4 Medical Advances Making a Difference in Heart Care
Scripps – Updated for October 2021
Author: Paul Teirstein, MD
Scripps leads way in innovative care for AFib, heart valve and coronary disease
Scripps has a strong history as a national leader in heart care. Scripps has been consistently ranked by U.S. News & World Report as No.1 in the San Diego region for cardiology and heart surgery.
“These recognitions are a testament to our commitment to provide our patients with the highest quality and most advanced level of care,” says Paul Teirstein, MD, chief of cardiology, Scripps Clinic, and medical director of the Prebys Cardiovascular Institute.
“Scripps heart specialists have long been at the forefront of innovation, ushering in new techniques and devices designed to help improve diagnosis, treatment and recovery from heart disease,” Dr. Teirstein says.
Scripps helped pioneer the following four technological innovations that have made surgery less invasive and enhanced patient care for complex heart conditions.
1. TAVR treatment for patients with aortic stenosis
The transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace a narrowed aortic valve that restricts blood flow to the aorta, the body’s main artery. The medical condition is known as aortic valve stenosis. If untreated, it can lead to heart failure.
TAVR used to be only available for patients who were too weak to undergo open heart surgery to replace damaged valves. It is now available for nearly all patients with severe aortic stenosis in all risk categories.
During the procedure, the physician inserts a catheter into the femoral artery through the groin or through the chest and navigates through arteries to the heart with the aid of advanced imaging to replace the aortic valve with a new artificial valve.
Structural heart specialists at Scripps were among the first in the nation to test TAVR in the first clinical trials. Scripps was the only health system in San Diego County that participated in subsequent clinical trials validating TAVR for use in low-risk patients.
“The TAVR procedure has revolutionized heart valve surgery by giving patients a much less complicated option for treatment that doesn’t involve the prolonged recovery of open-chest surgery,” Dr. Teirstein says.
2. Watchman treatment for patients with AFib
The Watchman heart implant device reduces the risk of stroke in people with atrial fibrillation (AFib) that is not caused by a heart valve problem. People with AFib have an irregular heartbeat that can affect blood flow in the heart and cause blood clots to form.
Doctors typically treat people with AFib with a blood thinner to prevent clots from forming and reduce the risk of stroke, but some patients with AFib are unable to take blood thinners because of their side effects or bleeding problems. The WATCHMAN device offers an alternative to blood thinners through a small, permanent implant.
The WATCHMAN – a parachute-shaped, self-expanding device – is used to close off the left atrial appendage (LAA), which is the area in the heart where blood can pool and clot. The Watchman closes the LAA and keeps it from releasing clots.
Scripps participated in the early clinical research trials that led to FDA approval for the WATCHMAN in 2015, and is currently the leading site in the nation for its implantation.
3. HeartFLow FFRct Analysis to better visualize heart disease
HeartFlow FFRct (fractional flow reserve) Analysis is an advanced diagnostic tool that allows physicians to better assess a patient’s arteries. It is used in addition to a CT scan to create a 3D image of the coronary arteries, and measures the flow through the coronary arteries, which allows for a more precise representation of a patient’s anatomy.
Physicians then use this information to develop an appropriate treatment plan for each patient: surgery, a stent, medicine, or relatively simple lifestyle changes.
Scripps was the first in the region to adopt HeartFlow for diagnosing coronary artery blockage. Coronary artery disease is the most common type of heart disease in the United States.
4. MitraClip treatment for patients with a leaky mitral valve
The MitraClip procedure treats the most common type of heart valve disease: mitral regurgitation, also known as a leaky mitral heart valve. This minimally invasive procedure is used to treat symptomatic patients who cannot have open heart surgery. The MitraClip is a small clip that is attached to the mitral valve which allows it to close more fully and reduce regurgitation.
A leaky mitral heart valve can be life-threatening if not treated. The mitral valve contains two flaps, known as mitral leaflets, whose purpose is to open and close tightly. When the leaflets become damaged and no longer seal completely, blood can flow backward, making the heart work harder than normal. Over time, larger leaks can lead to shortness of breath, fatigue and heart failure. Patients also face an increased risk of irregular heartbeat, stroke and heart attack.
In a MitraClip procedure, an interventional cardiologist inserts a catheter into a leg vein, guides it up to the heart, and carefully attaches the MitraClip to the mitral valve.
Scripps participated in several clinical trials that validated the MitraClip’s safety and efficacy before it received FDA approval in 2013, and has treated more patients with the MitraClip than any other hospital in the San Diego region.
Heart care advances continue
Scripps Memorial Hospital La Jolla is the only hospital in the region participating in the TRILUMINATE Trial to evaluate the safety and efficacy of the TriClip for treating tricuspid valve regurgitation as this leaky heart valve condition is known.
In 2020, Matthew Price, MD, a Scripps Clinic interventional cardiologist, became the first in California to repair a tricuspid heart valve using the tiny experimental clip that is placed inside the heart. The TriClip is essentially a modified version of the MitraClip.
Dr. Price used a catheter to implant three TriClips in an 82-year-old San Diego man who suffered from heart failure as a result of the leaky heart valve that separates the two chambers on the right side of his heart.
“Scripps’ participation in this clinical trial, and others that like it aimed to improve heart care, are just a few examples of our ongoing commitment to advance patient-centered research, technology and innovation,” Dr. Teirstein says.