Spring, 2013 - Hartford Hospital!

New Cardiac Frontiers
Interventional
cardiologists at
Hartford Hospital
make history
Hartford Hospital’s cardiac surgeons were the first in the region
to perform open-heart surgery on a beating heart and pioneered
the use of robotics for coronary bypass surgery. Hartford Hospital
performs more TAVRs (transcatheter aortic valve replacements)
than any other hospital in Connecticut. Now the hospital’s interventional
cardiologists have achieved another milestone—percutaneous
placement of a right ventricular assist device (RVAD).
Electrical impulses ripple across the heart, rhythmically
squeezing the upper chambers (atria), triggering the
filling of the lower chambers (ventricles) and circulating
blood in a continuous cycle. Your heart beats an estimated
100,000 times and pumps about 2,000 gallons of blood
through your body every day.
When the heart is damaged or diseased, the heart
muscle can’t pump enough blood to the rest of the body.
The heart tries to compensate, beating faster and becoming
stiff or flabby. Fluid fills the lungs, causing shortness
of breath. Symptoms of “heart failure” typically include
fatigue, feelings of fullness or bloating in the stomach,
heart palpitations and swelling of the feet, legs and ankles.
When medications fail, physicians sometimes place a
percutaneous (through the skin) ventricular assist device
(VAD), a mechanical pump that pulls blood from the ventricles
and forces it through the aorta to the arteries of
the body. The catheter-delivered device can be upgraded
to a surgical VAD if the patient’s heart does not recover.
Left ventricular assist devices (LVADs) are often placed as
a temporary “bridge” to a heart transplant.
“VADs have traditionally been used on the left side
to boost cardiac output and increase blood supply,” said
Ronan Margey, M.D., director of structural heart and adult
congenital heart intervention at Hartford Hospital. “We
were the first in the United States to use a new percutaneous
device to support the right ventricle.”
During Hurricane Sandy, a 64-year-old man suffered
right ventricular failure after a damaging heart attack.
“We received an emergency exemption from the FDA to
place the right ventricular percutaneous VAD temporarily,”
said Dr. Margey. “Six days later, the patient had recovered
fully and we removed the device.”
Last year, Hartford Hospital became the first hospital
in the region to offer “transcatheter aortic heart valve
replacement” (TAVR) for extreme-risk patients who aren’t
candidates for open-heart surgery. Now the nonsurgical
alternative for aortic valve replacement has been
extended to high-risk cardiac patients. Recently, the FDA
approved “transapical” delivery of the replacement aortic
valve through a two-inch incision in the ribs, as well as
through the femoral artery in the groin.
A multispecialty team of surgeons, specialists from
the cardiac catheterization lab and support staff performed
the transapical procedure on the first three
patients in December. The new method extends
the minimally invasive procedure to many women
whose femoral artery is too narrow to allow the
device to be threaded up to the heart from the groin.
“Over time, TAVR will become the standard of care
for patients at intermediate and high risk,” said Dr.
Margey.
“In some individuals, the structural ‘plumbing’
of the heart may not be perfect,” he added. “In the
past, children born with heart defects didn’t survive.
Now, thanks to interventional cardiology and cardiac
surgery, many are living into adulthood. New
techniques are continually being developed. We
have many new ways to repair a heart.”
Dr. Ronan Margey
We were the first in the
United States to use a
new percutaneous device
to support the right
ventricle.
— Dr. Ronan Margey
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