LEXINGTON In February 2014, MD-UPDATE Issue #84 shared the story of the “Heart Team” at KentuckyOne Health Cardiology Associates at Saint Joseph Hospital in Lexington. The team included cardiothoracic surgeons – Dermot Halpin, MD, FACS, Hamid Mohammadzadeh, MD, FACS, and Robert Salley, MD, FACS; and two cardiologists – Nezar Falluji, MD, MPH, FACC, FSCAI, and Michael Schaeffer, MD, FSCAI.
“At Saint Joseph Hospital, we’ve developed what I call a ‘Heart Team’ approach to caring for the cardiac patient,” Halpin said. “This unique team approach is a game changer, and it puts the patient at the heart of the matter.”
On the aortic stenosis front, the percutaneous valve team is now using the newly introduced self-expanding CoreValve® by Medtronic. This valve has a smaller sheath size, enabling it to be delivered in patients whose femoral arteries are not large enough to accommodate the Edwards SAPIEN Transcatheter Heart Valve™. “With the CoreValve, the size of the delivery system makes it very easy to deliver in most if not all patients,” says Falluji, executive co-director of KentuckyOne Health Heart and Vascular Care. “The selection between the two valves is based on the patient’s profile, the size of their vessels, and the other anatomical considerations. These are the only two valves available currently, but others are coming.”
On the mitral valve front, the team performed its first procedure together on July 7, 2013 at Saint Joseph Hospital (first in the state of Kentucky), but much has changed since then, and even more since early 2014. A significant change was the FDA approval for commercial repair of mitral valves in people with mitral valve disease. These patients are deemed high-risk by a surgical evaluation secondary to co-morbidities or prior open-heart surgeries. “Patients who have severe mitral regurgitation struggle with symptoms of heart failure and are frequently hospitalized due to heart failure symptoms,” Falluji says. “Now with this minimally invasive approach, these patients get a repair percutaneously using the Mitraclip system, a metal clip placed between the leaflets of the mitral valve, eliminating or at least reducing, mitral regurgitation. This reduces their hospitalization and gives them a better quality of life, making them breathe better and reducing symptoms of heart failure.”
Falluji reports that KentuckyOne Health Cardiology Associates has successfully performed 16 of these procedures. “That makes us the most experienced center in the state,” Falluji says. “I think experience brings success because the more you do, the better you get at this.” The reduced hospital stay for patients is notable across the board. The longest stay for any of these patients has been two to three days, with many returning home in less than 48 hours. The Heart Team is about to launch a clinical trial called “The Parachute Trial.”
This is another minimally invasive procedure in which a device is deployed percutaneously for patients with severe heart failure secondary to prior myocardial infarction-related damage to the front and apex of the heart.
Yet another relatively new procedure for KentuckyOne Health Heart and Vascular Care is the LARIAT Procedure, which became FDA approved about a year and a half ago. This procedure is used on patients with atrial fibrillation who have difficulty with blood thinners, putting them at risk for strokes. “With the LARIAT procedure, we isolate the left atrial appendage of the heart, which is the source of clot formation in patients with atrial fibrillation,” Falluji says. “This potentially eliminates that risk in patients who are unable to take blood thinners.”
“The device is deployed coming through the groin and also by a small incision under the sternum,” Falluji continues. “We create a rail, and we connect that rail with magnets through the atrial appendage wall. A little noose is then advanced over that rail, and we use that noose to ligate the appendage at its neck, isolating it from the rest of the atrium and from the rest of the circulation. It is a minimally invasive procedure with a recover y time of about two days after the procedure.”
While all of the new procedures, technologies, and capabilities are significant, perhaps the biggest ongoing change for Falluji and his peers is the formation of KentuckyOne Health. “The evolution of this organization is a very important development in the state,” Falluji says. “This is a big organization now. It has opened up relationships with academia, brought up the experience of private practices, and put those together in order to establish centers of excellence between Louisville and Lexington.”
He concludes, “Our collaborative relationship has been very helpful because it brings the University of Louisville Medical School’s academic excellence to that of the well- known, well-established hospitals, which have a long tradition of excellent cardiovascular care.”
EXPERIENCE BRINGS SUCCESS BECAUSE THE MORE YOU DO THE BETTER YOU GET AT THIS.– NEZAR FALLUJI, MD EXECUTIVE CO-DIRECTOR, KENTUCKYONE HEALTH HEART AND VASCULAR CARE
FOR PATIENT REFERRAL CONTACT: Nezar Falluji, MD KentuckyOne Health Cardiology Associates 1401 Harrodsburg Road, Suite A-300 Lexington, KY 40504 859.276.4429