5 minute read
Performed In Westmoreland County
Winter 2021 I Volume 2
Dear Colleague,
As you will discover in this latest edition of our newsletter, Excela Health continues to expand and enhance its capabilities in cardiovascular, thoracic and pulmonary care in the region.
Most notable is the recent addition of a hybrid operating room at Westmoreland Hospital. Our cover article by Dr. Nevin Baker details this development and the concurrent introduction of Transcatheter Aortic Valve Replacement here in the County. This represents another major step by Excela in providing local residents advanced, tertiary and quaternary care in a setting convenient to them and their loved ones.
You’ll learn about significant developments in minimally invasive cardiac and lung surgery that are occurring at Excela. You will also note our burgeoning sleep disorders program and increasing depth in the treatment of peripheral artery disease.
We’ll also introduce you to the latest additions to our medical staff along with a synopsis of their education, training and other credentials. The area’s best and brightest clinicians continue to gravitate to Excela as a place to practice.
By any measure, Excela Health is accelerating and elevating its position as one of the premier health systems in western Pennsylvania.
We appreciate your confidence in our capabilities and thank you for the partnerships we have developed in the care of your patients.
Sincerely,
James Adisey, MD, FACC
Medical Director, Heart, Lung and Vascular
Aortic stenosis is the most common adult valvular abnormality encountered in clinical practice. It is also the most common heart valve replaced worldwide. Current AHA/ACC guidelines recommend aortic valve replacement for the majority of patients with severe symptomatic aortic stenosis. These symptoms can include, but are not limited to, shortness of breath, angina, fatigue, syncope and palpitations. Most demonstrated symptoms are evidence of heart damage related to their valve disease. Without aortic valve replacement, severe aortic stenosis is a life-threatening disease and carries a poor short-term prognosis. Clinical evidence demonstrates that patients with symptomatic, severe aortic stenosis may have a survival rate as low as 50% within two years of symptom development.
Traditional methods of valve replacement have involved open heart surgery. Over a period of years, the landscape has significantly changed with regard to options for patients with symptomatic severe aortic stenosis.
CONTINUED ...
In This Edition:
n Transcatheter Aortic Valve Replacement Now Performed In Westmoreland County n Minimally Invasive Cardiac Surgery (MICS) at Excela Health 1-2
3-4
n Robotic Pulmonary Segmentectomy at Excela Health 4-5 n Managing Sleep Apnea During COVID-19 5-6 n Vascular Surgery at Excela Health 7 n New Appointments 7-8 n Fast Facts: Quality at Excela Health 8 n Cardiovascular Services, Referring Patients 9 n Awards and Accolades 9
While the standard of care has been surgical aortic valve replacement (SAVR), the role of Transcatheter aortic valve replacement (TAVR) is evolving and offers an alternative approach for many patients.
TAVR is a minimally invasive, percutaneous approach for aortic valve replacement. Typically, the valve is implanted through the femoral artery following placement of a large-bore access site sheath. Rarely is surgical cutdown necessary for this approach. Alternative arterial access such as carotid, axillary, or subclavian artery also have been used.
Excela has chosen the Edwards Sapien 3 Ultra (S3 Ultra) valve due to its proven safety and efficacy. The valve tissue is made from bovine pericardium, similar to that of surgically implanted valves. There is a geometric open-cell scaffold which surrounds the valve and a sealing outer “skirt” at the base of the valve. The valve is crimped upon a delivery balloon catheter system outside of the body, then advanced through the existing large bore arterial access sheath and across the aortic valve. Fluoroscopic landmarks and aortic root injection allow for proper valve alignment. After confirming proper location, the balloon catheter delivery system is used to expand the scaffolding system and the valve is implanted.
The procedure is considered elective in the majority of cases, and patients can expect, on average, a 48-hour stay in the hospital following an uncomplicated procedure. Potential risks with TAVR include bleeding or damaging blood vessels, which may require blood transfusion or surgical repair. In addition, similar to SAVR, there is risk of stroke or heart attack. TAVR has been associated with arrhythmic complications including high degree heart block and atrial fibrillation. Advances in TAVR technology have allowed for a more deliverable device with less risk of valve embolization or perivalvular leak/aortic insufficiency.
It has become a Class I indication (recommended) for patients with severe valvular heart disease to be evaluated by a multidisciplinary Heart Valve Team. Thus, the Excela Health Structural Heart Program upholds a multidisciplinary approach to the treatment of patients with aortic valve stenosis. The purpose of the Heart Team is to use a patient-centered approach when determining treatment for severe aortic stenosis.
As a multidisciplinary team, we review cardiac imaging, coronary angiography, CT scans along with clinical history during our multidisciplinary valve conference. Your patient’s clinical information will be reviewed by our team of cardiothoracic surgeons, interventional cardiologists, cardiovascular imagers, cardiac anesthesiologists, and nurse navigators. Our Structural Heart Program continually strives to provide unprecedented, collaborative care. Our structural heart nurse navigator will ensure your patients are scheduled for an appointment, their questions are answered, and you, as the referring provider, remain informed. If the decision is made to proceed with TAVR, you will be kept up-to-date throughout the process of scheduling and post-procedure discharge.
Patients identified as having symptomatic, severe aortic valve stenosis should be evaluated by a cardiologist who can then refer for evaluation by the multidisciplinary physicians within the Heart, Lung & Vascular Institute at Excela Health.
If you have any further questions, please do not hesitate to contact our structural heart nurse navigator Amanda Urosek at 724-961-0357. We continually look forward to providing your patients with all the cardiovascular tools and talent we have to offer, right here in Westmoreland County.
Juan J. Chahin, MD, FACC, FSCAI; Vinod S. Kudagi, MD; Hiroyuki Tsukui, MD, PhD; Nevin C. Baker, DO, FACC, FSCAI; Amanda Urosek, BSN, RN; Mitsugu Ogawa, MD
