The TAVR Procedure
For high-risk patients with valvular insufficiency who are not candidates for open heart surgery, another option is now available: transcatheter aortic valve replacement (TAVR), a catheter-based alternative treatment not requiring open heart surgery. TAVR produces results in lengthening patients’ lives.
The TAVR procedure can be performed through two different approaches:
Transfemoral approach - In the transfemoral approach, the valve is delivered via a catheter through the femoral artery.
Transfemoral TAVR Indication - The Edwards SAPIEN transcatheter heart valve is indicated for transfemoral delivery in patients with severe symptomatic calcified native aortic valve stenosis, without severe aortic insufficiency and with ejection fraction >20%, who have been examined by a Heart Team including an experienced cardiac surgeon and cardiologist and found to either be: 1) inoperable and in whom co-morbidities would not preclude the expected benefit from correction of the aortic stenosis; or 2) operative candidates for aortic valve replacement, but who have a Society of Thoracic Surgeons predicted operative risk score ≥8%, or are judged by the Heart Team to be at a ≥15% risk of mortality for surgical aortic valve replacement.
Transapical approach - In the transapical approach, the valve is delivered via a catheter through the apex of the heart.
Transapical TAVR Indication - The Edwards SAPIEN transcatheter heart valve is indicated for transapical delivery in patients with severe symptomatic calcified native aortic valve stenosis, without severe aortic insufficiency and with ejection fraction >20%, who have been examined by a Heart Team including an experienced cardiac surgeon and cardiologist and found to be operative candidates for aortic valve replacement, but who have a Society of Thoracic Surgeons predicted operative risk score ≥8% or are judged by the Heart Team to be at a ≥15% risk of mortality for surgical aortic valve replacement. The TAVR procedure is not right for all patients. In certain cases, the risks of the procedure may outweigh the benefits.
Deborah now offers the LARIAT procedure. Used in treating atrial fibrillation, this novel procedure offers hope to patients who cannot take blood thinners to reduce the risk of stroke from this irregular heart rhythm. Two magnetic wires are threaded to the heart's left atrial appendage. One magnetic wire is advanced into the appendage from the inside via a trans-septal heart catheterization. A second magnetic wire is manipulated to the outside tip of the appendage through a catheter inserted via a puncture through the skin, and advanced into the space between the ribs and the heart. When the wires get close to each other, their magnetic attraction joins them together. The appendage is then "lassoed" by a loop stitch advanced over the outer wire to the base of the atrium and tightened. This permanently seals off the left atrial appendage and blocks stroke-causing blood clots from traveling to the brain.
Advanced Cardiac CT Scanner
The Dual Source SOMATOM Definition CT is available at Deborah. The scanner's speed, detail, and non-invasive nature make this addition one of the most exciting new technologies available today. When you add this technology to the expertise and capabilities of this specialty heart hospital, the advantages to patients are significant.
The SOMATOM Definition CT uses two x-ray sources simultaneously which makes it the fastest CT available. It is faster than every beating heart. This is significant because until now, cardiac imaging was only feasible if the patient’s heart rate was adequately low and stable. The ability of this technology to ‘freeze’ the motion of a constantly beating and moving heart is critical to capturing high quality images.
ENERGEN CRT-D and ICD Device
The ENERGEN cardiac resynchronization therapy defibrillator (CRT-D) and implantable cardioverter defibrillator (ICD) is used to treat heart failure and sudden cardiac death. The system is designed to simplify and reduce the time needed for the implant procedure by combining three separate lead terminals into one integrated connector and reducing the number of connections and set screws needed in the device header. In addition, some patients will receive a remote monitoring system where an at-home communicator will allow physicians to monitor the patient’s device, as well as vital signs such as blood pressure and weight, in order to better manage this complex disease.
QuickOpt Technology Software technology that allows pacemaker patients to receive a “tune-up” check-up in less than 2 minutes when they come to Deborah’s Pacer Clinic for routine follow-up visits. It replaces a traditional echocardiogram, which is time-consuming and costly, and offers greater flexibility for Deborah doctors to quickly optimize devices (make sure they are working up to full potential) as often as necessary.
Rotational Atherectomy or Rotablator
Rotational atherectomy or Rotablator is a tiny football shaped diamond coated burr which comes in various sizes to match the vessel size being treated. It spins anywhere from 110,000 to 180,000 RPM (depending on the size) and is designed to ablate or cut away heavily calcified blockages. It works on the principle of differential cutting (like a cast saw), where the heavily calcified and fibrosed tissue is cut, but the healthy tissue is left unaffected. The ablated material is cut into 4 to 6 micron bits (smaller than a red blood cell) which essentially percolates away in the blood stream and is eventually cleared from the blood or “eaten” by white blood cells called macrophages. Rotational atherectomy is usually not a “stand alone” procedure; rather it is used as an adjunct to clear the tough, heavily calcified blockage, make the vessel more compliant, and therefore make it easier to balloon dilate or stent the vessel.
Stereotaxis Gentle Touch Magnetic System
Allows doctors the ability to view the inside of the heart, both anatomically and electrically. This machine also enables them to perform remote-controlled, image-guided computerized heart procedures, combining robotics, and 3D mapping system to create a map of the heart.
The Stereotaxis system allows doctors to use magnets to steer catheters gently and precisely through delicate areas of the heart. Because the catheters are driven by a magnetic steering system, they exert an even and steady pressure, which removes the potential for damage to the heart. The Stereotaxis system is able to navigate into the most remote areas of the heart, uncovering hidden damage and problems to provide the most comprehensive look at the heart’s electrical anatomy.
The TAPAS™ Catheter
The TAPAS Catheter is designed for use in peripheral vascular disease treatment. It is an innovative system with two compliant occlusion balloons that can deliver a controlled therapeutic -- or diagnostic -- agent and dose. This therapeutic infusion system has an adjustable length, so that long vessels can be treated with one device. It also offers the capability of extracting the medicine out of the vascular treatment zone if necessary, so there is no drug run-off during a localized intravascular treatment. The TAPAS Catheter can be used in conjunction with other interventional devices.
Unify CRT-D and Fortify ICD
Deborah is the first hospital in the region to implant new defibrillators, recently approved by the FDA, – the Unify CRT-D and the Fortify ICD.
The new devices increase the possibilities of heart failure patients and those with abnormal heart rhythms to live a longer, better quality of life. These devices also improve patient comfort with less bulk, reducing the need for set screws and lead connections to the device.