Structural heart disease includes conditions in which the heart’s valves, chambers, or walls have damage or flaws that alter the flow of blood. These conditions may develop before birth or later in life, and early diagnosis often leads to better outcomes. The NHRMC Structural Heart Program, which is part of the NHRMC Heart Center, enables interventional cardiologists, cardiac surgeons, cardiac imaging specialists and electrophysiologists to work together to look at each patient comprehensively, determine the diagnosis and implement the best course of treatment.
For decades open heart surgery was the only way to treat people with various types of structural heart conditions such as holes in the heart, aortic stenosis, caused when a valve isn’t able to open properly, and heart valve regurgitation, when a valve doesn’t close properly and therefore can leak. Over the past few years, minimally invasive procedures are being offered through the NHRMC Structural Heart program, giving many patients with structural heart disease an alternative treatment option to open heart surgery.
NHRMC’s Structural Heart Program also offers patients with Atrial Fibrillation, or AFib, a minimally invasive procedure to reduce their risk of stroke.
“We use multi-disciplinary teams working with different modalities to treat patients with a variety of issues to advance their health,” said Dr. Lance Lewis, an interventional cardiologist with NHRMC Physician Group – Cape Fear Heart Associates. “We find the right procedure for the right patient by having all the specialists working together to make that decision.”
Frequently, minimally invasive procedures are nonsurgical catheter-based procedures guided by advanced imaging.
The minimally invasive options typically shorten the recovery time needed, require fewer days in the hospital, lower the risk of infection and reduce trauma to the chest wall and heart. They also provide an alternative for patients who are ineligible or at high risk for open heart surgery due to factors such as having a weak heart, other illnesses, or advanced age.
Below are some examples of minimally invasive structural heart procedures offered at NHRMC.
Transcatheter Aortic Valve Replacement, (TAVR)
What it treats
Transcatheter aortic valve replacement is used to treat patients with aortic stenosis, which occurs when the heart’s aortic valve narrows, preventing the valve from opening fully, restricting the blood flow from the heart.
How it works
“The only way to treat it in the past was to do an open heart surgery and cut out the old valves and sew in a new valve,” Dr. Lewis said. “This technology has allowed us to replace the aortic valve just by going in through the groin via a small incision, similar to a heart catheterization.”
While surgery can usually lead to spending three to five days in the hospital, those having TAVR typically go home a day or two after the procedure.
Candidates for the procedure include
Most people with aortic stenosis.
Atrial Septal Defect (ASD) closure device and Patent Foramen Ovale (PFO) Closure Device
What it treats
Percutaneous Atrial Septal Defect and Patent Foramen Ovale closure are minimally invasive repair options for people who were born with congenital holes in their heart. An atrial septal defect (ASD) is a heart defect present at birth that results in a hole between the upper chambers of the heart. “An ASD puts a strain on the heart,” Dr. Lewis said, adding that over time it can lead to atrial fibrillation or irregular heart rhythms and even heart failure. A patent foramen ovale (PFO) is a hole in the heart that didn’t close as it should after birth. The small flap-like opening normally closes during infancy. “PFOs can be associated with strokes,” said Dr. Lewis.
How it works
A cardiologist can go in through the groin to repair these holes. During the treatment, the physician threads a closure device through a catheter, sends it up to the heart where the device is inserted into the opening to plug it, closing the hole.
Candidates for the procedure include
Patients at risk for forming blood clots or having a stroke may be candidates. “In patients where we believe a PFO has caused a stroke, we put a plug in to close the PFO, and that can significantly reduce their risk for having another stroke,” Dr. Lewis said.
Paravalvular Leak Closures
What it treats
Paravalvular leak closures are for patients who have had a surgical valve replacement placed and have developed a leak around the device as a complication. The closure device works as a plug to close a hole or gap that has formed next to where the valve replacement was placed. The hole can lead to significant leaking which over time can lead to heart dilatation or heart failure.
How it works
The closure device stops leaking from the hole near replacement valve.
Candidates for the procedure include
Patients with a prior valve replacement with significant leak around the valve.
Dr. Lewis said after a surgical valve replacement improper healing around the new valve can lead to a small hole with blood leaking around the valve which puts a strain on the heart. “So, it’s important that we are able to treat them without a surgery,” Dr. Lewis said. “Another surgery could lead to another leak.”
Left Atrial Appendage Closure - WATCHMAN® Implant
What it treats
The procedure is used to reduce the risk of stroke and eliminate the need to take blood-thinning medication for certain patients.
Stroke is a serious risk for patients with atrial fibrillation because the top chamber of the heart beats irregularly, which can lead to decreased blood flow to the body. This can lead to blood clots forming. Blood clots can travel to the brain and lead to stroke. Most often the blood clots form in the left atrial appendage in the top left chamber of the heart.
To reduce the risk of stroke in patients with atrial fibrillation, anticoagulants, commonly known as blood thinners, are prescribed.
How it works
The WATCHMAN® is a parachute-shaped device with an attached woven fabric cap, and it’s used to close the left atrial appendage. The device is delivered through a catheter inserted into the body through a vein in the leg, and once the device reaches the left atrial appendage, it opens like an umbrella and is implanted. The purpose of closing the appendage with the device is to prevent blood clots in the left atrial appendage from entering the blood stream.
Candidates for procedure include
Patients with atrial fibrillation who are at increased risk for stroke and are not good candidates for taking long-term anticoagulants (blood thinners).
Transcatheter Mitral Valve Repair-MitraClip
What it treats
The MitraClip is a device used for transcatheter mitral valve repair, and it’s for patients who have severe leaking of the mitral valve.
How it works
The procedure involves implanting a device through a catheter to your mitral valve to improve mitral valve closure and reduce the leakiness.
Candidates for procedure include
Patients who aren’t good candidates for open heart surgery because they are considered high-risk surgical patients and may not recover well from open heart surgery because of other illnesses, their advanced age or because their hearts are very weak.