Next-generation Care for Complex Cardiac Conditions

By Katy Mena-Berkley
Friday, March 24, 2017

Cardiac specialists at WellSpan Health offer patients an array of state-of-the-art treatments and technologies to manage valvular conditions, reduce stroke risk and enhance quality of life. An experienced team of surgeons, electrophysiologists, noninvasive cardiologists and interventionalists collaborates on individual cases to develop tailored treatment plans.

The WATCHMAN left atrial appendage closure device

For decades, patients with cardiac conditions such as atrial fibrillation and mitral regurgitation had few treatment options. Frequently those options involved either lifelong courses of medications fraught with bleeding risks or open-heart surgery that entailed an arduous recovery period and significant risks of its own for patients who could tolerate it.

Advances in minimally invasive technology have changed that. In the hands of experienced cardiologists at WellSpan, modern medical devices are extending the lives of patients with chronic cardiac conditions and restoring their ability to participate in activities they were previously able to enjoy.

High-level Treatment for Mitral Regurgitation

The journey to medical intervention is one that WellSpan’s cardiac specialists approach judiciously, transitioning to mechanical and interventional procedures only after medical therapies have proved unable to restore adequate cardiac function, says William Nicholson, MD, Director of Interventional Cardiology at WellSpan.

“There are excellent medical therapy options, and they should be utilized until patients either don’t tolerate the medications or the medications fail,” says Dr. Nicholson, who is fellowship-trained in interventional cardiology. “Then mechanical approaches and cardiothoracic surgery become relevant.”

The MitraClip is one advanced technology that WellSpan physicians may employ for patients who experience degenerative mitral regurgitation, a condition that occurs when the mitral valve does not close tightly, allowing the backward flow of blood in the heart. Patients often feel fatigued or short of breath. The MitraClip can be an effective, durable alternative for patients who are not candidates for conventional open surgery.

The procedure does not require the support of a heart-lung bypass machine. Instead, an interventional cardiologist specializing in structural heart disease, partnering with a cardiac surgeon and a cardiologist who specializes in valvular heart disease, performs a transseptal puncture on the left side of the heart as part of the procedure. The team inserts a thin catheter in the groin and threads it through the femoral vein to the heart and through the puncture to access the mitral valve. The MitraClip is then inserted into the catheter and guided to the affected portion of the heart, where it is attached to the mitral valve’s leaflets. In some cases, two clips may be used. The catheter is removed after the clips have been successfully attached to repair the valve.

“The MitraClip is a way of suturing the valve back together where it’s leaking,” Dr. Nicholson explains. “This technology allows us to avoid stopping the heart or opening up the chest, and it’s very well-tolerated.”

The procedure usually takes about an hour, he notes, though in some instances it can take as little as 35 minutes. Patients typically return home the next day, and improvements in quality of life accrue rapidly.

“The biggest thing we see is a change in patients’ functional capacity,” Dr. Nicholson says. “There is striking improvement in the fluid accumulation and shortness of breath related to congestive heart failure brought on by mitral regurgitation.”

“WellSpan Heart & Vascular has a depth of services that draws on the strengths of highly trained physicians, advanced practice clinicians and clinical staff in multiple disciplines, from preventive cardiology and noninvasive cardiology to interventional cardiology, electrophysiology and cardiothoracic surgery.”
— William Nicholson, MD, Director of Interventional Cardiology, WellSpan Health

Reducing Stroke Risk without Anticoagulants

Similarly, individuals with nonvalvular atrial fibrillation (AFib) may gain significant benefit from a permanent implant. About one in 10 Americans over age 65 experiences AFib. The WATCHMAN device is engineered to reduce AFib patients’ risk of stroke by closing the left atrial appendage in the heart, where clots frequently form. At the same time, the procedure eliminates bleeding risks associated with use of anticoagulants.

“Blood thinners have been used for years and are effective for preventing strokes related to atrial fibrillation, but not everybody tolerates them and they entail a major bleed risk,” Dr. Nicholson says. “The WATCHMAN procedure is a remarkably elegant solution. These atrial appendage occluders essentially wall off access to that appendage so clots can’t escape if they are forming inside and blood can no longer get into the appendage. As a result, patients are at much lower risk for stroke, and they don’t need to be on anticoagulants.”

Like the MitraClip, the WATCHMAN left atrial appendage closure device is implanted through a simple procedure under general anesthesia. The size of the implant — which is shaped like an umbrella to capture blood clots — may be determined by performing a transesophageal echocardiogram. The implant is then inserted utilizing transseptal access and guided toward the left atrium before arriving in the distal portion of the left atrial appendage. Typically, patients may leave the hospital the following day.

“The WATCHMAN offers the same protection from stroke without the one-in-20 chance of a major bleed each year of your life that you are on a blood thinner,” Dr. Nicholson says. “Patients tolerate this procedure very well.”

WellSpan is currently the only local facility that offers both MitraClip and WATCHMAN procedures, he notes.

The WATCHMAN left atrial appendage closure device, produced by Boston Scientific, is implanted through a simple procedure under general anesthesia.

The implant — which is shaped like an umbrella to capture blood clots — is inserted utilizing transseptal access and guided toward the left atrium before arriving at the opening to the left atrial appendage.

A Team Approach

Interdisciplinary collaboration at WellSpan ensures that wide-ranging expertise informs patient care.

“Our specialists meet regularly to discuss cases,” Dr. Nicholson says. “When you have everyone at the table for that discussion, you have more complete input to develop the most appropriate course of treatment. We do not work in silos where our physicians are unaware of what their colleagues are doing or of other effective treatments and technologies. It is really an ideal situation.”

Partnering with patients’ primary care providers is equally important, he adds.

“They know their patients best,” Dr. Nicholson says. “They want to remain deeply involved in their care and to serve as advocates for them. It is, and should be, an extremely collaborative process.”

For information on how to contact WellSpan’s cardiologists, electrophysiologists and cardiothoracic surgeons with referrals, visit