Cardiovascular Business - October/November 2007 - (Page 32) A: this image of a left coronary artery injection taken on the toshiba america Medical systems infinix system reveals an occluded stent which should be supplying flow to the left anterior descending branch of the lCa. also visualized are permanent leads for a pacemaker/defibrillator. B: this raO view of the right coronary artery shows mid-vessel CaD, including branch vessel involvement. Dual guidewires are placed in both the parent vessel and the stenotic branch in order to protect both segments during balloon/stenting. C: an inflated balloon is seen in a proximal right coronary artery during PCi, advanced over a guidewire placed down to the distal aspect of the rCa. A B C Acquaviva, is to maintain or grow other businesses like peripheral vascular procedures or EP work. The equipment mix at PinnacleHealth reflects the changing procedure mix. Two of the hospital’s five cath labs are outfitted with GE Healthcare Innova 3100 digital cardiovascular imaging systems, which can accommodate both peripheral vascular and traditional coronary catheterization procedures. The hospital plans to upgrade a third room to the Innova 3100 by the end of the year. Two EP suites rely on GE Biplane Advantx LCLP and Advantx LC+, and the remaining cardiac cath labs use Advantx LC, enabling flexibility in the changing market. Another ticket to maximum flexibility is a clinical ladder program that crosstrains staff across coronary, peripheral vascular and EP work. The hospital uses a streamlined, proactive approach to handle its large cardiac cath inventory. “We do keep a lot of equipment on hand, particularly new technologies,” says Acquaviva. Consignment is the first option with equipment, and most vendors are accommodating the hospital’s needs. “Sometimes our high volumes allow us to take advantage of special buys and bulk purchases to trim inventory costs,” adds Acquaviva. Other fixes center on education. Two recent research trials have sent mixed messages to patients and primary-care physicians, says Acquaviva. The first advocated medical management over stenting for some treatable blockages. The second questioned the benefits of drug-eluting stents over bare metal stents. Consequently, some patients are putting off elective catheterization, which affects volume. Hospitals need to launch a cohesive educational campaign that explains the drawbacks and benefits of various options, says Acquaviva. Small site, major challenges Johns Hopkins University Bayview Medical Center in Baltimore, Md., houses a single cardiac cath lab and one EP lab and has effectively countered national trends in declining volume cath lab volume. In fact, in the last three years, volumes have increased— particularly this year with the opening of the EP lab. The small site not only contends with typical challenges, but also faces other hurdles. For example, the medical center does not offer an open heart surgical option, so some patients are transferred to The Johns Hopkins Hospital for cardiac cath procedures. The cath labs at the downtown center are equipped with an array of cardiovascular x-ray systems including the Infinix DP-i/FD2 from Toshiba America Medical Systems and can handle both diagnostic and interventional angioplasty procedures. (Current regulations prohibit sites without surgical backup from performing interventional angioplasty.) Despite the challenges, the center has increased cath lab volumes in the last few years. We attribute volume increases to the new EP lab and successful marketing of the service, says Cardiac Cath Lab Manager Martha McDowell. The cath suites at the downtown hospital are taking a slightly different tactic and focusing on growing a peripheral vascular program. The dualplane Toshiba system can readily accommodate the hospital’s fledgling vascular program. Managing the complicated and ever-increasing inventory of stents and catheters presents another challenge. Stent technology changes constantly, and science has not yet embraced bare metal over drug-eluting stents or vice versa, forcing the 32 Cardiovascular Business October/November 2007
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