Wilton doctor performs revolutionary procedure
A breakthrough in heart surgery has a Wilton resident assisting in putting patients back in order in two days.
Rafael Squitieri MD, a cardiac surgeon at St. Vincent’s Medical Center in Bridgeport, is part of a team performing TAVR, formally known as Transcatheter Aortic Valve Replacement. The hospital is one of only three in Connecticut performing the procedure, and the only one in Fairfield County.
“You have to be a pretty high flier to be in contention to perform TAVR,” Dr. Squitieri said while sitting in his office.
The procedure, which is an aortic valve replacement, requires the movement of a new valve along a fine catheter moving backwards up the aorta beginning with an artery in the leg.
Traditionally, heart surgery has required long stretches of therapy and minimal activity. With this procedure, patients go home two days later with little or no restrictions.
“You see a 90-year-old person come in looking pale as a sheet, barely able to talk because they’re so short of breath,” he said. “No life in them at all. Two days later, they walk home, pink, remembering what they hadn’t thought of in years. They’re starting to think about living. It made it all worth it.
“We didn’t expect it to be that dramatic.”
Dr. Squitieri spoke modestly of his role in bringing TAVR to St. Vincent’s.
“You should be talking to Al DiMeo or Robert Jumper,” he said, speaking of two colleagues at the hospital. “This is a great team with little turnover.”
Dr. Squitieri attended Greenwich High School, where he played football as an “undersized” defensive end for legendary coach Mike Ornato. He knew medicine was in his blood, and it was especially in his genes.
“My grandfather was a doctor in the Bronx,” he said. “My father was a physician. It was something we naturally gravitated toward. I was drawn to anatomy and physiology. Specifically the heart. I always knew I would be a surgeon.
“My mother brought home a full cow heart for dinner. When she wasn’t looking I made a mess of it. I identified the structures that we work on today. I operated on a lot of stuffed animals and had pretty good results.”
Dr. Squitieri completed his undergraduate degree at Columbia University before heading to Mt. Sinai Medical School. That allowed him to work at various hospitals around New York City, which was considered to be a good training ground. He then moved on to Morristown Medical Hospital for his residency and returned to Mt. Sinai for his fellowship.
Among many experiences he recalled was working in China and Haiti.
Back in Wilton, Dr. Squitieri stays busy with his wife, Kelly Harkins-Squitieri, also a doctor at St. Vincent’s. Dr. Harkins-Squitieri is the head of women’s imaging. The Squitieris have four children ranging from kindergarten to college age.
The TAVR procedure has become the pride of the St. Vincent’s cardiovascular surgery group. It is, as Dr. Squitieri alluded to, a very collaborative effort. That is mandated, in part, as co-surgeons must be on every case. In a hybrid operating room, something also considered to be cutting edge, a heart surgeon and an interventional cardiologist must be present. The hybrid OR allows both surgeons to have the instruments and equipment they need.
St. Vincent’s is one of only two Connecticut hospitals to receive both Nursing Magnet® recognition and a Leapfrog “A” Hospital Safety Score. This honor recognizes quality care, as well as nursing excellence and innovations.
The Connecticut Hospital Association awarded the Medical Center the 2012 John D. Thompson Award for its safety program, and St. Vincent’s was also featured by the Joint Commission on the Accreditation of Healthcare Organizations. The accreditation is a nationwide seal of approval that indicates a hospital meets high performance standards. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.
“We knew that if we were going to do something so cutting-edge, every level had to perform at a top level,” said Dr. Squitieri. “We brought in an aviation technician for safety [Joe Brown]. He took aviation safety and could somehow layer it on top of medicine and created organization, structure, safety, and reliability. It’s all basically protocol, which isn’t traditionally how medicine works. To move forward beyond human error, we needed to do this.”
Although the hospital, the smallest to perform TAVR, performs only as many as two procedures a day, and only twice a week, the belief is that patients not wanting to travel to New York City will come to Bridgeport.
While there are risks, Dr. Squitieri said, the success rate at St. Vincent’s has been 100%. Patients are carefully selected for the procedure.
“The risks are different than open heart surgery,” Dr. Squitieri said.