Appleton Cardiologist First in USA to Use, Teach Alternative to Bypass Surgery

Kahldoon Alaswad, MD, Helps Found Peer-to-Peer Training

Heart bypass surgery. The idea of it strikes fear in the chests of most people who can begin to comprehend the traumatic nature of the surgery and the long, arduous recovery time. That’s why an alternative would offer so much promise and hope.

Now people in east central Wisconsin who suffer from heart disease and the potentially lethal threat of blocked coronary arteries have that exciting alternative to bypass surgery. Kahldoon Alaswad, MD, an interventional cardiologist with Appleton Cardiology since 2007, practices and mentors other cardiologists from around the world on the specialized technique of chronic total occlusion percutaneous coronary intervention or CTO PCI. In layperson’s language, it’s the use of heart catheters to unblock major heart arteries that would normally call for open heart surgery.

While heart catheterization has been around in evolving forms since the 1960s for clearing blockages in peripheral arteries or partial blockages in coronary arteries, only in the last decade have the most innovative cardiologists in Japan, Europe and North America begun to cross 100 percent blocked arteries in the heart catheterization lab instead of sending the patients to open heart surgery. During this CTO technique, known as recanalization, patients are often also equipped with drug-eluding stents to help support and maintain healthy blood flow where the blockage, or lesion, once existed.

 “This option literally changes lives,” Dr. Alaswad explained. “Open heart surgery is a stressful experience with a long recuperation. CTO PCI is a particularly excellent option for patients who have uncontrolled heart disease symptoms despite other medical therapies, or whose weakening of the heart muscle, or cardiomyopathy, poses significant risks to a successful surgical outcome. Research also tells us that the use of drug-eluding stents to keep arteries open is remarkably effective when compared to a surgical bypass that creates an entirely new portion of an artery.”

Dr. Alaswad’s skilled technique for a radial approach to a CTO PCI sets him apart as the only interventional cardiologist in the United States who predominately uses bilateral radial arteries as the entry points for the catheters during CTO PCI. This artery, on the inside of a person’s wrist, is widely believed to significantly lessen the risk of internal bleeding that is inherent in any heart catheterization procedure. Other physicians generally insert the catheter through the femoral artery near the groin. “With the smaller (radial artery), bleeding becomes more obvious, much earlier, and we can address it much more effectively,” he said.

It’s important to understand the CTO PCI procedure does not prevent heart attacks; it relieves the symptoms of a heart attack and improves heart function. Research has also shown improved blood flow that results from a successful CTO PCI can reduce the risk of death from a later heart attack, generally improve heart health, and reduce the occurrence of arrhythmias.

“CTO alone should no longer be an indication for automatically sending a patient into (open heart) surgery,” explained Dr. Alaswad. “The rate of major complications for CTO PCI is the same as traditional PCI for partially blocked arteries, about 1 percent for major complications.”

Improving Access Means Time in Training, Techniques

Dr.  Alaswad and a select group of interventional cardiologists with a special interest in CTO PCI formed CTOFundamentals.org in 2012, a hybrid online and peer-to-peer educational resource for cardiologists and their support staff who want to learn more about this leading-edge technique. Their goal is to train proficient physicians and increase patient access to this dramatic alternative to open heart surgery. Cardiologists begin by listening to lectures and viewing taped procedures. As they progress in their studies, the mentoring physicians travel to their hospitals to accompany them for their first four to five procedures, directing them on the use of the specialized equipment and their technique.

 “We build off of their skills and experience in regular PCI (heart catheterizations), but we change old dogmas,” Dr. Alaswad explained. “For instance, we teach a new retrograde technique where we approach the blockage not only through the main artery that is clogged, but we go backwards from small arteries that branch out from it. It’s coming at a problem from entirely new directions. And that’s what innovation is, isn’t it?”

ThedaCare™ is a community health system consisting of five hospitals: Appleton Medical Center, Theda Clark Medical Center, New London Family Medical Center, Shawano Medical Center, and Riverside Medical Center in Waupaca. ThedaCare also includes ThedaCare Physicians, ThedaCare Behavioral Health, ThedaCare At Work, and ThedaCare at Home. ThedaCare is the largest employer in Northeast Wisconsin with more than 6,175 employees. Follow us on Facebook and Twitter.