In October, Hackensack Meridian Health’s Hackensack University Medical Center announced it was the first hospital in the U.S. to successfully perform heart surgery with a new heart pump called the Impella 5.5 with SmartAssist. The device — manufactured by Abiomed Inc. — is designed to take the load off a heart while it’s recovering from a shock like a heart attack or other health episode, or surgery.

Recently approved by the FDA for use in the U.S., the pump also transmits vital data both through a direct cable to a monitor — and wirelessly through the cloud — to a central monitoring station where its performance can be monitored by technicians, who can contact the physician caring for the patient.
Health care today isn’t just about scalpels and medicine. Instead, New Jersey hospitals are exploring new, high-tech approaches. But what will it mean for doctors?

‘Game-changer’

“The Impella 5.5 device is about the size of a triple-A battery, and we can position it with minimally-invasive surgery,” according to Dr. Mark Anderson, chief of the Division of Cardiac Surgery and cardiothoracic surgeon at the Heart and Vascular Hospital at Hackensack University Medical Center and HMH. “It’s a game-changer that gives cardiac surgeons a new and potentially better option that can provide the benefits of heart recovery to some of our sickest patients.”

During Anderson’s 20-something years of practice, he’s literally held patients’ lives in his hand — for example, during a heart transplant — and he’s seen a sea change in procedures, thanks in part to technological advances. “In many cases, we no longer have to crack open a patient’s chest to do heart surgery,” he explained. “With miniature devices like the new Impella 5.5 pump, we can make a small incision by an individual’s collarbone and then feed the device through their artery. A built-in optical sensor enables the physician to position the device without relying on outside imaging like an X-ray, or an ultrasound.”

Besides giving the heart a much-needed rest for up to 14 days, patients can get up and walk around sooner. “Right now, they still have to stay in the hospital for an average of two weeks before being discharged,” Anderson said, explaining that they’re often “very sick,” and citing the need for the heart to recover. “Once the pump is removed, they can currently be discharged after a day or so. But a next-generation pump — called a bridge-to-recovery model — should be out in the next year or so and could enable a patient to be discharged in as little as a day after heart surgery.”

Blurred line

In some cases, the push to further integrate high-tech and health care has had an interesting side effect: turning medical professionals like Kate Gillespie — assistant vice president, Orthopaedic Service Line at the Virtua Joint Replacement Institute — into financial experts. A registered nurse and president of the New Jersey State Nurses Association who also holds an MBA, Gillespie works with Virtua’s finance department to help evaluate new devices. “In addition to the patient benefits, we consider the initial and additional costs and supplies it will incur, as well as the extra patient flow it may attract,” she said.

In 2017, Virtua announced it was introducing a surgeon-controlled robotic-arm for total knee replacements — earlier, the technology had been limited to partial knee replacements and hips. Now, medical teams use computerized tomography scans to create a customized, 3-D map of the affected area, enabling them to “customize the joint replacement for the patient’s anatomy to pre-plan the knee replacement,” according to Dr. Scott D. Schoifet, medical director of the Virtua Joint Replacement Institute.

By the end of 2018, Gillespie said, Virtua had done “just shy of 9,000 knee replacements and about 4,000 hip replacements.”

Getting a leg up with technology is more important than ever, she noted. Besides enhancing the quality of life for patients with problem knees, “[t]he contribution margins are quite high, and hospitals are looking for programs that bring in more revenue.”

On one hand, “people are living longer, and their joints are wearing out,” she noted, but patients are also recovering faster, thanks in part to robotic arms and other advanced techniques that enable minimally invasive surgery. At the same time, Medicare, as well as commercial health insurers, are pushing for shorter hospital stays.

“In 2018, when Medicare OK’d same day in-hospital knee replacement procedures, that accounted for about 8 percent of our knee-replacement activity among Medicare and commercial health insurance patients,” Gillespie said. “In 2019, same-day surgery accounts for 40 percent of our total knee replacement activity.”

New frontiers

Technological advances continue to push boundaries. Atlantic Health System recently introduced the ROSA Brain robot, a minimally invasive option for brain surgery. “ROSA Brain is a surgical navigation and positioning system, much like a GPS, that allows for precise spatial positioning and orientation of surgical instruments and tools,” according to Dr. Ronald Benitez, chief, endovascular neurosurgery at AHS’ Overlook Medical Center. “Neurosurgeons are able to place electrodes, which detect seizures in the brain, without having to open a patient’s skull or even shave a patient’s head, as other traditional methods require.”

Robotic surgery improves a patient’s experience because it enables “a less-invasive surgery with reduced operating time,” added Atlantic Health System Chief Innovation Officer Dr. Sylvia Romm. “This also means less bleeding, reduced risk of infections and less pain resulting in reduced recovery time.”
These kinds of robots “will not replace surgeons,” she said. “But surgeons who use robots and other new technology to assist in their procedures will likely, over time, replace surgeons who don’t.”