
an incision in the chest and repair heart valves.
Heart surgery didn’t establish itself until the late
1950s, and we’ve made exponential progress in not
only the surgeries, but also the recovery process and
reducing risks.
8

Q: Is heart disease on the rise globally?
A: Globally, in comparable countries to the U.S., deaths
from heart disease are on the decline. However, in
the U.S., deaths from heart disease are on the rise.
Diet – mostly portion sizes – is a huge contributor to
this problem along with obesity and inactivity. France
and Japan, for example, have one of the lowest rates
of heart disease because part of the culture involves
a lot of physical activity during the day there, but it
surprisingly might not include going to the gym;
it’s walking to work or the store. Americans drive
everywhere, and activity isn’t built into our routine.
I also think our lives are a lot more stressful – stress
contributes to heart health.
Q: In addition to taking medication, how can patients
improve their heart health?
A: Increasing activity, practicing portion control and
de-stressing are the biggest things. Incorporating
some form of physical activity or exercise into the
daily routine; 30-40 minutes, 4-5 days a week of just
walking. It’s a part of our daily routine that’s missing
and is what probably needs to change. People underestimate
the value of very basic physical activity
because they think they must get a gym membership
and start working out, but it’s even simpler than that.
An effort at even basic physical activity improves
cardiovascular health and importantly reduces stress.
* This article first appeared in Philadelphia Magazine’s
2020 Go Red for Women special edition.
Alexandra Tuluca, MD
Associate Chief of Cardiac Surgery for
Einstein Healthcare Network
Dr. Alexandra Tuluca graduated summa cum laude with Honors
from Fairleigh Dickinson University, and received her medical
degree at Robert Wood Johnson Medical School in New Jersey
where she was inducted into the Alpha Omega Alpha medical
society for academic excellence. She subsequently completed
her general surgery training at Temple University Hospital
in Philadelphia, Pennsylvania and went on to complete
her fellowship in cardiothoracic surgery at the Texas Heart
Institute/Baylor College of Medicine in Houston, Texas.
Dr. Tuluca is dual-board-certified in thoracic surgery and
general surgery by the American Board of Thoracic Surgery.
She specializes in minimally invasive valve, coronary bypass
and aortic aneurysm heart surgery. In addition, she performs
complex re-operative valvular surgery and adult congenital
surgery. She was recognized by the Pennsylvania Medical
Society as a Pennsylvania Top Physician Under 40 in 2016.
She is an active member of the Society of Thoracic Surgeons,
Women in Thoracic Surgery, and a fellow of the American
College of Surgeons.
9

Meet Christian F. Witzke, MD
Dr. Witzke is Director of the Structural Heart
Disease Program and Director of the Latin-
American Cardiovascular Program at Einstein
Medical Center Philadelphia.
Dr. Witzke has a special interest in the field of structural
heart disease. He focuses on percutaneous
closure of heart defects, paravalvular leaks and
management of various valvular heart diseases,
including aortic stenosis and mitral valve disease.
Dr. Witzke is a leading implanter of percutaneous
aortic valve prosthesis – also known as TAVR –
in patients with aortic stenosis. He also helped
develop the Cardiogenic Shock Program at Einstein.
MitraClip Repairs Leaking Valve When
Surgery’s Not an Option
Last spring, Thomas McCabe’s long history of
heart problems had left him almost confined to his
Conshohocken home.
“I couldn’t walk very far,” says McCabe, 68. “With a set
of eight or nine steps, when I’d get to the top I’d have
to stop for a couple of minutes. I was afraid to drive.
I couldn’t last long in a food store, maybe about 10 or
15 minutes. It was really getting annoying.”
But a procedure in April at Einstein Medical Center
Philadelphia fixed the heart-valve problem that was
causing his symptoms – without surgery. He was
discharged the next day.
“I do believe that if it wasn’t for Einstein, I wouldn’t
be here today,” he says.
MitraClip – A New Option
McCabe was one of the first patients at Einstein to receive
a device called a MitraClip to correct a backflow of blood
through the heart’s mitral valve, called mitral regurgitation.
Usually the valve is repaired with open heart surgery,
but the MitraClip can be used to help people who are
too sick for surgery.
Einstein Philadelphia began offering the procedure in the
spring of 2019. McCabe was “one of our first patients and
he just did amazingly well,” says Christian Witzke, MD, an
interventional cardiologist who performed the procedure
along with cardiothoracic surgeon Alexandra Tuluca, MD.
“So, it’s more encouraging to the next patient,” Dr. Witzke
says. “The bottom line is that it’s an amazing technology.”
Dr. Witzke estimated that 30% of Einstein’s patients
with mitral regurgitation are too sick for surgery. So far,
18 of them have received the MitraClip procedure. He’s
expecting to double that by the end of the year.
“Most of our patients have been discharged the next day,”
he says. “And they all come back into the office feeling
so well, more energetic and less out of breath. It’s a very
successful procedure with low risk for complications,
including minimal risk of excess bleeding. We’re very
happy to have this treatment option.”
How Regurgitation Happens
The mitral valve regulates the flow of blood coming back
into the heart from the lungs. The valve sits between the
left atrium, one of the heart’s upper chambers, and the
left ventricle below it. The valve’s two flaps open to allow
blood to flow into the left ventricle, the main pumping
chamber. Then the flaps close to prevent blood from
flowing backwards.
Mitral regurgitation occurs when the flaps don’t close
completely. As a result, some of the blood flows backwards
into the left atrium. The condition can be caused by
a variety of problems with the heart. Regurgitation can lead
to shortness of breath, fatigue, an irregular heart rhythm
and even heart failure.
The MitraClip looks like a little clothespin made of fabriccovered
metal. The clip is attached to a long, thin tube
called a catheter that the doctor inserts through a vein in
the groin and then guides into place in the heart. It’s used
to fasten the two flaps of the valve together in the middle,
tightening the opening and reducing regurgitation.
Because there’s no need to open the chest or stop the
heart, the MitraClip procedure reduces risk for a patient
like McCabe, who has extensive heart conditions that
place him at a high risk for valve surgery. McCabe believes
most of his health problems were caused by alcohol.
He quit drinking in 2003 after his first heart attack.
MitraClip is a trademark of Abbott or its related companies. Abbott, © 2019. All rights reserved.
10

Earlier Valve Problem
McCabe first came to Einstein through the Emergency
Department, where a doctor diagnosed a problem with
his heart’s tricuspid valve. In 2016, he had a procedure at
Einstein called ring annuloplasty. This surgery tightens the
heart’s tricuspid valve by putting a plastic or metal ring
around it.
The ring helped McCabe to breathe better and gave him
more energy, but the recovery was tough, Dr. Witzke said.
“He had a long hospitalization and a difficult post-surgical
recovery.”
When McCabe later developed mitral valve regurgitation,
he didn’t want another heart surgery. The MitraClip
seemed like the best option.
Dr. Witzke says he and Dr. Tuluca perform these procedures
together because each of them has a different
expertise. “I understand ultrasound and X-rays and
catheters; that’s my niche. But she sees mitral valves
anatomically more than I do because she’s in the OR
and knows how the anatomy should be. So I think our
skills blend together.”
Another important doctor on the team is Gregg Pressman,
MD, a cardiologist who specializes in reading the ultrasound
images provided by an echocardiogram to guide
heart procedures.
McCabe still remembers waking up after the MitraClip
procedure. “Dr. Tuluca was standing there. She got me
up out of bed that afternoon, the second day. I wasn’t in
the mood to do that. But she made me walk all the way
down to one end of the hallway and all the way back.
She wanted to know what I felt like. I felt pretty good.”
When he went home later that day, “I was afraid to do a
lot because I wasn’t used to doing a lot. But then I started
taking some short walks, and then the walks got longer.”
Now McCabe says he’s back to a more normal routine.
“I feel 100% better.”
by Lisa Ellis for Einstein Perspectives
Originally appeared in Einstein Healthcare Network’s
Perspectives blog. To access the blog and more information
about network services, please visit www.einstein.edu.
Christian F. Witzke, MD
Director of the Structural Heart Disease Program and
Director of the Latin-American Cardiovascular Program
Einstein Medical Center Philadelphia
Dr. Witzke completed his Internal Medicine residency and Cardiovascular
Medicine fellowship training at Einstein Medical Center.
He then completed two-year training in Interventional Cardiology
and Structural Heart Disease at the Massachusetts General
Hospital (MGH), Harvard Medical School. At MGH, Dr. Witzke
became competent in the performance of coronary intervention
and mastered the management of extremely ill cardiac patients
that required high-risk percutaneous procedures.
Dr. Witzke has a special interest in the growing field of Structural
Heart Disease. During his last years of training, he became
specialized in the management of valvular and structural heart
disease. He is proficient in the art of percutaneous closure of
heart defects, paravalvular leaks and management of various
valvular heart diseases, including aortic stenosis and mitral
valve disease and is the leading implanter of percutaneous aortic
valve prosthesis – also known as TAVR – in patients with aortic
stenosis. He also helped develop the Cardiogenic Shock Program
at Einstein Health Network. He has published in numerous
journals and has participated in international meetings as
an expert in the field of Structural and Valvular Heart Disease.
Areas of Interest
Adult Congenital Heart Disease, Adult Structural Heart Disease,
Cardiac Catheterization, Cardiovascular Diseases, Valvular
Heart Disease
11

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Phone: 215-456-7200
PrushanC@einstein.edu
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