Cutting Edge

Title
Less invasive options for common cardiac conditions
Date
04/10/2017
Article

CAMC is among the first hospitals in West Virginia to offer the most advanced procedures for treating defects in the heart's valves, chambers or vessels, commonly known as structural heart disease.

"We can close holes in the heart, repair leaky valves and replace valves without even opening the chest," said Chris Adams, MD, interventional cardiologist.  "These procedures are safe and offer benefits like less scarring, less blood loss and pain and quicker recovery than open heart surgery."

Some structural heart diseases are present at birth while others can develop with age.  When you have one of these diseases, your heart must work harder to pump blood through the body, draining your energy and putting you at risk for serious complications like arrhythmia, stroke and heart failure.

CAMC's heart specialists are at the forefront of the latest heart and vascular treatments, along with groundbreaking research studies, which brings new options - and hope - for patients considered too risky for traditional open heart surgery.

Watchman

Patients with atrial fibrillation (AFib) who must take blood thinning medications on a long-term basis to help prevent blood clots and stroke may have another alternative: the Watchman Left Atrial Appendage Closure Implant.

Watchman.jpgAFib is a common irregular heart rhythm that can allow blood clots to form in the heart, especially in the left atrial appendage (LAA), which is the pouch attached to the left upper chamber of the heart.  As a result, people with AFib are five to seven times more likely to have a stroke than the general population.

The most common treatment to reduce stroke risk in patients with AFib are blood-thinning medications, such as Warfarin, or a new class of anticoagulant drugs called novel oral anticoagulants.  Despite its effectiveness, long-term anticoagulation therapy carries a significant risk for bleeding complications and is not well-tolerated by some patients.

The Watchman implant, which is about the size of a quarter, is placed in the heart through a catheter (through a vein in the leg).  It is designed to close off the LAA to keep harmful blood clots from entering the bloodstream and potentially causing a stroke.  By closing off the LAA, the risk of stroke may be reduced and, over time, patients are able to stop taking Warfarin anticoagulation therapy.

MitraClip

Mitral regurgitation is a debilitating, progressive disease where a leaky mitral valve causes a backward flow of blood in the heart.  The condition affects nearly 4 million people in the United States and can lead to stroke and heart failure.

MitraClip.jpgSome mitral regurgitation patients who cannot have open-heart surgery due to other health complications may be candidates for MitraClip, which is a device that cardiac specialists at CAMC use to perform a procedure called percutaneous (using a needle instead of open surgery) mitral valve repair.

The MitraClip device is guided through a catheter in the leg to the heart where it "clips" the leaky portion of the valve to eliminate the backflow of blood and restore normal blood flow through the heart.

This procedure has been shown to greatly decrease the risk of heart failure, improve overall quality of life and reduce mitral regurgitation.

TAVR

Aortic stenosis, or narrowing of the aortic valve, is one of the most common valvular heart diseases affecting patients in their 60s, 70s and 80s.  The condition prevents the aortic valve from opening and closing properly, which puts an increased amount of stress and pressure on the heart.  This can lead to shortness of breath, fatigue, chronic heart failure and even death, if left untreated.

TStructural%20Heart%20Disease%20D.%20TAVR.jpgranscatheter Aortic Valve Replacement (TAVR) is a treatment option that enables some patients with severe and moderate aortic stenosis to receive a new heart valve without undergoing open heart surgery.

"There are no good medications for aortic stenosis, so traditionally we were only able to treat it by opening the chest to replace the valve or by using a balloon to open the valve," Adams said.  "But calcium rebuilds within six months, so that wasn't long-lasting.  With TAVR, we're able to insert a catheter through the leg, neck or chest and put in a new valve."

TAVR is recommended for patients who aren't candidates for open-heart surgery due to risk factors such as advanced age, frailty and other health problems.  It offers many benefits over conventional open heart surgery, including less pain, shorter procedure time, shorter recovery time and fewer risks for patients who are high-risk for complications.  As surgeons have become more skilled in performing the procedure, patients who are at moderate operative risk can be candidates for the surgery as well.

The leading edge of heart disease

CAMC stays on the leading edge of structural heart disease through research, education and technology.  The hospital is currently involved in 30 clinical trials related to structural or vascular disease, which is an important step in discovering new treatments and ways to reduce the risk of the disease.  Plus, the hospital's team of highly-trained specialists in cardiology, interventional cardiology, cardiac surgery, cardiovascular imaging and cardiac anesthesia are constantly advancing the fast-evolving field of interventional cardiology.

"We have an incredible team," Adams said.  "Dr. Steven Lewis, who has been here since 1988, helped develop the field of interventional cardiology and has been involved in multiple studies.  Dr. John Deel is probably one of the most skilled surgeons in the United States on catheter-based techniques.  Dr. Aravinda Nanjundappa has been here for a decade and speaks internationally regarding interventional cardiology.  I also just completed two years of specialized training at the University of Kentucky, where I was involved in multiple trials for cardiac devices and worked with some of the leaders that helped develop this field."

"There is no need to leave the area for the best care," Adams said.  "We have it all right here."