Life-Changing Cardiac Procedures Close to Home

Before Salinas Valley Memorial Healthcare System launched its transcatheter aortic valve replacement (TAVR) program, local patients had to make numerous long-distance trips to Bay Area hospitals for required testing, consultations and the specialized procedure.

That has now changed.

Interventional cardiologist Patrik Zetterlund, MD, Medical Director of the Cardiac Catheterization Lab, and Vincent DeFilippi, MD, cardiovascular surgeon at Salinas Valley Memorial Hospital, performed the first TAVR procedure at SVMH in January 2019 – and in November 2021, the SVMHS Structural Heart   Program celebrated the completion of its 100th TAVR.

“TAVR is a complex, highly technical procedure which requires an interventional cardiologist with advanced skills, a cardiac surgeon and a team of experienced physicians, nurses and technicians working side by side in the Cardiac Cath Lab to complete each case,” says Anne Timberlake, RN, MSN, Program Coordinator for TAVR and MitraClip™ at SVMH. “We are very proud of the way our Cath Lab and Cardiac Surgery staff worked hard together to form a cohesive team and launch the TAVR program with excellent patient outcomes.”

Bud Hall has had one of those excellent patient outcomes. Hall was diagnosed in 2021 with aortic stenosis, a narrowing of the aortic valve that restricts blood flow and can weaken the heart and eventually shorten life expectancy. In the past, replacement of the aortic valve was possible only through open-heart surgery, which is a much more invasive procedure with a longer recovery time.

Luckily, Hall was able to turn to SVMHS for TAVR, a minimally invasive procedure that introduces an expandable artificial heart valve through a blood vessel in the patient’s groin. The catheter is guided up to the heart where the new valve is expanded inside the defective aortic valve, opening it up to blood flow and allowing the heart to pump more efficiently.

Patients typically spend just one or two nights in the hospital after TAVR and can return to normal activities in about a week. After his procedure, Hall says his symptoms disappeared almost immediately.

“Within a matter of a day or two, I had no problem going up the steps and was able to take a full breath of air,” Hall says. “I did take it easy for a couple of days, but we went on a vacation about 10 days later – no problems whatsoever.”

TAVR is no longer just for high-risk patients who are not candidates for open-heart surgery.

“We started doing moderate-risk patients and now we do low-risk patients. So, it’s very rare we see anyone who is not a candidate,” says Dr. Zetterlund. “I would say that at Salinas Valley, close to 90% of people who have aortic valve problems will get the minimally invasive procedure.”

A Minimally Invasive Option for Patients with AFib

Reaching another remarkable milestone in providing advanced heart procedures, the Structural Heart team also celebrated the completion of its 100th WATCHMAN™ device implant procedure in February 2022. The WATCHMAN is a small, permanent, self-expanding device that closes the left atrial appendage, a small sac in the upper left chamber of the heart, and helps prevent blood clots from forming there.

Patients with an irregular heart rhythm called atrial fibrillation (AFib) are at higher risk of stroke due to the possibility of a blood clot forming in the left atrial appendage. To reduce that stroke risk, patients are usually prescribed blood thinners for life. However, blood thinners can cause serious bleeding, especially for people at risk for falling or who have a history of gastrointestinal problems. The WATCHMAN can help some patients avoid blood thinners. Cardiac electrophysiologist Harlan Grogin, MD, and cardiologist Steven Regwan, DO, performed the hospital’s first WATCHMAN procedure in August 2018.

“Patients typically spend just one night in the hospital, and most are able to safely stop taking blood thinners about six weeks after the procedure,” says Jennifer Rodriguez, RN, BSN, WATCHMAN Program Coordinator.

A New Way to Treat Mitral Valve Regurgitation

In October 2021, SVMH began offering transcatheter mitral valve repair with the MitraClip™ device, with the first four procedures performed by Dr. Zetterlund and cardiologist Kanae Mukai, MD. The program is expected to grow rapidly.

The MitraClip is an alternative to open-heart surgery for qualified patients with severe mitral valve regurgitation, a condition in which the mitral valve does not close effectively.

“Normally, the mitral valve acts as a gate to allow the blood into the heart so it can be pumped forward into the body. In mitral valve regurgitation, the blood starts leaking back into the lungs, leading to shortness of breath and heart failure,” Dr. Zetterlund says. “MitraClip is a minimally invasive way to repair the valve and prevent blood from leaking backward,  alleviating the symptoms.”

Patients with mitral valve regurgitation undergo a specialized echocardiogram at the hospital to determine if it is possible to place the MitraClip device onto the leaflets of their mitral valve, using  a catheter, to repair the leaky valve.

After this procedure, patients typically spend just one or two nights in the hospital and can return to normal activities in about a week.

SVMH is proud to offer these highly effective cardiovascular procedures to save and improve lives in the communities we serve.