Haim D. Danenberg, MD, is the head of the Irma and Paul Milstein Heart Center, at Hadassah Hospital Ein Kerem He is a specialist in cardiology and has served as the director of Cardiovascular Research at the Hadassah Hospitals and was a Visiting Scientist at Harvard-MIT Division of Health Sciences and Technology, Boston, MA. Prof. Danenberg is an Associate Professor of Medicine at the Hadassah-Hebrew University School of Medicine. He is the Secretary of the Israeli Workgroup for Interventional Cardiology and serves as a member of Medical Advisory Board of Paieon, Inc., and a member of Scientific Advisory Board at Lithotech Medical, Ltd. Haim Danenberg received his M.D. from Hadassah-Hebrew University School of Medicine and did a post-doctoral fellowship at the Harvard-MIT Health Sciences and Technology Program.

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Transcription:

Melanie Cole (Host): Heart Disease is the number one killer of men and women and is more deadly than all forms of cancer combined which is amazing when you think of those statistics. Today, we're talking with Professor Haim Danenberg on this episode of Hadassah On-Call.

Welcome. My guest today is Professor Haim Danenberg. He's the head of Interventional Cardiology Unit in the Department of Cardiology at Hadassah Medical Organization and he's the Chairman of the Israeli Working Group for Interventional Cardiology. Welcome Professor. I'm so glad that you could join us today. Tell us a little bit about yourself and how you came to Hadassah Medical Organization.

Professor Haim Danenberg (Guest): Well I can't even remember how I came to Hadassah since I've – I'm in Hadassah actually forever. I started medical school here in Hadassah when I was 17-years-old, before my military service. And then after completing military service as a physician, got back to Hadassah, did my internship, residency in medicine, then cardiology, interventional cardiology and actually other than three years in MIT in Boston, actually all my career is here in Hadassah.

After doing my fellowship in cardiology, I continued to interventional cardiology and I'm running this wonderful operation of interventional cardiology in Hadassah for almost 10 years now.

Host: Wow. What a resume. So, tell us a little bit, because you have mentioned interventional cardiology. Not everybody knows what that is Professor. What is an interventional cardiologist and how is that different from say a cardiothoracic surgeon or a cardiologist?

Professor Haim Danenberg: Well interventional cardiology I think is the hottest frontier in cardiology or cardiovascular medicine. We are the ones that are doing procedures within the heart without actually opening the chest or cracking the chest but rather in a minimally invasive procedures. We're doing the coronary angiographies and whenever there is a need, whenever there is a blockage or clotting in a coronary artery; which brings to a heart attack or angina; we intervene. We can open the arteries, these very small vessels with balloons, with stents and bringing a cure to the heart. And in the last couple of years, we are part of the revolution in which we are treating not only coronary disease but structural heart disease. We replace valves, heart valves without opening up the chest, without surgery, actually without even anesthesia. We treat a leaking valve. We close holes within the heart. There is a lot to do in intervention cardiology. And yet, our daily practice is actually day and night treating patients with heart attacks.

Here, we need to intervene in an immediate manner. Patients with heart attacks are brought directly to our Cath lab center. We are the ones who open the closed arteries.

Host: Isn't that fascinating? What an exciting time to be in your field as you said, it's so innovative. For some of our listeners who may not have heard of the new and exciting Irma and Paul Milstein Center at Hadassah Hospital, you have some of the most advanced cardiac intensive care units in Israel. Tell us about that.

Professor Haim Danenberg: We have I think the most advanced, not in Israel but worldwide. Very few centers can now compare with what we have here in Hadassah. Not in the intensive care unit and definitely not in our wonderful spacious state-of-the-art very, very modern Cath labs here in Hadassah. I was fortunate and I'm still fortunate to travel around the world and teach new procedures worldwide including in the US and very seldom I reach places that look even close to what we have here in Hadassah now.

And having such a nice, as I said modern state-of-the-art Cath labs allows you to give your patients, I think the best therapy ever. It's not only about the infrastructure, it's mainly about the manpower and we've got an excellent team here. But combining the wonderful manpower, wonderful medical and paramedical team here in Hadassah with the outstanding infrastructure that we have; it's a winning solution.

Host: Well you mentioned a little bit before about the time factor involved if someone is suffering from a cardiac event and I've also heard that Hadassah has one of the lowest times of getting a patient into the Cath lab to prevent death from heart attack. Speak about that and while you are doing that, tell us about the Hybrid Cath Lab and what that means for patients and physicians.

Professor Haim Danenberg: Okay so, as for time, from arrival to opening up the closed or clogged artery. In heart attack, time matters. When you delay treatment, when you delay therapy which in this case is bringing the patient to the Cath lab and treating the clogged arteries; time matters. Any delay costs the patient in muscle, in myocardial tissue, with the morbidity and mortality associated with it.

And therefore, our goal for many years it to try and shorten this time period to the shortest possible. We changed our practice years ago. Patients that arrive with a heart attack don't go through the Emergency Room anymore. The EMS [inaudible 00:07:02] the ambulances call our physicians immediately whenever they reach a patient with a heart attack, straight from the patient's home. And we activate our system so whenever a patient with a heart attack arrives at the hospital; they come straight to the Cath lab. The team is ready, and the procedure is done in the most, in the fastest and swiftest manner possible.

And indeed, we are proud to win year after year in the shortest time to therapy and this correlates directly with very low death rate from heart attack that we do see here in Hadassah.

As for your other question, the Hybrid Room. Having a Hybrid Room allows you to do the most sophisticated and modern procedure as it combined. Every once in a while, surgery or minimal surgery with what we do in interventional cardiology. We are a Center of Excellence in doing first in men trials. Israel is a startup nation. So many Israeli startups and we are the ones that actually bring to practice the very new and modern devices, and this can be done only in Hybrid Rooms like the ones that we have here in Hadassah.

Host: When people hear the word catheterization, they don't really know what that is. Is this something that is mostly curative as you say in the case of a cardiac event or heart attack or can they also be diagnostic? What can you reveal with catheterization and tell us a little bit about some of the exciting biplane technology system that you use that can provide three dimensional imaging of the heart from two cameras at the same time. That is just amazing.

Professor Haim Danenberg: Well the procedure is very often a diagnostic one. About almost 50% of our procedures are diagnostic. Every procedure starts with a diagnostic phase and based on the results, based on the information that we get in the diagnostic phase; we reach a decision whether we need to proceed to intervention. So, and the whole procedure is done via a tiny puncture either in the radial artery or very seldom now in the groin. We bring tiny catheters, those tiny, very tiny one and half to two millimeter catheters to the heart, inject and reach diagnoses regarding the coronary artery vasculature.

The equipment that we have here including the biplane allows us to do procedures in a very accurate manner. The resolution is outstanding. We can do procedures with minute amounts of contrast media which have it's adverse events or in some patients we need to be very frugal to save in the contrast and this can be done with the equipment, the imaging equipment including the biplane that we have here in our Cath lab.

Host: Are there any new research projects that you are working on related to heart disease that you can speak about briefly?

Professor Haim Danenberg: There are many projects that we are involved with. A lot of new devices to shorten procedure of time to improve outcome, to improve safety but I would like to share with you a project that we do currently which is actually trying to learn what's important to our patients. Kind of the wisdom of the crowds of out patients and based on this, improve therapy that we provide to our patients and this is fascinating. We learn that it's not always what we think as physicians, but patients wish is very important and when you try to provide your patients with what they think of in of course in a very safe and effective manner; it definitely improves their satisfaction and they go out with a big smile. Even sick patients do enjoy the therapy here when you try to provide it according to what they ask for.

Host: What a great model of care Professor and certainly as patients, we need to be our own best health advocates. We are learning the more and more and women and heart disease and recognizing our symptoms. It's all coming together truly. Is there anything else you'd like to add that you think is important for our listeners to know about in regards to heart disease and what you're doing there in Israel and how really ongoing and comprehensive this field of study is.

Professor Haim Danenberg: We live in an exciting period. There is so much research and development, things are changing and for the good. Yet, I think what's very important from a patient point of view is how to refrain from becoming a patient. And this is keep the optimal lifestyle and we all know what is an optimal lifestyle. Eat less, exercise more, don't smoke, treat all your risk factors whether it's hypertension, dyslipidemia, diabetes, live right and refrain from getting to our hands. And I think this is the best advice that I can provide to everybody. Physicians and patients as well. And one more thing, happy Purim, it's a holiday here in Israel so you Melanie and the listeners Chag Same'ach.

Host: Chag Same'ach to you too as well Professor. Thank you so much for coming on, sharing your expertise and explaining to us about really what an exciting time this is in interventional cardiology as you say. What a burgeoning field and you've explained everything so well to us. Thank you again for joining us. This is Hadassah On-Call, New Frontiers in Medicine brought to you by Hadassah, the Women's Zionist Organization of America. The largest Jewish Women's organization in America, Hadassah enhances the health of people worldwide through medical education, care and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine please visit www.hadassh.org, and to hear more unbelievable episodes in this podcast series please visit my.hadassah.org/podcasts, that's my.hadassah.org/podcasts. I'm Melanie Cole. Thanks for tuning in.

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