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Technology’s impact on the treatment of heart disease has reached a level many healthcare providers probably couldn’t have envisioned when they began their careers.
Patients with a myriad of heart conditions are now benefiting from such innovation at Edward-Elmhurst Health’s Cardiac Innovations & Structural Heart Center®. The Center’s physicians and providers care for patients at Edward Hospital in Naperville and Elmhurst Hospital. They use complex, minimally invasive heart procedures to treat patients who have often been told that traditional surgery is too risky.
What are some of these high-tech treatment options that are making a difference for heart disease patients?
"Before TAVR (transcatheter aortic valve replacement), we’d have to say to these patients, 'You'll want to get your affairs in order.' Now patients who would have faced certain death are having treatment that's highly successful," says Bryan Foy, M.D., a cardiothoracic surgeon with Cardiac Surgery Associates who performs surgery Edward-Elmhurst Health.
TAVR is a treatment for severe aortic stenosis, a narrowing of the valve opening that leads from the body's main artery, the aorta. This makes it difficult for the heart to pump sufficient blood to the rest of the body. Valve replacement through open heart surgery is the treatment of choice, but some patients are considered too high risk for this invasive approach.
Edward-Elmhurst is one of the few providers in Illinois that performs TAVR to treat high-risk patients who can’t have traditional open heart surgery. In the procedure, a small incision is made in the patient’s chest (in some cases access is through the groin) and a sheath (tube) about the width of a pencil is inserted into the heart.
After that, the narrowed valve is widened by expanding a balloon attached to a catheter that was sent through the sheath. This sets the stage for delivery of the Edwards Lifesciences SAPIEN prosthetic heart valve, in compressed form, to the existing valve. The new valve is expanded, pushing the diseased valve aside.
Dr. Foy and a team of 20 performed the three-hour TAVR procedure on Leon Lasota in November 2013 at Edward Hospital. Lasota was 92 years old at the time. Now 95, he’s still doing well. All things considered, his experience with severe aortic stenosis and the TAVR procedure pale in comparison to events earlier in his life.
The Romeoville resident survived an attempt on his life in the late 1930s arising from political conflicts in his native Poland. During World War II he escaped Buchenwald, a Nazi concentration camp, after a three-year imprisonment, and he suffered a gunshot wound while serving in the armed forces.
"I was very pleased about the less invasive surgery and felt very comfortable and confident with the doctors,” says Lasota. “My recovery was quick and better than I expected. I no longer have trouble breathing, especially when walking."
In March 2015, Edward became the first community hospital in the Chicago area to use the catheter-based MitraClip Percutaneous Mitral Valve Repair System to treat patients with severe mitral regurgitation (MR). This serious condition occurs when a weakened mitral valve allows blood to leak backward into the heart, forcing it to pump the extra blood.
In the past, open heart surgery to repair or replace the valve was the only alternative if medications weren't working. The MitraClip, which was FDA-approved in 2008, provides a much less invasive option for MR sufferers who are too sick for open heart surgery. The physician delivers the device via catheter to the left ventricle of the heart, where the clip is positioned so it can grasp the valve's leaflets and control the flow of blood.
Mark Goodwin, M.D., system medical director of Edward-Elmhurst Health’s Cardiac Innovations & Structural Heart Center and interventional cardiologist with Advocate Medical Group, and the cardiac team performed valve repairs using MitraClip on two women in their 80s. He says, "Both patients were discharged to home within a week without complications and are doing well." The procedure has been shown to control MR, improve cardiac function and reduce hospitalizations for heart failure.
Edward-Elmhurst is currently one of only a few providers in the country to offer the WATCHMAN implant to treat atrial fibrillation (AFib), a common heart rhythm problem. AFib comes with a five-fold increased risk of stroke caused by a blood clot, and an AFib-related stroke is more often disabling or fatal.
During the catheter-based implant procedure, the WATCHMAN device is inserted into a vein in the leg, where it’s guided to a pouch in the heart called the left atrial appendage. This is the area where blood tends to pool and form stroke-causing blood clots in people with AFib. Once the device is in place, its parachute-like component is opened to about the size of a quarter. This seals off the area, preventing blood clots from traveling through the blood stream to the brain where they can cause a stroke.
Dr. Goodwin believes WATCHMAN technology will be considered one of the most significant developments in the treatment of AFib.
Edward used left ventricular assist device (LVAD) the first time in 2012 to treat a 67-year-old male patient. “Without this, he certainly would have died,” says Dr. Foy. “In (this patient’s case), it brought him from end stage heart failure, with a risk of death within six months, to a heart function that's tantamount to normal."
LVAD, which also is used as a "bridge to transplant" for patients on a waiting list, is just one of the heart failure treatments that were unavailable to people of earlier generations. “More people need to know that if you develop heart failure there are options available. You don't have to suffer in silence," says Dr. Foy.
Edward is the only community hospital in the Chicagoland area to offer LVADs to non-transplant patients.
Coronary artery chronic total occlusions (CTOs) remain a clinical dilemma and a challenge for clinicians treating patients with cardiovascular disease. There are hundreds of thousands of people with CTOs, which, in many cases, were untreatable. Some CTOs are treated with bypass surgery, but 60 percent of patients with CTOs are treated only with prescription drugs.
Now, new techniques and strategies developed by an elite group of doctors from around the world, including Edward-Elmhurst Health cardiologists like Dr. Goodwin, have made it possible to unclog those arteries. These new techniques have allowed doctors to reopen the clogged arteries 90 percent of the time.
“This is a great new advance to give patients options and improve their quality of life,” Dr. Goodwin says. “(One of the patients we treated) had no options. Afterward, he felt like he got his life back.”
Edward-Elmhurst is a national training site for CTO procedures and among the leaders in the country in terms of its success rate. If a blockage is too hard to push through, doctors have developed new techniques to go around or through the blockage.
Topera 3D Mapping System
Nearly three million people in the U.S. have atrial fibrillation (AFib), an irregular heart rhythm that makes a person feel breathless, tired, weak or dizzy. It’s a condition that, if left untreated, can lead to congestive heart failure. Afib also increases a person’s risk of having a stroke.
In September 2014 at Elmhurst Hospital, Holly Linneweh became the first patient in Illinois to be treated with the Topera 3D Mapping System, which allowed doctors to pinpoint the locations of the chaotic electrical activity that disrupted the normal rhythm of Linneweh’s heart and caused the persistence of her AFib episodes.
A catheter is inserted into the upper chambers (atria) of the heart where an expandable “basket” conforms to the shape of each heart chamber. The basket has eight “splines” with 64 evenly spaced electrodes that create a three-dimensional map of each chamber, which enables doctors to find the exact sources of the arrhythmia, and quickly and precisely ablate the spots in the heart with improved results.
Studies show an 80-85 percent success rate one year after an ablation procedure using the 3D mapping system. That’s a success rate that was previously unheard of for the treatment of patients with persistent AFib. Before the new mapping technology, success rates when using ablation to treat persistent AFib had only been about 40-60 percent.
In spring 2014, Elmhurst Hospital became the first hospital in the western suburbs to implant the smallest available wireless cardiac monitor in a patient — the Medtronic Reveal LINQ Insertable Cardiac Monitor System. The patient had been experiencing fainting episodes for a period of time. Traditional cardiac testing and monitoring devices were unable to determine what was causing the episodes.
The Reveal LINQ monitor, about one-third the size of an AAA battery, allows doctors to track her irregular heartbeat (a risk factor for stroke) for up to three years while remaining virtually undetectable under her skin.
The insertion is done on an outpatient basis. The monitor is placed just below the skin via an incision that is less than 1 cm, and is nearly invisible to the naked eye once inserted. The monitor transmits data daily to a patient’s physician, who can request notifications to alert them if the patient is having a cardiac event.
Each night while the patient sleeps, information stored on her monitor is wirelessly transmitted to the doctor’s office via a remote monitoring system. While a continuous record of cardiac activity is transmitted each day, the patient has a handheld device that can be used to alert the doctor’s office when she feels unusual cardiac activity, such as an irregular heartbeat or a fainting episode.
External cardiac monitors are not worn for extended periods of time and may not capture an episode of atrial fibrillation. The insertable cardiac monitor, on the other hand, can be left in place for up to three years, which increases the chances of detecting a condition.
This monitor is a game changer in the diagnosis of cardiac arrhythmias. It’s an easy procedure for the patient and the subsequent monitoring doesn't interrupt their lifestyle while we wait for a diagnosis.
Edward is among the first hospitals in the country to offer a breakthrough approach in the treatment of peripheral artery disease (PAD) in the upper leg. This common condition, which significantly increases the risk of heart attack and stroke, results from plaque build-up in the arteries in the leg. Traditional treatment involves angioplasty using a plain balloon-tipped catheter that's threaded through the body to the site of the blockage.
In December 2014, the FDA approved the IN.PACT Admiral drug-coated balloon for use in this type of procedure in the upper leg. The balloon delivers a drug to the artery walls to help prevent the artery from narrowing again. In February 2015, Dr. Goodwin and the cardiac team performed an angioplasty at Edward using IN.PACT on a patient with PAD in his upper leg. Edward also had been a site for an IN.PACT clinical trial.
Studies demonstrated significantly better outcomes with the IN.PACT drug-coated balloon, compared to the plain balloon, for treatment of PAD in the upper leg. There also is less need for stenting and repeat procedures.
"In the past, there was a high rate of re-narrowing in the artery within a couple of years,” says Dr. Goodwin. “With the drug-coated balloon, that rate falls to less than 20 percent."
You can depend on the Cardiac Innovations & Structural Heart Center® team at the Heart Hospital of Edward-Elmhurst Health to effectively treat your heart condition with a number of minimally invasive options.
Learn more about innovations in cardiac care at Edward-Elmhurst Health.
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