The Structural Heart & Valve Clinic at Mary Washington Hospital focuses
on assessing patients dealing with aortic valve stenosis. This condition
arises when the aortic valve becomes narrower, causing a blockage in the
blood flow from the heart to the rest of the body through the aorta. As
the condition worsens, the heart becomes weaker due to the increased effort
needed to pump blood across the narrowed valve.
For those facing aortic stenosis, there's a technique called TAVR (transcatheter
aortic valve replacement). It's a minimally invasive surgical method that
offers a treatment option for patients who might not be suitable candidates
for the traditional open heart surgery due to moderate risk or other reasons.
If you're experiencing symptoms related to aortic stenosis, it's a good
idea to discuss your situation with your cardiologist. They can guide
you through an assessment at Mary Washington Hospital's Valve Clinic to
explore potential alternative treatment plans.
Collaborative Heart Care Team
Mary Washington Hospital’s Structural Heart & Valve Clinic Team
consists of specialists with various areas of expertise who review each
patient’s tests and results to develop a customized treatment plan.
John Cardone, MD, and Alex Na, MD, cardiothoracic surgeons; Arijit Chanda,
MD, and Micaela Iantorno, MD, interventional cardiologists, work with
cardiologists and primary care physicians in the region to make life-saving
aortic stenosis treatment options available to patients.
A multidisciplinary heart team reviews patient test results in conjunction
with the patient’s cardiologist or referring physician to determine
an appropriate treatment plan which may include Transcatheter Aortic Valve
Replacement (TAVR), surgical aortic valve replacement or medical therapy.
A dedicated Valve Clinic Coordinator assists potential patients with navigating
the evaluation and testing process and facilitates the recommendations
of the Collaborative Heart Team and referring cardiologist.
TAVR – Transcatheter Aortic Valve Replacement
TAVR (transcatheter aortic valve replacement) is a minimally invasive surgical
technique that makes heart valve replacement a treatment option for many
patients who have aortic stenosis but are considered moderate risk or
are not surgical candidates for traditional open heart surgery. TAVR is
a less invasive option that enables surgeons to use a catheter to guide
an artificial heart valve through the carotid artery or an artery in the
groin -- directly into the heart, position it within the patient’s
native heart valve and implant the new valve allowing it to restore blood flow.
Because it is less invasive, TAVR typically has a shorter recovery time
and lower risk for complications than traditional open heart surgery.
Post-procedure hospitalization is typically 2-4 days. Risks for stroke
and other complications are similar to traditional surgical valve replacement.
Your physician can help you determine the best treatment options based
on your condition.
Mary Washington Hospital’s Cardiac Hybrid Room, designed specifically
for TAVR procedures, combines equipment and features found conventional
operating rooms with state-of-the-art imaging technology.
Please contact your cardiologist with additional questions or for a referral
to one of our surgeons.
WATCHMAN: A One-Time Implant that Helps Reduce AFib Stroke Risk
Mary Washington Hospital adds Watchman treatment for Atrial Fibrillation
to its heart patient services.
How Does AFib Increase Stroke Risk?
The average person with atrial fibrillation (also called AFib or AF) is
five times more likely to have a stroke than someone with a regular heartbeat.1 That’s because AFib can decrease the heart’s pumping capacity
by as much as 30%.2 Because blood isn’t pumped out of the heart normally, it’s
easier for blood cells to stick together and form clots in an area of
the heart called the left atrial appendage (LAA).2, 3 When a blood clot escapes from the LAA and travels to another part of the
body, it can cut off the blood supply to the brain, causing a stroke.1, 4
An Alternative to Blood Thinners
WATCHMAN is a permanent implant that offers an alternative to the lifelong
use of blood thinners. It’s about the size of a quarter and made
from very light and compact materials commonly used in many other medical implants.
How WATCHMAN Works
WATCHMAN effectively reduces the risk of stroke by permanently closing
off the LAA to keep blood clots from escaping. WATCHMAN can eliminate
the bleeding risks and regular blood tests and food-and-drink restrictions
that come with warfarin. In a clinical trial, 9 out of 10 people were
able to stop taking warfarin just 45 days after the WATCHMAN procedure.6
How is WATCHMAN Implanted?
WATCHMAN is implanted into your heart in a one-time procedure. To implant
WATCHMAN, your doctor makes a small cut in your upper leg and inserts
a narrow tube, as done in a standard stent procedure. Your doctor then
guides WATCHMAN into your heart’s LAA. The procedure is done under
general anesthesia and takes about an hour. Patients commonly stay in
the hospital overnight and leave the next day.
After the Procedure
Following the WATCHMAN procedure, you’ll take warfarin for 45 days
or until your LAA is permanently closed off. During this time, heart tissue
will grow over the implant to form a barrier against blood clots. Your
doctor will monitor this process by taking pictures of your heart to see
when you can stop taking warfarin.
Your doctor will then prescribe a medicine called clopidogrel (also known as Plavix®) and aspirin for you to take for six months. After that, you’ll
continue to take aspirin on an ongoing basis. A very small number of patients
may need to keep taking blood thinners long term.
In a clinical trial:
92% of patients were able to stop taking warfarin just 45 days after the procedure6
99% of patients were able to stop taking warfarin within 1 year after the procedure6
Is WATCHMAN Right for You?
If you have a history of bleeding or a lifestyle, occupation or condition
that puts you at risk for bleeding, WATCHMAN may be right for you. But
like any medical procedure, WATCHMAN comes with risks, so it isn’t
right for everyone.
Your cardiologist will weigh your risk of a stroke against your risk of
a serious bleeding problem to determine the right treatment for you.
Sources
1. National Stroke Association.
Making the Afib-Stroke Connection. https://www.stroke.org/sites/default/files/resources/Afib-Connection%20for%20hcp.pdf.
Published 2012. Accessed September 1, 2016.
2. Harvard Health Publications. Atrial fibrillation. http://www.health.harvard.edu/heart-health/atrial-fibrillation-common-serious-treatable. Harvard University Medical School. Published November 2011. Accessed August 25, 2016.
3. Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in
cardiac surgical patients with atrial fibrillation.
Ann Thorac Surg. 1996;61:755-759.
4. Cleveland Clinic. Atrial fibrillation (Afib). http://my.clevelandclinic.org/services/heart/disorders/arrhythmia/atrial-fibrillation-afib. Published May 2015. Accessed August 25, 2016.
5. National Stroke Association. Making the Afib-Stroke Connection. https://www.stroke.org/sites/default/files/resources/Afib-Connection%20for%20hcp.pdf. Published 2012. Accessed September 1, 2016.
6. Holmes DR Jr, Kar S, Price MJ, et al. Prospective randomized evaluation
of the Watchman Left Atrial Appendage Closure device in patients with
atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial.
J Am Coll Cardiol. 2014;64(1):1-12.
