Structural Heart Procedures

Three procedures performed cohesively by the Structural Heart Team at Saint Joseph Hospital are the Mitra Clip® procedure, transcatheter aortic-­valve replacement and the new Lariat procedure to help patients suffering from atrial fibrillation.

For information on all Structural Heart procedures available at Saint Joseph Hospital, please call 859.276.6925.

Mitra Clip®

MitraClip therapy offers a minimally invasive alternative to open-heart surgery. In October of 2013, Drs. Falluji and Schaeffer performed the first MitraClip procedure in Kentucky at Saint Joseph Hospital.

The MitraClip is a small metal clip that helps patients with mitral regurgitation (MR), a condition where the heart’s mitral valve flaps do not close tightly, causing blood to leak into the heart’s left atrium. Mitral regurgitation can lead to advanced heart failure. Symptoms of mitral regurgitation include:

Shortness of breath

• Fatigue
• Coughing
• Lightheadedness
• Swollen feet or ankles
• Excessive urination
• Shortness of breath

MitraClip therapy increases treatment options for selected patients with MR, especially those who are not candidates for invasive open-heart surgery. This procedure allows the Structural Heart Team to use catheter-based technology to repair the mitral valve, without patients undergoing cardiopulmonary bypass. During the MitraClip procedure, which takes place in the cardiac catheterization lab at Saint Joseph Hospital, the Structural Heart Team uses traditional catheter methods to guide the clip into the left atrium. The clip is lowered and attached to the valve to repair or reduce MR. Before final placement, the clip can be moved and rotated to ensure the best fit. The MitraClip procedure shortens recovery time and ultimately improves quality of life for patients experiencing life-altering symptoms.

Transcatheter Aortic-­Valve Replacement (TAVR)

Transcatheter aortic-valve replacement (TAVR) is a minimally invasive heart procedure for patients with severe aortic stenosis who are not candidates for open- heart surgery. During the TAVR procedure, the cardiologist and the cardiothoracic surgeon on the Structural Heart Team work together to implant a new heart valve.

Prior to surgery, the patient must undergo several heart tests to help the Structural Heart Team determine if the TAVR procedure is the best treatment option. Those tests include an echocardiogram, cardiac angiogram, computed tomography scan (CT scan), transesophageal echocardiogram, pulmonary function test and a carotid ultrasound.

In TAVR, the replacement valve is inserted into the body through the femoral artery in the leg or through the side of the chest using a small incision. Once the new valve is in place, it immediately begins functioning in place of the patient’s valve. The TAVR procedure allows for valve replacement while the heart is beating, avoiding cardiopulmonary bypass.

The Structural Heart Team at Saint Joseph Hospital performs transfemoral and transapical approaches tothe TAVR procedure. During the transfemoral approach, an incision is made in the leg. During the transapical approach, an incision is made between the ribs to access the lowest point of the heart.

All TAVR procedures are completed in the Hybrid OR at Saint Joseph Hospital, where the Structural Heart Teamis able to work side by side with access to diagnostic and imaging equipment, advanced robotics and operating equipment. The Hybrid OR enables the team to work collaboratively and make informed decisions about patient care and evaluate procedures in real time.

LARIAT

Atrial fibrillation, or afib, is a heart rhythm disorder that’s associated with clot formation and dislodgment, leading to arterial blockages and resulting in a stroke if the clot migrates into the brain arteries.

Afib is seen frequently in the elderly and in patients with hypertension, diabetes or heart failure, or combinations of these problems. In order to reduce the risk of stroke in patients with afib, the standard of care is to place the patient on a blood thinner. However, not all afib patients are candidates for blood thinners, especially those with a history of bleeding events, or high risk for falls, noncompliance or bleeding disorders.

New technology approved by the FDA and used by the Structural Heart Team at Saint Joseph Hospital offers those patients an alternative to blood thinners.

A device called the LARIAT is used to isolate the left atrial appendage of the heart, which is where clots form in patients with afib.

The Structural Heart Team uses the LARIAT to separate the left atrial appendage, isolating it from the arterial circulation and thus eliminating the risk of clot formation and dislodgment into the circulatory system.

This minimally invasive procedure is done in the cardiac cath lab at Saint Joseph Hospital. Unlike invasive procedures, the LARIAT procedure is done through two small incisions. One catheter is placed inside the heart, while the other catheter goes outside of the heart to create a suture loop over the left atrial appendage to close it permanently. 

Contact Structural Heart Team

Nellie Goodin, Structural Heart Team Coordinator
P. 859.582.0038