New Car­diac Pro­ce­dures Come to Naples

NCH Heart In­sti­tute un­veils Struc­tural Heart Pro­gram

Gulf & Main - - Contents -

Some­times, the best just keeps get­ting bet­ter. The NCH Heart In­sti­tute—al­ready ranked among the top 10 per­cent of car­diac sur­gi­cal ser­vice providers na­tion­wide—re­cently an­nounced the ad­di­tion of a new pro­gram that brings two new cut­ting-edge car­diac pro­ce­dures to Col­lier County.

The NCH Struc­tural Heart Pro­gram, launched in fall 2017, in­tro­duces the tran­scatheter aor­tic valve re­place­ment (TAVR), a non­in­va­sive pro­ce­dure for aor­tic steno­sis, and the Watch­man im­plant, used to re­duce atrial fib­ril­la­tion (AFib) stroke risk.

“We want to cre­ate a fully com­pre­hen­sive valve cen­ter for the treat­ment of all car­diac valvu­lar dis­eases, whether sur­gi­cal or tran­scatheter,” ex­plains Dr. Brian Solomon, NCH Heart In­sti­tute car­dio­tho­racic sur­geon. “We have ex­panded not just the amount, but also the depth of sur­gi­cal pro­ce­dures, which al­lows us to achieve that goal—of­fer­ing the full spec­trum of pro­ce­dures with a com­pre­hen­sive team of car­di­ol­o­gists and sur­geons. Now, we can take on the most chal­leng­ing and com­pli­cated cases and have ex­cel­lent out­comes.”

Ac­cord­ing to Solomon, the TAVR pro­ce­dure al­lows car­diac sur­geons to treat aor­tic steno­sis in intermediate- and high-risk pa­tients. “It is an equiv­a­lent type of surgery for those who may not oth­er­wise sur­vive open­heart surgery, giv­ing them the same out­come,” he says. “In­stead of a chest in­ci­sion and with­out re­quir­ing us to stop the heart, a catheter is in­serted into a groin artery.”

Solomon trained at New York Univer­sity un­der the TAVR pro­ce­dure’s de­vel­oper, per­form­ing the pro­ce­dure on about 400 pa­tients. He was also in­volved in the ini­tial train­ing for FDA ap­proval, and in FDA and pri­vate tri­als for the pro­ce­dure when it was first in­tro­duced.

The Watch­man Im­plant pro­ce­dure, an al­ter­na­tive to pre­scrip­tion War­farin for pa­tients with AFib not caused by a heart valve problem, was brought to the car­diac pro­gram by Dr. Di­nesh Sharma, NCH Heart In­sti­tute car­di­ol­o­gist, spe­cial­iz­ing in elec­tro­phys­i­ol­ogy, who trained at Mount Si­nai Hospi­tal in New York.

Sharma says that AFib is a com­mon cause of stroke be­cause blood flow is slug­gish. “Clots start form­ing in a small pouch in the up­per left cham­ber of the heart, the ap­pendage,” he ex­plains. “We can im­plant the Watch­man, which is like a plug, into that pouch to seal the ap­pendage from the rest of the up­per cham­ber. Re­cov­ery is six hours of bed rest, an overnight stay, then the pa­tient is dis­charged.”

Ac­cord­ing to Sharma, pa­tients are then pre­scribed blood thin­ners, and af­ter six weeks, an echocar­dio­gram is per­formed to en­sure that the seal is com­plete. When the seal is con­firmed, blood thin­ners are dis­con­tin­ued, and the pa­tient is put on an as­pirin reg­i­men. Can­di­dates for the Watch­man im­plant in­clude AFib pa­tients at risk of stroke who can­not tol­er­ate blood thin­ners such as War­farin, Coumadin, Eliquis or Xarelto for long­time use, or who are at high risk for falls or other is­sues.

Pa­tients who are un­der a car­di­ol­o­gist’s care can re­quest an eval­u­a­tion to see if they are good can­di­dates for this pro­ce­dure, says Vanessa Russino, ARNP-BC, NCH Struc­tural Heart Pro­gram co­or­di­na­tor. She fol­lows up with all pro­gram pa­tients and says pa­tients re­port ex­cel­lent re­sults and are very pleased with the Watch­man im­plant pro­ce­dure that al­lows them to stop us­ing blood thin­ners.

Brian Solomon, M.D. Di­nesh Sharma, M.D.

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