Advances in Care

Erin Welsh is joined by Dr. Jennifer Haythe, director of the Adult Pulmonary Hypertension Center and Cardio-Obstetrics programs at NewYork-Presbyterian and Columbia, to discuss the prevalence of high-risk pregnancies due to heart disease and the multi-disciplinary efforts required for optimal patient care. 

Many women in the US are having children at a later age than in the past, and with that comes an increased occurrence of certain conditions that create risk for heart disease during, or after, pregnancy. In fact, cardiovascular disease is the leading cause of maternal mortality in the US, with pulmonary hypertension and peripartum cardiomyopathy posing significantly high risks. Dr. Haythe discusses how coordinated, multi-disciplinary care is crucial in treating these vulnerable patients, and how the cardio-obstetrics program at Columbia is approaching care to allow women, many of whom have been told they could never give birth, achieve safe and successful pregnancies. Dr. Haythe also talks about the latest cutting edge research for cardiac conditions in pregnancy and her program’s involvement in the ReBIRTH study, a national, multi-center, randomized placebo controlled trial examining the use of bromocriptine as a course of treatment for pregnant patients with peripartum cardiomyopathy - a study that could potentially introduce a new paradigm in high-risk pregnancy care. 

Chapters:

[00:00 - 5:49] Columbia’s Multidisciplinary Cardio-Obstetrics Program

Dr. Haythe and Erin discuss how the multidisciplinary cardio-obstetrics program at Columbia and the growing population of pregnant patients with heart disease.

[05:49 - 10:28 ] Navigating Cardiovascular Complications 

Dr. Haythe and Erin talk about the risks of pulmonary hypertension and other cardiovascular complications in pregnant patients, including during the post-partum period, and also highlights new research that may help change the course of treatment. 

[10:28 - 14:08] A Rewarding Patient Story

Dr. Haythe tells a story of a pregnant patient with pulmonary hypertension who delivered successfully, demonstrating how the program effectively managed her care. 

[14:08 - 17:12 ] Vision For the Future

Dr. Haythe shares her experience as part of the New York City Maternal Mortality Review Board, a committee formed to review maternal deaths and determine how to minimize the risk of recurrence going forward. 

[17:12 - 18:04] Credits

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Jennifer Haythe, MD, is the Director of the Adult Pulmonary Hypertension Center, and the Cardio-Obstetrics program at Columbia. She is currently the Irene and Sidney B. Silverman Associate Professor of Cardiology, Center for Advanced Cardiac Care at Columbia, and Co-Director of The Columbia Women’s Heart Center.

Dr. Haythe specializes in pulmonary hypertension, cardio-obstetrics, heart failure, HFPEF, and cardiovascular disease in women.

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On this episode of Advances in Care, Erin Welsh and Dr. Jeffrey Greenfield, pediatric neurosurgeon at NewYork-Presbyterian and director of the Chiari CARE program at Weill Cornell Medicine, discuss a rare condition called Chiari malformation. 

Typically diagnosed by MRI, Chiari malformation is classified when part of the cerebellum descends into the upper spinal canal. Though some of the most severe types of Chiari malformation can be diagnosed during pregnancy, the most common type may present asymptomatically until adolescence or adulthood, with symptoms that are often misdiagnosed as other disorders. To address the unmet need for proper diagnosis and management of this condition, Dr. Greenfield created the Chiari CARE program–a multidisciplinary approach involving neurology, pain management, neuropsychology, radiology, and more–to help provide full-spectrum care to patients. A key factor of the Chiari CARE program is its emphasis on transitional care, which includes both treating patients who come in as pediatrics throughout their adulthood as well as those who are diagnosed later in life. 

But Dr. Greenfield’s vision extends to the future. Having just treated the program’s thousandth surgical patient, his team is amassing and analyzing outcomes data and using machine learning to refine predictions for which future patients would be good candidates for surgery or require other treatment methods that will enhance overall quality of life. 

Chapters:

[00:00 - 4:12] Chiari CARE

Dr. Greenfield and Erin discuss a rare congenital brain condition called Chiari malformation, and highlight Dr. Greenfield’s Chiari CARE program at NewYork-Presbyterian and Weill Cornell Medicine.  

[4:12 - 8:35] The Importance of Transitional Care 

Dr. Greenfield expands on the importance of transitional care for patients with congenital neurological conditions like Chiari malformation. 

[8:35 - 11:51] Determining the Right Approach 

Dr. Greenfield explains how he and his team determine whether their patients need surgery or not, and the challenges of diagnosing and treating Chiari malformation in adults. 

[11:51 - 14:31] Harnessing Data to Advance Research

Dr. Greenfield describes how his team is utilizing the MRI scans from over a thousand patients to develop models that could predict who may be a good candidate for surgery or other treatment avenues. 

[14:31 - 18:35] Advancing Diagnostics 

Dr. Greenfield shares his vision for an improved coordinated care model for patients newly diagnosed with Chiari malformation. 

[18:35 - 19:20] Credits 

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Jeffrey Greenfield, MD, PhD is a board-certified neurosurgeon who specializes in pediatric neurosurgery. In addition he sees certain adult patients with congenital neurosurgical conditions. Compassionate clinical care, research, and education are all central to his philosophy as a neurosurgeon and physician. His clinical expertise includes Chiari malformation, all forms of tethered spinal cord, pediatric brain tumors and congenital neurosurgery into adulthood. 

As creator and director of the Chiari CARE program, Dr. Greenfield has developed an international reputation caring for children and adults with Chiari malformation, tethered cord, syringomyelia, and other associated conditions such as craniocervical instability, CSF leaks, and hydrocephalus as part of a large multidisciplinary team.

For more information visit 

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Erin Welsh is joined by Dr. Jeffrey Port, a thoracic surgeon at NewYork-Presbyterian and Weill Cornell Medicine, and a leader in thoracic surgical oncology, to discuss advances in minimally invasive robotic surgery and the unique collaborative care model that his program employs to operate on complex chest tumors.

When Dr. Port first started his career, the surgical techniques used to operate on lung cancer patients were akin to open heart surgery. But in recent years, his team has pioneered new techniques in thoracic surgery, specifically a minimally invasive single port robotic approach, which utilizes a multi-finger robotic hand to operate through one incision. Weill Cornell Medicine is currently one of only 10 centers nationwide using this technology for thoracic surgery, and the highest-volume center in the country that is performing these advanced procedures. Dr. Port also discusses the unique collaborative model his team utilizes to perform complex chest tumor surgeries which oftentimes require cardiopulmonary bypass. This combination of cutting edge surgical techniques, high case volume, and a multidisciplinary approach, is meaningfully expanding treatment options for patients who cannot be treated elsewhere.

Chapters: 

[00:00 - 04:39] Introduction to Thoracic Surgery

Dr. Port and Erin discuss the standard of care for thoracic surgery as it stood a few years ago and his pioneering use of robotics in single port thoracic surgery today. 

[04:39 - 09:06] Recovery Benefits of Single-Port Robotic Surgery

Dr. Port expands on how the technology differs from standard robotics and the recovery benefits of single-port robotic thoracic surgery. 

[09:06 - 13:20] NewYork-Presbyterian/Weill Cornell Medicine as Early Adopter of Innovative Technology

Dr. Port details his department’s efforts as a training facility, teaching surgeons and health care professionals from across the world the techniques and workflows that contribute to their success. 

[13:20 - 16:16] Multidisciplinary Approach as a Key to Cardiopulmonary Care

Dr. Port outlines how multi-specialty care allows his team to undertake very complex cases with success. 

[16:16 - 17:01] Credits

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Dr. Jeffrey L. Port is a Professor of Thoracic Surgery at Weill Cornell Medicine and a leader in thoracic surgical oncology. For more than two decades, he has helped shape Weill Cornell’s robotic thoracic surgery program and played a central role in advancing both minimally invasive and complex, high-risk chest surgery. His clinical focus spans lung cancer and other thoracic malignancies, with particular expertise in robotic approaches and coordinated cardiac–thoracic procedures for patients with advanced disease. 

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On this episode of Advances in Care, host Erin Welsh is joined by Dr. Mirella Mourad, maternal-fetal medicine specialist at NewYork-Presbyterian and co-director of the Preterm Birth Prevention Center at Columbia, to explore a groundbreaking new technology aimed at improving the diagnosis and treatment of preterm birth.

Preterm birth impacts approximately 1 in 10 pregnancies in the United States, making it a leading cause of neonatal complications and long-term health challenges. But despite its prevalence and associated risks, innovative solutions to address the condition have lagged behind. To address this gap, Dr. Mourad and her collaborator, Dr. Kristin Meyers, a professor of mechanical engineering at Columbia’s School of Engineering, are developing a new tool: a patient-specific “digital twin” of the cervix. This advanced technology has the potential to revolutionize obstetric care for patients, by allowing clinicians to test new treatment methods, collect data to better understand why certain people are at risk for preterm birth, and overall, catalyze innovation in the historically under-researched field of maternal-fetal medicine, ultimately helping to drive better outcomes and successful pregnancies. Dr. Mourad also discusses how this digital twin can potentially assist with identifying women with placenta accreta spectrum disorder, and inform more precise and proactive treatment plans for patients with this high-risk condition.

Chapters:

[00:00 - 4:24] The Prevalence of Pre-Term Birth

Dr. Mourad discusses the prevalence of pre-term birth and what drew her to obstetrics. 

[4:24 - 8:10] Room for Improvement in Diagnostics and Intervention

Dr. Mourad explains how pre-term birth is currently diagnosed and the limited tools for intervention. 

[8:10 - 13:00] The Digital Twin 

Dr. Mourad describes the “digital twin,”and how it can be used to simulate a patient’s biomechanics to better predict whether they may have a pre-term birth. 

[13:00 - 19:40] Looking Forward 

Dr. Mourad outlines how the use of AI and digital twins could not only help predict pre-term birth, but could also provide critical insights into testing new treatments and navigating other risky conditions like placenta accreta spectrum disorder. 

[19:40 - 20:25] Credits

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Mirella Mourad, MD is the Co-Director of the Preterm Birth Prevention Center and a Maternal-Fetal Medicine specialist at Columbia University Irving Medical Center. She is particularly interested in the medical diseases that affect pregnancy, focusing on maternal cardiac conditions, autoimmune diseases, and surgical complications involving abnormal placentation. Dr. Mourad is a fellow of the American College of Obstetricians and Gynecologists and a member of the Society of Maternal-Fetal Medicine.

For more information visit 

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On this episode of Advances in Care, Erin Welsh is joined by Dr. Cara Agerstrand, director of the Medical ECMO Program at NewYork-Presbyterian and Columbia, and Dr. Matthew Baldwin, critical care specialist at NewYork-Presbyterian and research lead of Columbia’s Baldwin Lab which focuses on the study of critical illness survivorship. 

Thousands of people suffer from cardiopulmonary conditions such as cardiac arrest and severe respiratory illnesses in the United States every year, with many requiring mechanical ventilation and critical care in the ICU. To better serve these patients, NewYork-Presbyterian and Columbia has built a renowned program to manage these patients on rescue therapies like extra-corporeal membrane oxygenation (ECMO), the most advanced form of cardiopulmonary life support. Since 2009, the team at NewYork-Presbyterian and Columbia has established an expertise to care for the sickest respiratory and cardiac failure patients with this technology, and has been at the forefront of utilization which has rapidly evolved from early pediatric use to post H1N1 and COVID surges. 

The standards of care for ECMO treatment and patient outcomes set by New York Presbyterian and Columbia over the past decade has earned them recognition as an ELSO Platinum Level Center of Excellence, one of only a few centers worldwide to have consistently achieved this status since it was first awarded. The team takes this expertise further through advanced research in The Baldwin Lab, which focuses on a variety of projects to better understand the biological factors of why some patients fully recover from ICU stays and others do not, as well as physical, mental, and emotional wellbeing for patients.

Chapters:

[00:00 - 4:07] ECMO and Post-Intensive Care Syndrome 

Dr. Agerstrand describes advances in ECMO care and Dr. Baldwin outlines his research in post-intensive care syndrome and targeted recovery efforts. 

[4:07 - 9:25] Refining ECMO

Dr. Agerstrand discusses how Columbia’s early ECMO adoption positioned them to refine techniques and set a new standard for its use in the ICU. 

[9:25 - 14:33] Recovery After Prolonged Critical Care

Dr. Baldwin explains the pressing need for continued care for patients discharged after receiving prolonged critical care, and his research connecting ongoing inflammation with slowed recovery. 

[14:33 - 19:01] Advancing Post-ICU Care 

Dr. Baldwin shares how his team has identified a hyper-inflammation biomarker with implications for post-ICU care and beyond. Dr. Agerstrand reflects on the rewarding aspects of an often challenging field. 

[19:01 - 19:41] Credits

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Dr. Cara Agerstrand is an Associate Professor of Medicine and Director of the Medical ECMO Program at Columbia University Irving Medical Center / NewYork-Presbyterian Hospital. Dr. Agerstrand completed her Internal Medicine residency and Pulmonary & Critical Care fellowship at Columbia University Irving Medical Center. She is an elected member of the Steering Committee of the Extracorporeal Life Support Organization, a member of the ECMO and Mechanical Circulatory Support Domain Task Force of the American College of Chest Physicians and is extensively involved in clinical care, research, and educational efforts involving extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal (ECCO2R). She has special interests in the use of ECMO for severe forms of the acute respiratory distress syndrome (ARDS), pulmonary hypertension and in pregnant and postpartum patients. Dr. Agerstrand is widely published and is an internationally invited speaker.

Dr. Matthew Baldwin, MD, MS, is a board-certified pulmonary and critical care physician and clinical investigator with a Masters in Biostatistics. Dr. Baldwin’s laboratory aims to improve critical illness survivorship. His research into survivors of acute respiratory failure works to elucidate the mechanisms of post-ICU frailty as therapeutic targets for improving physical recovery. He has identified frailty subtypes in acute respiratory failure survivors, and discovered that aging-related plasma biomarkers of inflammation, neuro-endocrinopathy, and muscle mitochondrial myopathy are potential therapeutic targets for post-ICU interventions. His research related to palliative care aims to improve ICU survivorship, and he has developed novel palliative care interventions for mechanical ventilation patients, such as chaplain-led communication-board-guided spiritual care.

For more information visit nyp.org/Advances