The James Family Heart Center

Heart Surgery

Interventional Cardiology and Interventional Radiology

Cardiac Electrophysiology

  • What is cardiac electrophysiology?
    • This is a subspecialty – or branch – of cardiology. Cardiac electrophysiologists are specially trained to diagnosis and treat heart rhythm disorders, also called arrhythmia.

     

  • What happens during a cardiac electrophysiology exam?
    • During one of these exams, the cardiac electrophysiologist tests your heart’s electrical activity to diagnose the type of arrhythmia (abnormal heartbeat) and pinpoint its location.

    At YRMC’s James Family Heart Center, these exams generally take place in our state-of- the-art hybrid operating room

     

  • What treatments may be recommended to address arrhythmia (abnormal heartbeat) after a cardiac electrophysiology exam?
    • Your doctor will recommend a treatment to address your type of arrhythmia. This may include medication or one of following:
    • Cardiac Ablation
      During this procedure, the electrophysiologist makes a tiny incision in a vein and inserts a long, slender, flexible tube (catheter) that is threaded to the heart. The physician then uses either cold (cryoablation) or heat (radiofrequency ablation) to destroy the tissue that triggers irregular heartbeats.
    • Cardiac Resynchronization Therapy (CRT)
      People with heart failure who develop arrhythmia, may be candidates for cardiac resynchronization therapy (CRT). During CRT, a small pacemaker is implanted, usually just below the collarbone. Three wires, also called leads, are then connected to the pacemaker. The device monitors the heart rate and emits tiny electrical pulses to correct irregular heartbeats.
    • Implantable Cardioverter Defibrillator (ICD)
      Implantable Cardioverter Defibrillators (ICDs) are usually inserted under the skin in the upper chest. An ICD includes a pulse generator and wires, called leads. These devices use electrical pulses to monitor heart rhythm and treat arrhythmias that occur in the heart’s lower chambers. If the ICD detects an irregular rhythm, it uses low-energy electrical pulses to restore a normal rhythm.
    • Pacemaker
      This small device is placed in the chest or abdomen to help control abnormal heart rhythms. Pacemakers use electrical pulses to prompt the heart to beat at a normal rate.

     

Mitral Valve Repair with MitraClip

  • What is the mitral valve?
    • This valve allows blood to flow from one chamber in your heart – the left atrium – to another chamber called the left ventricle. It’s the job of the left ventricle to pump oxygenated blood to tissues all over the body.

     

  • What is mitral valve regurgitation?
    • The heart is designed to pump blood in one direction. If blood isn’t going in the right direction through the mitral valve, it’s called mitral valve regurgitation. This condition causes blood to leak backward instead of flowing out to the rest of your body. Mitral valve regurgitation can make you feel tired and out of breath. It can also lead to high blood pressure and a buildup of fluid in your lungs.

     

  • Why is my physician recommending a mitral valve repair with MitraClip?
    • If you have severe mitral valve regurgitation and if you are unable to have open heart surgery, your physician may recommend this minimally invasive treatment. Mitral valve repair with MitraClip can reduce the symptoms of mitral valve regurgitation and improve the quality of your life without open heart surgery.

     

  • Where does the procedure take place and who performs it?
    • Mitral valve repair with MitraClip is performed in YRMC’s Hybrid Operating Suite or one of our Cardiac Catheterization Labs. These facilities are equipped with advanced technology and sophisticated imaging equipment. A highly qualified YRMC interventional cardiologist will perform the procedure with a team that includes an anesthesiologist as well as experienced nurses and radiologic technologists.

     

  • What happens during a mitral valve repair with MitraClip?

    • During a mitral valve repair with MitraClip, interventional cardiologists:
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    • Make a small incision near the groin in order to guide a narrow, flexible tube into the leg vessels to the heart.

    • Pass a small metal clip that is covered in fabric through the tube, positioning the clip over the leaky mitral value and securing it in place.
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    • Ensure that the valve is opening and closing on either side of the clip, allowing blood to flow on both sides while stopping blood from flowing in the wrong direction.

  • How long does the procedure take?
    • The procedure usually takes from one to three hours, sometimes longer depending on the complexity of the case.

     

  • How soon can I go home after the procedure?
    • Everyone is different, but most people are home within 48 hours.

     

  • What is the recovery like?
    • You should experience relief from your symptoms quickly after the procedure. At home, you won’t need any special help outside of assistance for other unrelated health conditions you may have. You may be prescribed blood thinning medication to reduce the risk of developing a blood clot after the procedure.

     

Paravalvular Leak (PVL) Closure

  • What is a paravalvular leak?
    • A paravalvular leak (PVL) is a leaky heart valve. This happens when blood flows through a space between the natural heart tissue and a prosthetic valve replacement. The leak allows blood to flow backwards, which leads to shortness of breath, fatigue and even bleeding.

     

  • What is the treatment for a PVL?
    • In the past, patients with PVLs needed to return to the operating room to repair the leak. Today, interventional cardiologists repair PVLs during a nonsurgical, catheter-based procedure called paravalvular leak closure.

     

  • Where does the procedure take place and who performs it?
    • PVL closures are performed in one of YRMC’s Cardiac Catheterization Labs or the Hybrid Operating Suite, using advanced technology and sophisticated imaging equipment. A highly qualified YRMC interventional cardiologist will perform the procedure with a team that includes an anesthesiologist as well as experienced nurses and radiologic technologists.

     

  • What happens during a PVL closure?

    • During a PVL closure, YRMC interventional cardiologists:
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    • Use imaging technology to pinpoint the location of the PVL.

    • Make a small incision near the groin in order to guide a narrow, flexible tube to the upper-left chamber of the heart.

    • Guide the tube to the paravalvular leak, where a small, metal plug that’s covered in mesh is placed to stop the leak.

     

  • How long does the procedure take?
    • Most PVL closures take approximately one hour.

     

  • How soon can I go home after the procedure?
    • Although everyone is different, most people are home within 48 hours.

     

  • What is the recovery like?
    • First, as with any “transcatheter” repair, it’s important to manage your incision by making sure your dressings are clean, dry and free of blood.

    And while complications from a PVL closure are uncommon, it’s good to be aware of them. They include:

    • Irregular heartbeat – If you experience an irregular heartbeat, you and your physician will develop a treatment plan.

    • Complete electrical heart block – A small percentage of people experience complete electrical heart block after a PVL closure. This is when the electrical signal can’t pass normally from the heart’s upper chambers to the lower chambers. This condition may require a temporary pacemaker to assess the severity of the heart block. If it continues more than 24 hours, you physician will recommend a permanent pacemaker.

     

Patent Foramen Ovale (PFO) Closure

  • What is a patent foramen ovale (PFO)?
    • About 25 percent of people have a PFO. This is a hole between the right and left upper chambers of the heart that didn’t close following birth. Most people don’t know they have a PFO unless it’s discovered during tests for other health issues. Most PFOs never need treatment.

     

  • When can a PFO become a problem and how is it treated?
    • People who have multiple strokes or transient ischemic attacks (TIAs) that can’t be controlled with other medical therapy, may be candidates for PFO closure. Also, larger PFOs can be dangerous if they allow substantial amounts of blood to move between the left and right sides of the heart. This can cause pressure and enlarge the heart. In all of these cases, PFO closure can help the heart work correctly.

     

  • Where does the procedure take place and who performs it?
    • This non-surgical procedure is performed in one of YRMC’s Cardiac Catheterization Labs or the Hybrid Operating Room, using advanced technology and sophisticated imaging equipment. A highly qualified YRMC interventional cardiologist performs the procedure with a team that includes an anesthesiologist as well as experienced nurses and radiologic technologists.

     

  • What happens during a PFO closure?
    • During these procedures, YRMC interventional cardiologists:
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    • Use imaging technology to pinpoint the location of the PFO.

    • Make a small incision near the groin to insert a narrow, flexible tube with a disc.

    • Guide the tube and disc to the PFO, where the disc is placed. Over time, heart tissue grows over the disc to seal the PFO.

     

  • How long does the procedure take?
    • Most PFO closures take approximately one hour.

     

  • How soon can I go home after a PFO?
    • Although everyone is different, most people are home within 24 hours.

     

  • What is the recovery like?
    • A small percentage of people develop an irregular heartbeat following a PFO closure. This condition may be treated with a beta blocker (metoprolol) to reduce the irritation in the heart immediately following a procedure. Some people may experience compete electrical heart block. This means the electrical signal can’t pass normally from the heart’s upper chambers to the lower chambers. Your physician may recommend a permanent pacemaker to treat this.

     

Transcatheter Aortic Valve Replacement

  • What is the aortic valve?
    • The heart has four chambers – two upper chambers called the left and right atriums, and two lower chambers called the left and right ventricles. Within these four chambers are four valves that control the flow of blood through the heart by opening and closing: the aortic, mitral, pulmonary and tricuspid valves. When your heart beats and pumps blood through these valves, the valves open and close to allow blood to move forward and prevent backflow.

     

  • What is aortic stenosis and aortic regurgitation?
    • Aortic stenosis is when a valve is too narrow to pump blood effectively, due to calcium buildup, high cholesterol or a birth defect. Aortic regurgitation is when a valve cannot close fully, causing blood to leak backward through the valve. Both problems cause your heart to work harder, which can weaken heart muscle. Severe aortic stenosis is usually caused by calcium buildup over time. Without treatment, the heart can quickly deteriorate, increasing the risk for heart failure.

     

  • What are the symptoms of aortic stenosis?
    • If the heart has to work harder to pump blood, this can reduce the body’s ability to receive enough oxygen-rich blood. Patients with severe aortic stenosis often feel shortness of breath, chest pain or fatique, or they may feel like they will pass out.

     

  • How is severe aortic stenosis treated?
    • Severe aortic stenosis cannot be treated with medication. Patients can undergo aortic valve replacement, a surgical procedure that replaces the defective valve with a new mechanical or tissue valve. This procedure is performed through open-heart surgery, which requires patients to have their blood pumped with a heart-lung machine. However, age, a history of heart disease, or other health issues may prevent some patients from being able to undergo open-heart surgery. For those patients, there is a new treatment option called Transcatheter Aortic Valve Replacement (TAVR).

     

  • What is TAVR?
    • TAVR is a heart valve replacement procedure for patients with severe aortic valve stenosis who have been determined to be high risk or too sick for open-heart surgery. This less invasive procedure allows a prosthetic valve to be inserted into the diseased valve.

    The TAVR procedure can be performed through three different approaches: transfemoral , through the leg artery, transapical , through the chest between the ribs, or transaortic , through the upper chest. Once in place, the heart valve is intended to function like a normal, healthy valve with proper blood flow. The recovery time is less for patients who undergo a TAVR procedure and usually go home from the hospital within 3-5 days.

    For more information about TAVR or to see if you may be a candidate, please speak with your cardiologist or call The James Family Heart Center’s patient navigator at (928) 771-5609.

     

  • What are the advantages of TAVR?
    • TAVR is a less invasive approach to aortic valve replacement and is an option for people with severe aortic stenosis who may not qualify for open aortic valve replacement surgery.

    For more information about TAVR or to see if you may be a candidate, please speak with your cardiologist or call The James Family Heart Center’s patient navigator at (928) 771-5609.

     

  • How will I know if I am a candidate for a TAVR procedure?
    • After thorough testing, our multidisciplinary team will evaluate your results and determine the best way to treat your aortic stenosis.

     

  • How long will I be in the hospital?
    • Patients undergoing a TAVR procedure typically stay in the hospital between three and five days.

     

  • Who performs TAVR at the James Family Heart Center at YRMCl?
    • TAVR is performed in YRMC's Hybrid Operating Suite by these Heart Center Physicians:
  • What is the recovery like?
    • You will receive detailed instructions after your procedure to guide you through the recovery process. Most patients go back to their lifestyle after a few days and return to normal activities faster than with major surgery.

     

  • How can I learn more about TAVR?
    • For more information about TAVR or to see if you may be a candidate, please speak with your cardiologist or call The James Family Heart Center’s patient navigator at (928) 771-5609.

     

Transcatheter Mitral Valve Replacement

  • What is the mitral valve?
    • This valve allows blood to flow from one chamber in your heart – the left atrium – to another chamber called the left ventricle. It’s the job of the left ventricle to pump oxygenated blood to tissues all over the body.

     

  • Why is my physician recommending a transcatheter mitral valve replacement (TMVR)?
    • TMVR is a non-surgical procedure for people with severe mitral valve regurgitation or mitral stenosis – a narrowing of a bioprosthetic mitral valve. The patient usually has multiple health issues that make open heart surgery too risky.

     

  • Where does the procedure take place and who performs it?
    • This non-surgical procedure is performed in YRMC’s Hybrid Operating Suite, using advanced technology and sophisticated imaging equipment. A highly qualified YRMC interventional cardiologist and a cardiothoracic surgeon perform the procedure with a team that includes an anesthesiologist as well as experienced nurses and radiologic technologists.

     

  • What happens during a TMVR?
    • During these procedures, a YRMC interventional cardiologist and a cardiothoracic surgeon:

    • Make a small incision near the groin, and then thread a narrow, flexible tube to the damaged mitral valve in the heart.

    • Replace the damaged mitral valve with a mechanical valve or a biological tissue valve (from a pig, cow or human heart tissue organ donor).

     

  • How do I decide what's best for me: a mechanical valve or a biological tissue valve?
    • There’s a lot to consider when deciding if a mechanical valve or a biological tissue valve will work best for your lifestyle. Here’s some information about each option:

    • Mechanical Heart Valve – These are known for their lifelong durability. Their biggest drawback is that you will need blood thinning medication (anticoagulants) for the rest of your life. However, anticoagulants have greatly improved in recent years so there are fewer side effects and dietary restrictions. If you decide a mechanical heart valve is right for you, your physician will prescribe the anticoagulant that’s best for you.

    • Biological Tissue Valve (Bioprosthetic Valve) – These heart valves do not require blood thinning medication. They do, however, deteriorate over time, requiring repeat procedures.

    Speak to your physician about the valve options. YRMC’s patient navigator is also an excellent source of information.

     

  • How long does the procedure take?
    • Most TMVRs take between two and four hours.

     

  • How soon can I go home after a TMVR?
    • You should be able to return home 48 hours after the procedure.

     

  • What is the recovery like?
    • After a TMVR you will have a small incision – approximately one-inch wide – between your ribs. These stitches will be removed during a follow-up appointment with your surgeon, who will also check on how you are healing. Most people are cleared to start driving within two weeks of coming home from a TMVR.

     

WATCHMAN™ (Left Atrial Appendage Closure)

  • What is the WATCHMAN™ procedure?
    • The “WATCHMAN™”, as it is commonly called, is also known as the left atrial appendage closure (LAAC) procedure. During this procedure, the heart’s left atrial appendage is permanently closed using the WATCHMAN™ device. The quarter-sized device – made of very light and compact materials used in many other medical implants – can prevent strokes by keeping blood clots from escaping the left atrial appendage. A large percentage of blood clots that cause strokes originate in the left arterial appendage.

     

  • Who is eligible for the WATCHMAN™?
    • The WATCHMAN™ is for people with Afib (atrial fibrillation) that is not caused by a faulty heart valve as well as people who cannot tolerate medications for their condition. Afib patients are typically prescribed blood thinning medications – Warfarin or Plavix, for example – to reduce their stroke risk. Some people, however, cannot tolerate blood thinning medications due to bleeding issues, concerns about falling and other problems. For these people, the WATCHMAN™ may be an alternative to reduce stroke risk.

     

  • How will my physician decide which is right for me: blood thinners or the WATCHMAN™?
    • Your physician will use a scoring method to determine which blood thinning medication would be best for you or if you are eligible for the WATCHMAN™ procedure. This scoring method also helps identify Afib patients for whom blood thinners may not work. The scoring method assigns points to the following:

         • Congestive heart failure
         • Hypertension
         • Age ≥ 75
         • Diabetes
         • Stroke

     

  • Where is the WATCHMAN™ performed and who does the procedure?
    • The WATCHMAN™ is performed in YRMC’s Hybrid Surgical Suite – regarded as among the finest in the nation – by either Soundos Moualla, MD, FACC, FSCAI, or Nisha Tung-Takher, MD.

     

  • What happens during a WATCHMAN™ (left atrial appendage closure) procedure?
    • The left atrial appendage closure (LAAC) is a one-time procedure during which a WATCHMAN™ device is implanted into your heart. The WATCHMAN™ is designed to permanently close off the LAA and keep life-threatening blood clots from escaping. This permanent device doesn’t have to be replaced and can’t be seen outside of the body. To implant a WATCHMAN™ device, your James Family Heart Center physician will make a small incision in your upper leg and insert a narrow tube, as is done for a standard stent procedure. The physician then guides the WATCHMAN™ into the left atrial appendage (LAA) of your heart where it is placed. This closes off the LAA and keeps blood clots from escaping. You’ll receive general anesthesia for the LAAC, which takes about an hour. Most likely, you will stay overnight at YRMC.

     

  • What can I expect after a WATCHMAN™ procedure?
    • Most likely, you will remain overnight at YRMC after your WATCHMAN™ procedure. You’ll return to your normal activities immediately following the procedure. WATCHMAN™ eliminates the need for regular blood tests and food-and-drink restrictions that come with blood thinners. You will continue to take your blood thinning medication for approximately 45 days after the WATCHMAN™ procedure.

     

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