Overview of key technological advancements in cardiac interventional procedures
by Curtiss Stinis, Interventional Cardiologist
Heart disease remains the number one cause of death among both men and women in the United States. Fortunately, however, statistics show that fewer people are dying from cardiac disease today as compared to 10 years ago.
This is due in part to an improved understanding of heart-related diseases, development of more effective medications to treat heart disease, and key technological advancements in cardiac interventional procedures.
Stent replacement vs. traditional bypass surgery
Over the past few decades, however, angioplasty and the development of increasingly advanced stents have revolutionized CAD treatment, and many patients now opt for stent placement rather than traditional bypass surgery because of much shorter recovery times; patients often go home the next morning and are back to their usual routine within just a few days.
Minimally invasive procedures for aortic stenosis
Disease of one or more of the valves of the heart (known as valvular heart disease) is another common condition; the valves either leak or restrict the flow of blood. Among older Americans, a form of valvular heart disease known as aortic stenosis is especially prevalent.
In this condition, the aortic valve becomes thickened by calcium deposits and cannot open properly, which creates elevated pressure on the heart chambers and decreases the amount of blood leaving the heart. This can lead to shortness of breath, chest pain, fainting spells, congestive heart failure and even death.
Until recently, open heart surgery was the only viable treatment for aortic stenosis; the surgeon would open the chest, remove the diseased valve, and replace it with a mechanical valve or one made of cow or pig tissue.
Because many aortic stenosis patients are elderly and often have multiple coexisting medical problems, they may not tolerate this type of surgery.
Scripps is currently one of only a handful of hospitals participating in an FDA-approved clinical research trial designed to determine the safety and effectiveness of a new trans-catheter aortic heart valve replacement procedure for patients who are at high risk for traditional open heart surgery.
In this minimally invasive procedure, a cow tissue valve very similar to that used in traditional open surgery is stitched onto a large stent, which serves as the “scaffolding” for implanting the valve into the heart.
This is then compressed onto a balloon catheter that is about the diameter of a pen, and threaded through the patient’s circulatory system from a small incision in the leg or inserted directly into the heart between the ribs. The balloon is inflated, and the valve is placed onto the heart.
This less invasive procedure offers the possibility of fewer risks and complications than open heart surgery, and appears to be an excellent alternative for high-risk patients.
We have seen dramatic improvements in patients so far in the clinical trial, and expect this procedure to become a mainstream treatment for aortic valve disease in the coming years.
Advances in treatment for mitral regurgitation
Another promising advancement involves treatment for mitral regurgitation, which occurs when there is a leak in the mitral valve, which regulates the flow of blood from the left atrium into the left ventricle of the heart.
Conventional therapy usually involves open heart surgery to repair or replace the leaky valve, however, newer technologies use a small catheter inserted into the heart to stitch or clip the valve walls together and stop the leak.
Scripps will participate in a research study to further develop this technology in the next year.
New hypothermia treatment for cardiac arrest patients
Finally, we’ve all heard anecdotal stories of children who have fallen into frozen lakes or rivers and are revived successfully with no brain damage. Scientists have long known that cold temperatures seem to slow and potentially preserve brain function; this is the basis for a new hypothermia treatment for cardiac arrest patients.
When someone suffers cardiac arrest, the heart stops pumping blood to the body and brain; time is critical to restore circulation and limit the amount of damage to the brain and other organs.
Ideally, CPR or an electrical shock delivered to the patient’s heart will resume normal function, but if the brain is deprived of oxygen for too long, permanent brain injury may result. Scripps La Jolla is one of several centers around the country pioneering the use of hypothermia therapy to cool patients down in an attempt to minimize damage to the brain or nervous system in such scenarios.
We use various methods to reduce body temperature, including wrapping patients in cooling blankets and infusing cool liquid into the bloodstream, then slowly bring temperature back to normal over several hours. We have had several dramatic patient success stories as a result of this therapy.
Such cutting-edge therapies offer patients more successful, safer and cost-effective treatments for serious illnesses, and Scripps continues to be among the first hospitals in the country to investigate these new approaches.
This Scripps Health and Wellness information was provided by Curtiss Stinis, interventional cardiologist at Scripps Clinic.