Two years after adopting the WATCHMAN and MitraClip technologies, WellSpan York Hospital has become a high-volume center for structural heart procedures, fostering excellent outcomes and remarkable levels of patient satisfaction.
Conditions affecting heart valves and appendages can be extremely difficult to treat, especially in patients who cannot tolerate surgery. Since initiating the Structural Heart Program in 2016, experienced WellSpan cardiologists can now offer hope for such patients, giving them effective treatment options that can often be implemented via minimally invasive procedures.
WellSpan brings together the expertise of diagnostic cardiologists, interventional cardiologists, electrophysiologists, advanced practice clinicians and clinical staff to treat structural heart conditions.
“The main reason for our success these past two years is the extensive collaboration among our working groups,” says James Harvey, MD, MS, an interventional cardiologist and Director of the Structural Heart Program for WellSpan Health.
“WellSpan Health’s Structural Heart Program is cutting-edge, and the expertise of our providers is on a par with that of the physicians and surgeons anywhere a patient might go.”
— William Nicholson, MD, Director of Interventional Cardiology at WellSpan Health
Dr. Harvey gives a bird’s-eye view of conditions the program addresses and the multidisciplinary approach that makes its high rates of positive, durable outcomes possible.
“One condition, atrial fibrillation, is among the most common problems we treat,” he says. “Instead of contracting in a normal cadence, the blood swirls, forming clots. These clots can break loose and travel throughout the body, putting patients at risk of stroke.”
“Classically, atrial fibrillation is treated by ablation therapy performed by an electrophysiologist,” Dr. Harvey adds. “However, structural cardiology — encompassing the nonsurgical care of nonvascular parts of the heart — is now the fast-growing modality to treat this condition.”
With the WATCHMAN procedure, structural cardiologists seek to reduce stroke risk for AFib patients by preventing clots from forming in the left atrial appendage. While surgeons have had the option for decades to remove the appendage via open-heart surgery, that approach carried high levels of risk for patients. Instead, cardiologists typically prescribed blood-thinners to manage stroke risk.
The WATCHMAN provides a minimally invasive means of closing off the left atrial appendage. A folded-up, cage-like device is introduced via femoral vein catheter access. The surgeon crosses the interatrial septum to expand the WATCHMAN device into the left atrial appendage, resulting in eventual complete closure. Stroke risk reduction is comparable to that provided by warfarin, according to WATCHMAN literature.
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.
WellSpan has become the highest-volume WATCHMAN program on the East Coast, according to Dr. Harvey. It performs about 150 procedures annually, with more than 98 percent resulting in successful implantation.
The Structural Heart Program also treats patients who have mitral regurgitation, or backflow across the mitral valve, which can lead to heart failure. In the MitraClip procedure, an interventional cardiologist inserts a clipping device through a femoral catheter. The arms of the clip close the leaflets of the mitral valve.
“To place the transseptal puncture exactly, we rely on the combined skills of an interventional cardiologist, an electrophysiologist and an expert in cardiac imaging,” Dr. Harvey says. “We perform about two or three of these procedures each week.”
A Coordinated Team
“WellSpan has one of the busiest structural heart programs in Pennsylvania,” says William Nicholson, MD, Director of Interventional Cardiology at WellSpan Health. “Electrophysiologist Brian Schuler, MD, was responsible for building the program. He has put together a comprehensive atrial fibrillation program.”
Patients typically first see Dr. Schuler, who evaluates them for medical therapy, such as anticoagulants, or WATCHMAN implantation, Dr. Nicholson says. Dr. Schuler initiates treatment and guides patients to the optimal course of treatment.
“It is a great collaborative effort,” Dr. Nicholson says. “Dr. Harvey, Dr. Schuler and I, with support for imaging from Dr. Michelle Consolini, a diagnostic cardiologist, have put together a streamlined process from preplanning through recovery. This multidisciplinary approach yields excellent results.”
The physicians at WellSpan train continuously to build on their already high level of expertise. They regularly engage in research on the most effective ways to approach structural heart procedures, selecting clinical trials dictated by medical necessity in the local community, according to Dr. Nicholson.
“We are always interested in cutting-edge technology,” he elaborates. “We want to make care a more efficient process, reducing recovery times and effectively meeting the community’s needs. Atrial fibrillation is a big issue everywhere, and we have everything we need in York for our patients. In addition to providing high-level care, our program’s research appears in multiple journals, and we’re actively enrolling 10 or 20 clinical trials at any given time.”
“Every day, we ask, ‘How can we help people?’ We’re proud of where we work and what we get to do for patients, and collaboration among specialties lets us do it well.”
— James Harvey, MD, MS, Director of the Structural Heart Program for WellSpan Health
WellSpan adopts new devices and approaches along the same principle, selecting according to community need, Dr. Nicholson says. One exciting innovation involves implanting the WATCHMAN without the use of general anesthesia.
Still in the experimental stages, the procedure was successfully performed to meet the needs of a patient who could not tolerate transesophageal echocardiogram. Imaging was performed via echocardiogram through a vein instead. Because the patient did not need to be on a breathing machine, he underwent the procedure under only local anesthesia and recovered well, Dr. Harvey reports.
Getting patients off blood thinners while still mitigating their risk of blood clots results in substantial health benefits. Dr. Harvey gives a telling example.
“Like some heart medication therapies, the prolonged use of blood thinners can be problematic,” he says. “They prevent or reduce the risk of clots in the left atrial appendage, yes. But the oldest patients can experience bruising on their arms, and there is a risk of a life-threatening bleed in a small percentage of patients.”
The WATCHMAN device has radically improved treatment for patients in those categories.
“With the WATCHMAN, after the first 15 or 20 procedures, we began to receive enormous amounts of gratitude from patients, and they started coming to us asking to get off their blood thinners — as much for the quality-of-life improvement as the survival benefit,” Dr. Harvey adds. “We are humbled by how much we can positively affect the quality of life of our patients.”
To learn more, visit WellSpan.org/HV.