The only hospital in New York top-rated for both angioplasty and heart surgery
Dr. Greg Ribakove, Chief of Cardiothoracic Surgery and Vice Chair of Surgery at Maimonides Medical Center in Brooklyn, New York, has been at the forefront of research and development of minimally invasive heart surgery and has published extensively throughout his career. Before Maimonides, he held a series of prestigious positions, including attending surgeon at NYU Medical Center, Director of Surgical Intensive Care, NYU Medical Center; Chief of the Division of Cardiac Surgery, Bellevue Hospital Center, New York; and Vice Chairman of the Department of Cardiothoracic Surgery, NYU Medical Center. A fellow of the American College of Surgeons, he is also a member of the Society of Thoracic Surgery (STS), the New York Society of Thoracic Surgery (NYSTS), the Andrew G. Morrow Society of Cardiovascular Surgeons, the Spencer Surgical Society, the Society of Critical Care Medicine and the International Society of Heart & Lung Transplantation.
The Maimonides Heart & Vascular Institute has been rated one of the top cardiac health institutions in the country. We asked Dr. Ribakove about the Institute and its achievements, as well as his own background.
Why did you choose cardiothoracic surgery and what led you to Maimonides Medical Center?
I chose to become a cardiothoracic surgeon because the heart is an amazing and powerful organ. I was fascinated by the notion that the average person’s heart beats 36,500,000 times a year or billions of times in a lifetime, and I wanted to be able to fix it when something went wrong.
Maimonides is a very important hospital to me. I chose to come to Maimonides because it’s the last bastion of tertiary care in Brooklyn—the kind of complex and advanced care that is increasingly needed in an aging population. It’s a borough with three million people, but few options for excellence in care. I was also inspired by the hospital’s great history of cardiac services, such as having performed the first heart transplant in the United States, and having developed and utilized the world’s first intra-aortic balloon pump—right here at Maimonides. Coming to Maimonides was also a chance to further reinvigorate the Maimonides Heart & Vascular Institute by developing new programs, which we’ve successfully accomplished.
Maimonides Heart & Vascular Institute performs the most advanced groundbreaking surgeries and has some of the best ratings both in New York and nationally.
Tell us about those achievements.
The New York State Department of Health published its annual reports on patient outcomes for angioplasty and adult cardiac surgery in June of 2017. As New Yorkers have come to expect, the news for the Maimonides Heart & Vascular Institute is once again outstanding.
In fact, Maimonides is the only hospital in the state to have both its cardiac surgery and its angioplasty programs commended for significantly low mortality rates by the New York State Department of Health. The report shows mortality rates for angioplasty in three categories: emergency cases, non-emergency cases and all cases. Maimonides is the only hospital in the state to achieve significantly low rates in all three categories of angioplasty for the three-year period reported.
The Adult Cardiac Surgery Report shows mortality rates for CABG (or heart bypass) surgery and valve surgery. The team of cardiac surgeons at Maimonides was among five teams state-wide that achieved significantly low mortality rates—and the cardiac surgeons at Maimonides achieved mortality rates lower than any program in Manhattan.
In addition to the accolades mentioned above, our angioplasty program is one of seven in the state to achieve noteworthy re-admission rates—and the lowest re-admission rate in New York City. This refers to whether a patient has complications within 30 days of the original procedure and must return to the hospital for further care.
These days, cardiac surgery is more commonly performed by applying minimally-invasive approaches without the need to cut the chest open. The heart surgeons at Maimonides specialize in these minimally-invasive approaches to surgery, and have pioneered many of the techniques that are now considered best practices across the country.
We wouldn’t be able to achieve this type of success if it weren’t for our interdisciplinary approach to patient care, where the patient comes first.
What kinds of conditions or situations can be treated now that weren’t possible to treat just a few years ago? Tell us about those advancements in training, technique and technology.
In 2012, Maimonides began implanting the Left Ventricular Assist Device (LVAD) in patients with end-stage heart failure, and is one of the leading hospitals in New York City performing this procedure, in both volume and success rates (over 60 LVADs implanted as of January 2018). Also, we recently became the first non-transplant, non-trial center hospital in the tri-state to implant the new HeartMate 3 LVAD, a major advancement in LVAD therapy.
We also take pride in our AFIB Hybrid Ablation Program, combining cardiothoracic surgery and electrophysiology procedures under one anesthesia. We perform the high- est volume of hybrid ablation procedures in the tri-state area, achieving excellent results with minimally-invasive techniques.
Since 2012, our Transcatheter Aortic Valve Replacement (TAVR) Program has helped patients with severe aortic stenosis (narrowing of the blood vessel), those with failed valve replacement in the past, or those at high risk for open-heart surgery. Without incisions, a small, thin tube containing the artificial valve is inserted into an artery in the groin, and threaded up to the aortic valve where the device is implanted, restoring blood flow. We have performed over 300 TAVR procedures (the highest volume in Brooklyn) and were the first hospital in Brooklyn to do so.
The Extracorporeal Membrane Oxygenation (ECMO) Program has also saved countless lives by implementing a heart-lung machine to mimic the natural function of the heart and lungs. This innovative procedure gives patients temporary respiratory and cardiac sup- port as they undergo treatment to the a ected organ, allowing the heart and lungs to rest. The Maimonides ECMO Team will also travel to other hospitals to perform this lifesaving procedure where it’s not otherwise available, before transferring the patient to Maimonides for further medical management.
The vascular team is renowned for its wound care, limb salvaging, and focus on therapeutic options for repairing blocked arteries using minimally-invasive procedures in the hybrid operating room. We also take pride in our Aortic Center—the only one of its kind in Brooklyn. Maimonides works with several emergency rooms across the borough so that they can transfer patients in need of emergent care to us for repair of any type of aortic aneurysm. Time is of the essence for these catastrophic events.
Tell us about the hybrid OR. What does it offer to clinicians and patients?
Maimonides Medical Center is a hub for cutting-edge technological advancements. The hospital has two, multimillion-dollar hybrid operating rooms, the only institution in Brooklyn with these types of operating rooms, which allow more than one surgeon to operate at the same time on patients with multiple or complex conditions, reducing the need for multiple surgeries and providing better patient outcomes. This allows the multidisciplinary cardiovascular teams to work together, using the most advanced imaging and state-of-the-art surgical technology.
What should a patient understand when researching patient outcomes and options?
A collaborative team approach is essential to ensure that our patients receive the optimal care they have come to expect from us. Consistent communication among our surgeons, cardiologists, anesthesiologists and radiologists—and collaboration with our nursing professionals and primary care physicians—is mandatory for achieving the best patient outcomes. And that’s the only way we work.
Dr. Ribakove can be reached at the Maimonides Heart & Vascular Institute at 718-283-8902. www.maimonidesmed.org/heart