Breaking New Ground

Searching for ways to extend and enhance life, some Virginia hospitals are influencing the future of health care.

     No one can predict what the next big discovery in medicine will be, but Dr. Zobair M. Younossi believes that personalized and predictive medicine soon could become standard practice. “That’s the future of health care,” says Dr. Younossi, who serves as chairman of the department of medicine at Inova Fairfax Hospital and vice president for research at Inova Health System.

     Using the study of genes, doctors can combine a patient’s medical information with his or her individual DNA to diagnose a disease and devise a personalized treatment plan tailored precisely to that patient. Just as importantly, this type of information can be used for wellness and prevention strategies. “We believe that a large number of diseases could have a genetic component,” Dr. Younossi says. “We would be able to predict who would get chronic diseases based on risk models, clinical data and sophisticated tests using technologies such as genomics and proteomics.” And if we can predict the onset of a disease, we can take measures to prevent it.

     Inova clinicians and investigators are currently involved in a research study called “First 1,000 Days of Life.” The groundbreaking study, not yet reported in the national media, will help researchers learn how genes predict the growth and health of infants during the first 1,000 days of life. The study is being conducted through the Inova Translational Medicine Institute along with Inova’s departments of obstetrics and pediatrics. Blood samples from more than 500 infants and families, mostly from Virginia, are currently being collected for genomic testing.

     Inova’s program, the world’s first newborn study of its kind, will spotlight the impact of the first few months of life on the ability to predict what types of diseases one will be susceptible to. “If you can predict now,” says Dr. Younossi, “you can develop strategies such as lifestyle changes to remedy that when the time comes.” The resulting information, which will be available in the next few years, will be valuable in dealing with chronic diseases that a person may develop in in the next 10 to 15 years, says Dr. Younossi.

     While future advances will shed light on potential diseases, many need help for diseases they struggle with now. One of the biggest advancements in medical technology today is the transcatheter aortic valve replacement procedure (TAVR). The minimally invasive, lifesaving procedure is performed by a team of interventional cardiologists and cardiac surgeons in a state-of-the art special hybrid catheterization lab/operating room. The Federal Drug Administration has only approved the procedure for those patients who are deemed inoperable or at very high risk for surgery and have severe aortic stenosis. Many of the patients receiving the procedure are elderly and debilitated prior to the procedure due to their condition.

     The Edwards SAPIEN Transcatheter Heart Valve is currently the only FDA-approved device in the United States. Carilion Clinic, HCA Virginia, Sentara Heart Hospital and the University of Virginia are the only programs in Virginia performing TAVR with this device at this time. “This has been a controlled rollout by Edwards and the FDA,” says Dr. Chiwon Hahn, cardiothoracic surgeon for HCA Virginia. “They have selected centers with the most qualified physicians and best clinical cardiac outcomes. It is only in 50 centers nationwide.”

     HCA Virginia started using the procedure in July on patients between the ages of 77 and 94 from around the region. The first, 88-year-old Wilbert Story, was unable to walk to the mailbox without becoming out of breath when doctors first saw him. Since his surgery, he has been able to breathe adequately on his own. “Many of these patients have a bed-to-chair existence,” says Dr. Charles W. Phillips, interventional cardiologist for HCA Virginia. “If Mr. Story had undergone cardiac surgery, he would have been in a nursing home for three months. He was out of the hospital in three to four days.”

     Conventional treatment for aortic stenosis, which involves narrowing of the heart valves, is open-heart surgery where the heart has to be stopped and restarted. “The new procedure inflates the valve in patients without opening the chest and stopping the heart,” says Hahn. According to the PARTNER Trial, which was documented in The New England Journal of Medicine in 2010, the one- and two-year survival rate for TAVR compared to medicines alone was 50 percent higher.

     With TAVR, doctors are able to treat patients who, in the past, may never have been considered for treatment because they were deemed too old or too weak for heart surgery. “The thought is that this new technology will bring options to a lot of patients who would not have entered the tertiary medical system,” says Hahn, adding that the team at HCA has had no complications to date.

     In the fight against cancer, Sentara Dorothy G. Hoefer Comprehensive Breast Center in Newport News, part of the Sentara Cancer Network, is the first center in Virginia to offer Radioactive Seed Localization. Using the approach, doctors can pinpoint with precision very small breast cancers and remove them. “It allows me to focus on exactly where to place my incision and provides me more options during surgery,” says Dr. Jason P. Wilson, surgical oncologist at Sentara CarePlex Hospital. “This new procedure gives me real-time feedback in the operating room. For patients, it’s more convenient.”

     Used before a lumpectomy, doctors insert one or two tiny seeds through a hollow needle to mark the suspected area of the cancer instead of the past practice of marking the area with a wire. The new procedure minimizes discomfort to the patient. “The seeds can be placed up to five days prior to surgery, and our patients love that added convenience,” says Lisa Bowles, the center’s manager. “Instead of having the wire localization and waiting for surgery that same day, our patients can schedule both procedures at a time that works for them.”

     Inaugural studies, groundbreaking techniques and searches for ways to predict and prevent illnesses before they occur are putting Virginia’s hospitals and physicians at the forefront of future developments in medicine.

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