Experts from Hackensack Meridian Jersey Shore University Medical Center’s Structural Heart Disease Program recently performed, to the program’s knowledge, New Jersey’s first transcatheter double heart valve replacement, combined with a procedure to improve blood flow in the heart. The three treatments were completed together during one visit to the academic medical center’s advanced hybrid operating room, to ensure the patient’s safety.
The patient is now home and is recuperating well, after dealing with cardiac issues for several years. Cardiothoracic Surgeon Kourosh Asgarian, D.O., performed coronary artery bypass graft surgery (CABG) to correct blocked arteries in 2017 and since that time, she has been under the care of her cardiologist Steven Daniels, M.D. Over the past year, Dr. Daniels became very concerned for the patient, as two of her valves deteriorated and heart functions weakened, forcing her to frequently seek care for congestive heart failure. He consulted with Jersey Shore University Medical Center’s Structural Heart Disease Program Director Matthew Saybolt, M.D., FACC, and Dr. Asgarian to discuss potential treatment options. The two physicians then performed the combined corrective procedures.
The patient was struggling simultaneously with severe aortic stenosis and severe mitral valve stenosis, or narrowing of the heart valve openings, heart failure, pulmonary hypertension, and substantial calcification of the heart valves. “Since the patient could not safely undergo open heart surgery for a second time, and was suffering with these conditions, we decided it was best to avoid completing multiple procedures at separate times, that would strain the patient’s heart,” said Dr. Saybolt. “To reduce the risk to the patient who was likely to struggle if we delayed complete correction over many months, we performed the minimally invasive valve replacements, TAVR and TMVR, simultaneously followed by a procedure called an alcohol septal ablation to make room in the heart chamber for these prosthetic valves and ensure blood flow was not impeded.”
“Serving as a health care executive for many years, I can safely say, I have never met a more amazing team of interventional cardiologists, echocardiographers, electrophysiologists, cardiologists, and cardiac nurses,” said Vito Buccellato, MPA, LNHA, chief hospital executive, Jersey Shore University Medical Center. “I’m proud that they are able to provide their expertise and compassion to our community.”
Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure that treats aortic stenosis. Physicians place a new aortic heart valve with a catheter inserted in a major leg artery, through the patient’s vascular system. The new valve, made from a stent and animal heart tissue, is delivered inside the diseased valve to increase blood flow.
Transcatheter mitral valve repair (TMVR) works the same way but rather than replacing an aortic valve, a valve designed for aortic valve replacement or TAVR, is used in a compassionate and off-label way to treat the mitral valve when no other options exist. “Another procedure we have expertise in, the MitraClip procedure, while FDA approved and commercially available would not have worked for this patient because her valve was too tight and hardened with calcium,” said Dr. Saybolt. “We planned well in advance for the possibility that replacing two valves at once may result in some crowding within the chamber of the heart which we detected intra-operatively and corrected successfully with an alcohol septal ablation procedure.” A catheter with a balloon tip is used during the septal ablation to inject alcohol into the select arteries supplying an abnormally thickened portion of the patient’s heart, essentially stunning it and causing it to thin out over time. “This is a procedure I typically offer to patients with a different disease called hypertrophic cardiomyopathy, but we repurposed it to treat our patient,” said Dr. Saybolt.
“I’m happy to say the patient was home from the hospital within four days and we expect her to make a full recovery and have an improved quality of life. Completing a complex and advanced case like this is a testament to the expertise of our complete team of cardiovascular physicians and nurses working together using state-of-the-art technology,” said Dr. Saybolt. “We certainly could not have offered this procedure without our full team of nurses and anesthesiologists, but most notably our world class echocardiographer Dr. Lance Berger who creates the images that guide our more complex minimally-invasive procedures. Our technology vendor also informed us that this was the first double transcatheter valve and ablation procedure completed in our state and I’m sure it is rare throughout the country.”
For many years, Jersey Shore University Medical Center specialists have performed the second highest volume annually of diagnostic and interventional cardiac patient procedures in New Jersey. “That wealth of experience gives our patients confidence in our services, and it shows, as our volume is growing,” said Kenneth N. Sable, M.D., MBA, FACEP, regional president, Southern Market, Hackensack Meridian Health. “Early this year, we embarked on a $45 million, invasive cardiovascular expansion project creating a dedicated cardiovascular suite and significant technology upgrades to meet the growing needs of our community.”
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