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Expertise in Cardiovascular Intervention

Coronary Artery Disease

PERCUTANEOUS CORONARY INTERVENTION

CORONARY STENTS

CORONARY ATHERECTOMY (Rotational, Orbital, Laser)

INTRACORONARY LITHOTRIPSY (Shockwave)

CHRONIC TOTAL OCCLUSION INTERVENTION (CTO)

COMPLEX HIGH RISK INDICATED PCI (CHIP) PROCEDURES

IMPELLA/HEMODYNAMIC SUPPORTED PCI

Coronary artery disease (CAD) results from a build-up of cholesterol laden plaque in the arteries that lie on the surface of the heart muscle bringing the heart oxygen and nutrients. The stable forms of CAD can usually be treated medically although symptoms such as chest pain/pressure and shortness of breath are often more adequately treated with procedures to relieve these blocked arteries. Acute unstable forms of CAD are the number one killer of adults in the United States and for these conditions interventional therapy is often lifesaving.

Dr. Zelman completed his cardiac interventional fellowship at Brigham and Women’s Hospital in 1997 and since then has performed procedures at over half a dozen major academic centers in Boston alongside many of the pioneers in this field. He championed the effort to bring lifesaving coronary intervention to within reach of patients suffering acute myocardial infarction (heart attack) in their own communities (see Dateline NBC episode on resources page) performing the first community hospital Primary Stent procedure in Massachusetts. Dr. Zelman has performed over 5.000 coronary interventions and is recognized as one of the most skilled and experienced coronary interventionalists in the nation. He is the only physician in Massachusetts to have been recognized by the Commonwealth as having achieved statistically better than anticipated outcomes for these procedures multiple years in a row and has performed over 2000 acute myocardial infarction procedures on patients suffering heart attacks, perhaps more than any other physician in the nation. Procedure results are highly correlated with operator experience and volume.

PERMANENT PACEMAKER DEVICES

TEMPORARY PACEMAKERS

PERMANENT SINGLE AND DUAL CHAMBER PACEMAKER IMPLANTATION AND FOLLOW UP

LEADLESS PACEMAKER INSERTION

Permanent pacemakers are implantable electronic devices that can sense when a persons intrinsic heart rate is too slow and then deliver an electronic impulse either via a lead inserted through a vein into the chambers of the heart or directly to the heart muscle when one of the newer forms of leadless devices are selected for implantation. Since the initial implantation of a pacemaker in 1958, improvements in these devices have resulted in them designated amongst the most dependable and durable therapies in modern medicine.

 

Dr. Zelman trained to perform pacemaker implantation and follow up at Brigham and Women’s Hospital prior to becoming head of the Pacemaker Service at Boston University Hospital. Since this time Dr. Zelman has implanted many hundreds of these devices.

STRUCTURAL HEART DISEASE

TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI/TAVR)

TRANSCATHER MITRAL EDGE TO EDGE REPAIR (MITRACLIP TEER)

TRANSCATHETER MITRAL VALVE REPLACEMENT (TMVR)

TRANSCATHETER TRICUSPID VALVE EDGE TO EDGE REPAIR (TTEER)

TRANSCATHETER TRICUSPID VALVE REPLACEMENT (TTVR)

PERCUTANEOUS CLOSURE OF PATENT FORAMENT OVALE (PFO)

PERCUTANEOUS CLOSURE OF ATRIAL SEPTAL DEFECTS (ASD)

Structural heart disease is a group of conditions that effect either one of the larger structures of the heart such as one of the four heart valves or abnormal communications between the chambers of the heart themselves. During the past two decades there have been tremendous advances in this field that have allowed specially trained physicians to care for many patients without open chest/open heart surgeries (a great many of these patients who would not have been candidates for this invasive type of therapy.)

 

After having received training in Munich Germany with a leading expert (Dr. Markus Kasel at the German Heart Center), Dr. Zelman founded the Structural Heart Program at Cape Cod Hospital in 2015. Since that date he has performed over 1200 structural heart procedures and is the only physician to have performed these types of procedures as primary operator in Southeastern Massachusetts. His outcomes have been among the best in the Commonwealth and he is recognized as one of the most skilled and experienced structural cardiologists in New England. Procedural results are highly correlated with operator experience and volume.

ATRIAL FIBRILLATION THERAPIES

CARDIOVERSION

LEFT ATRIAL APPENDAGE CLOSURE (WATCHMAN)

Atrial Fibrillation is the most frequent heart rhythm disorder effecting 1-2% of Americans but with increasing prevalence in older age groups such that over 10% of persons over the age of 80 are affected. The condition may be symptomatic (irregular rapid palpitations) or asymptomatic, but both forms equally predisposing patients to stroke (over 15% of strokes are caused by atrial fibrillation.) The most effective therapy to prevent stroke is blood thinner medication, however many patients are not good candidate for this therapy and an even larger proportion of patients just refuse to be compliant with blood thinner therapies long term. With the realization that >90% of blood clots forming due to AF arise in the left atrial appendage, therapies such as Left Atrial Appendage Closure with the Watchman device have been developed in order to protect AF patients from stroke while eliminating the need for blood thinners to be prescribed.

 

Dr. Zelman started the Watchman Left Atrial Appendage Closure Program (LAAC) at Cape Cod Hospital in 2016 and has performed over 250 of these procedures with excellent success and safety. Since 2021 as the highest volume interventional cardiologist operator in Massachusetts he has achieved a 98% success rate with a procedural mortality rate of 0% and procedure times under 40 minutes. Procedural results are highly correlated with operator experience and volume.

PERIPHERAL VASCULAR DISEASE

Percutaneous Peripheral Arterial Interventions

Carotid Arterial Interventions

Visceral Arterial Interventions

Peripheral artery disease, carotid artery disease and visceral artery disease are disorders relating to buildup of atherosclerotic cholesterol deposits in the arteries to the extremities, to the brain or to the major abdominal organs. Stable disease can usually be treated effectively with medication and exercise regimens, however more symptomatic or severe disease is often better treated with intervention to relieve significantly blocked arteries.

 

Dr. Zelman was one of the first interventional cardiologists to partner with vascular surgeons and interventional radiologists to create a multidisciplinary vascular center of excellence. He was the first to perform carotid artery stenting successfully at a non-academic teaching hospital and to adopt vascular stents and atherectomy into the armamentarium of devices to utilize in peripheral intervention. He still collaborates extensively with experienced surgeons like Stephen Brooks M.D. and experienced interventional radiologists like Philip Dombrowski M.D. to bring forth to patients the most comprehensive and expert care for their peripheral vascular disease.

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