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Structural Improvements
The structural heart program at Saint Joseph Hospital uses the latest minimally invasive techniques to treat problems with the heart’s valves and other components. Conditions affecting the valves, chambers, walls and muscles of the heart are known as structural heart disease. A variety of conditions fall into this category, but some of the most common issues are narrowing of the aortic valve and leakage of the mitral valve. Thanks to technological and technical advancements, patients at Saint Joseph Hospital have more treatment options — and, for many individuals, surgery isn’t necessary.
Closing the Door on Dangerous Blood Clots
If you have atrial fibrillation — the most common type of irregular heartbeat, or arrhythmia — you have a higher risk for stroke. Atrial fibrillation can cause blood to pool and clot in a small pouch in the heart called the left atrial appendage (LAA).
A clot can travel to and block an artery that carries blood to the brain, causing a stroke. Implanting a small device, either the WATCHMAN™ or Amplatzer™ Amulet™ Left Atrial Appendage Occluder, closes the LAA to reduce stroke risk without medication.
“LAA occlusion is for patients who can’t take oral anticoagulation therapy, or blood thinners, because of the risk of bleeding episodes or falls, or problems with taking medication as prescribed,” said Nezar Falluji, MD, MPH, an interventional cardiologist at CHI Saint Joseph Medical Group – Cardiology and director of the structural heart program at Saint Joseph Hospital.
“With the patient under general anesthesia, we make a small cut in the groin and send WATCHMAN or Amulet through a catheter inside a vein to the LAA. The procedure takes 20 or 30 minutes, and patients return home the same day or the next day.”
Sending in a Replacement
Four valves ensure blood flows on a one-way path through your heart. The aortic valve opens and closes to allow blood to enter the aorta, a major artery that helps carry blood to the rest of your body.
If this valve opening narrows, the heart has to work harder to supply blood. A procedure called transcatheter aortic valve replacement (TAVR) installs a new valve without open-heart surgery.
“We perform TAVR through a puncture in the groin,” said Hamid Mohammadzadeh, MD, FACS, FACCS, a cardiovascular and thoracic surgeon at CHI Saint Joseph Medical Group – Cardiovascular and Thoracic Surgery, and Saint Joseph Hospital.
“Using real-time imaging to guide us, we send a bioprosthetic valve through a catheter inside an artery and deploy it inside the dysfunctional aortic valve. The new valve starts working right away. TAVR uses a far smaller incision than open heart surgery, and the length of stay in the hospital is much shorter.”
Michael Schaeffer, MD, an interventional cardiologist with CHI Saint Joseph Medical Group – Cardiology and Saint Joseph Hospital, said patients with aortic valve stenosis today are receiving new technologies that have completely revolutionized treatment.
“It has extended the lives of millions of people. It’s not that often in medicine that you see the paradigm shift in this way,” Dr. Schaeffer said.
“Before 2000, if you had aortic valve stenosis and you were too infirm to have open heart surgery, it was most likely going to result in your demise.”
Clip Fix
If the two leaflets, or flaps, of the mitral valve don’t close properly, blood can leak backward into the heart. This can increase the risk for atrial fibrillation. Repairing the valve with a dime-sized device called MitraClip™ can restore a proper seal and keep blood from flowing the wrong way.
Like other structural heart procedures, MitraClip implantation is performed via a puncture in the groin to insert a catheter. Once the catheter is in place inside an artery, the MitraClip is guided to the mitral valve.
“We perform MitraClip implantation with the patient under general anesthesia,” Dr. Falluji said. “MitraClip brings the edges of the two leaflets together to ensure reduced leakage. It’s a highly sophisticated, meticulous procedure that can take one to five hours. Patients go home the following day and can resume normal activities within a few days.”
Dr. Schaeffer said the number of cases using such things as TAVR or MitraClip has increased, as baby boomers age and begin to have problems with their valves. He also said the earlier the diagnosis, the better outcomes with treatment.
“If someone has an evolving valve problem, they should be seen by a cardiologist and evaluated, then by someone connected to a structural heart program,” he said. “We’re learning the longer these conditions go on, the more cumulative damage to the heart occurs.”
Ann Louise Jones, APRN, a recently retired nurse practitioner for cardiothoracic surgery at Saint Joseph Hospital, remembers the first mitral valve heart surgery performed there in 1972 — 50 years ago this summer. The first open-heart surgery was performed at Saint Joseph Hospital in 1959. Two years into her career, Jones was present for the pioneering operation — an open mitral commissurotomy to repair the patient’s mitral valve.
“It was like going to the moon,” Jones said. “I’m proud of our patient outcomes. I think ours is one of the top heart surgery programs in the country.”
New Hope for Patients
Heart valve conditions aren’t the only structural heart problems the team treats. They also treat congenital heart disease, or structural abnormalities present at birth, including holes in the heart, such as atrial septal defect, ventricular septal defect and patent foramen ovale, among others.
“Many patients with structural heart disease may have been told they’re not a candidate for treatment or that medications are their only option,” Dr. Mohammadzadeh said. “With all of these new technologies that arrive or improve seemingly every day, a patient who might not have been a candidate for a procedure in the past may be eligible for one now.”
A version of this article originally appeared in the Summer 2022 print edition of Spirit of Health.
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