Written By El Camino Health Interventional Cardiologists:
Chidambaram Rammohan, MD
Frederick St Goar, MD
Heart and vascular procedures have historically involved long hospital stays, long recovery times and, often, a high risk of morbidity and mortality. Interventional cardiology, which often uses catheter-based approaches instead of large incisions or open-heart surgery, is changing the game dramatically in recent years. El Camino Health is one of the pioneers.
Community hospitals are not usually known for groundbreaking research and the development of new technologies and treatment options. But our team serves Silicon Valley, and the spirit of innovation and constant improvement has infused our culture. We are fortunate to be part of a team of clinicians and researchers who are committed not only to providing the safest, most effective care possible — but also to advancing interventional cardiology through innovation and the careful, timely application of new knowledge. El Camino Health's close collaboration with the nationally respected Fogarty Innovation Center and their location on our hospital campus helps to support and speed collaboration and progress.
Innovations Already Saving Lives
Among other contributions, our team has been vital to the development and evolution of the Mitraclip, a device that can treat mitral valve disease in patients who are not candidates for traditional surgery. We recently completed enrollment for a study comparing the use of the Watchman device to traditional anticoagulant therapy for atrial fibrillation (AFib). We are leaders in transcatheter aortic valve replacement (TAVR) for patients with severe aortic stenosis.
Yet our most promising innovation to date may be the introduction of a comprehensive clinic model for interventional cardiology. Our team's coordinated clinic approach is designed to streamline care, improve outcomes, and enhance the patient and family experience. Patients can meet with a cardiac surgeon, an interventional cardiologist and others involved in their care, without having to attend multiple appointments at various locations.
Each patient receives a complete examination and is presented with all options so they can make an informed, shared decision about the treatment plan. They may be a candidate for a minimally invasive procedure or surgery. Or, perhaps waiting and monitoring is the most appropriate choice. Most patients leave their first appointment with a procedure date and a plan of care designed specifically for their needs and preferences.
Mitraclip: Treating Mitral Valve Disease When Surgery Isn't an Option
The standard treatment for mitral valve disease — in which the heart valve doesn't close properly — is open-heart surgery. When Dr. St. Goar's team developed the MitraClip (manufactured by Abbott), it opened up a new treatment option for patients who are at too great a risk to have traditional surgery. The new procedure is called TEER (transcatheter edge-to-edge repair). The MitraClip is placed using a catheter, a thin tube that is guided through a vein in the leg to reach the heart. To date, MitraClip is the only alternative to open surgery that is approved by the Food and Drug Administration (FDA). It's also approved for patients with congestive heart failure who have exhausted other treatment options. Different sizes and configurations of the device are now available to better fit different patients and situations.
Watchman: Managing AFib without Anticoagulants
Because AFib creates an irregular heartbeat, blood can pool in an area of the heart called the left atrial appendage, increasing the risk of blood clots and stroke. The Watchman device is placed using a catheter and keeps clots from moving into the bloodstream and causing a stroke. It is approved by the FDA for patients with AFib who are unable to take anticoagulants because they have conditions that increase their risk for bleeding. The Champion trial compared Watchman use versus traditional anticoagulation therapy for AFib patients who can stay on their anticoagulants. Enrollment was completed at the end of 2022, and the study is being evaluated by the FDA. The results could lead to possibly expanding Watchman use to include all AFib patients. El Camino Health was a site location for this study.
TAVR: Replacing the Aortic Valve for Severe Aortic Stenosis
Severe aortic stenosis narrows the aortic valve opening, restricting blood flow to the rest of the body. Replacing the aortic valve has conventionally required open-heart surgery. Transcatheter aortic valve replacement (TAVR) offers a minimally invasive treatment using the Medtronic CoreValve Evolut valve and the Edwards SAPIEN valve. TAVR replaces the diseased valve with a bio-prosthetic heart valve. A catheter guides the valve to your heart where it is expanded, pushing the diseased valve aside. El Camino Health was selected as one of 40 hospitals during the original research on the device, which is now commercially available for the treatment for aortic stenosis.
Community Service and Global Impact
Our team has always found El Camino Health's leadership to be highly supportive of its physician community and our close collaboration with industry — from large, established companies to small, promising start-ups. This culture of partnership, innovation and service is key to providing the best possible care for our own patients, while also having a national and global impact on the future of heart and vascular care. Learn more about Heart and Vascular Care at El Camino Health.
This article appeared in the February 2024 edition of the HealthPerks newsletter.
