Minimally Invasive Procedures in Heart & Vascular Care Speed Recovery and Improve Outcomes

ChristianaCare’s Center for Heart & Vascular Health is transforming patient care with minimally invasive treatments for heart rhythm disorders, arthritis pain and damaged heart valves — offering faster recoveries and better outcomes than ever before. That’s in large part because the interdisciplinary team at the Center for Heart & Vascular Health is composed of experts in cardiac surgery, vascular surgery, vascular interventional radiology, cardiology and interventional nephrology in one location, all focused on the problems that come along with heart and vascular disease.

“We are among the rare medical centers with heart and vascular clinical services arranged in this way, which encourages collaborative care,” said Kirk Garratt, M.D., MSc, medical director of the Center for Heart & Vascular Health. “Our providers are committed to exploring innovation and solving problems in a collaborative, synergistic manner. “The clinical outcomes of the care we provide right here in Delaware is equivalent to outcomes at large academic health centers, and we offer a more personalized patient experience,” he said. “We create a welcoming environment that assures patients that they’re going to get the best care.” The latest at ChristianaCare’s Center for Heart & Vascular Health:

Atrial fibrillation (A-fib), the most common type of irregular heartbeat (arrhythmia), makes the heart beat significantly faster than normal. It’s caused by abnormal electrical impulses within the heart.

In healthy people, the sinus node (an area within the heart’s upper-right chamber) fires an electrical impulse with every heartbeat. During A-fib, electrical impulses mistakenly arise from abnormal tissue at several different locations within the heart. This prompts the heart to beat more quickly, causing heart palpitations, chest pain, shortness of breath, dizziness or fainting. To treat A-fib, a cardiac electrophysiologist (a health care provider who specializes in heart-rhythm disorders) destroys the tissue where the abnormal electrical impulses originated within the heart.

For years, providers have frozen (cryoablation) or heated (radiofrequency ablation) the abnormal tissue. But the procedures are time-consuming, and there’s a risk of damaging neighboring structures, like the lungs or esophagus. A new treatment called pulsed field ablation destroys the abnormal tissue more quickly, without risking damage to nearby structures. During the procedure, a cardiac electrophysiologist inserts catheters into the patient’s groin, then threads them through blood vessels to reach the heart. They deliver very short durations of very high electrical pulses through the catheter to areas in the heart that have been identified as the sources of abnormal electrical activity. “The ablation sends out signals at high voltage at microseconds of duration,” said Wen-Chi Kevin Tsai, M.D., a cardiac electrophysiologist at ChristianaCare. “The cell membranes are disrupted leading to cell death as cells wither away. "The electrical pulses are absorbed at different levels by different cells, so the neighboring structures are not affected at this level of energy. It’s a very deliberate scar formation in the heart, and nothing around it is susceptible.”

Osteoarthritis can cause painful inflammation within the knee. Although arthritis doesn’t affect the heart or blood vessels, providers can ease arthritis pain by providing treatment through the blood vessels. Patients with mild to moderate knee pain caused by arthritis may benefit from a minimally invasive procedure called genicular artery embolization, which blocks blood flow to the areas of inflammation within the knee. Research shows that the technique effectively dulls arthritis pain. During an outpatient procedure, an interventional radiologist makes a small incision in the patient’s groin or wrist, then threads catheters through blood vessels to reach the knee.

When they’re at the correct location, they pump tiny bead-like particles into the blood vessel to block blood flow to the area and decrease the inflammation that is causing the pain. This technique also can help relieve pain and increase mobility to the knee. “It has a good clinical success rate in improving patients’ pain, and it has great success in reducing the number of medications that patients take,” said Christopher Grilli, D.O., an interventional radiologist at ChristianaCare. “A number of studies prove that patients who have the procedure don’t need as many anti-inflammatory medications, opioids or joint injections, which is huge, and the pain relief can last years.”

The tricuspid valve, located between the heart’s upper-right and lower-right chambers, opens and closes to keep blood flowing in the right direction through the heart. If the tricuspid valve becomes damaged, blood leaks backward through gaps in the valve, leading to heart failure. Patients experience symptoms like fatigue, shortness of breath, swollen legs and ankles, weight gain or chest pain. Surgeons can repair or replace the tricuspid valve during open-heart surgery, but patients with heart failure are rarely eligible. “Patients with heart failure often have a lot of additional medical issues, which limits the ability to get them safely through open-heart surgery – a lengthy procedure,” said Neil Wimmer, M.D., MS, an interventional cardiologist at the Center for Heart & Vascular Health.

New minimally invasive treatments for damaged tricuspid valves offer hope to patients with heart failure. An interventional cardiologist can make a small incision in a blood vessel in the patient’s groin, then thread thin tubes (catheters) through the blood vessels to the heart. Once they’re in, the cardiologist has two options: To repair the leaky tricuspid valve by attaching the valve’s leaflets together or to replace it with a new valve. “The new treatment is a big step forward because it makes more patients with heart failure eligible for care,” Wimmer said. “Patients stay in the hospital overnight, and after a few days, they can be back to their normal activities, feeling better. “That is in contrast to patients who undergo open-heart surgery. They are hospitalized for a week, then recover at home for two months. The rapid recovery with the minimally invasive procedure has been a tremendous advance for patients.”

ChristianaCare’s Center for Heart & Vascular Health is a national, regional and local leader for heart care, recognized by U.S. News & World Report as high performing in care for heart failure, heart attack and heart bypass and for five consecutive years by the American College of Cardiology with a National Distinction of Excellence Award. To learn more about these treatments and more for your heart and vascular health, click here.