Cardiac

To Prevent Stroke, Start with the Heart

Posted on Feb 13, 2020 in Affiliates, Cardiac, Carousel, Expanding Access, Innovation, Mills-Peninsula Health Services, Neuroscience, Quality, Research, Scroll Images, We're Awesome, Women's Services

BURLINGAME, Calif. – Does it sometimes feel like there are butterflies in your chest? Does your heart race or skip a beat? If it’s not your crush making your heart go pitter-pat, it could be a common heart condition called atrial fibrillation or AFib for short. This Valentine’s Day, take heart and consider seeing an expert if you are experiencing these symptoms. After all, AFib dramatically increases the odds of having a life-threatening stroke.

“Stroke occurs when arteries in the brain are either blocked by a blood clot or burst under high pressure,” said Ilana Spokoyny, M.D., neurologist who cares for patients at Sutter’s Mills-Peninsula Medical Center. “So when we talk about stroke prevention, it’s natural that we emphasize how to keep clots from forming or keep blood pressure regulated—and both start with the heart.”

Heart health and stroke prevention were the focus of a recent educational event, hosted by United Airlines, and led by Sutter Health. Attendees toured Northern California’s only Mobile Stroke Unit – a specialized ambulance that has the staff and equipment on-board to start stroke treatment while enroute to a hospital – and heard from the unit’s director, Dr. Spokoyny, about two common heart conditions that increase stroke risk.

Atrial fibrillation

AFib is caused when the upper part of your heart beats out of sync with the lower half. While not usually life-threatening by itself, AFib alters the normal function of the heart which leads to the formation of blood clots in the heart. Eventually these clots are pumped out of the heart and can travel to the brain where they causes a stroke.

According to Dr. Spokoyny, nearly one in every six strokes is the result of AFib, and these strokes are often more serious. “Not only are AFib patients nearly five times more likely to suffer a stroke than those without the condition, AFib-related strokes are nearly twice as fatal and twice as disabling as non-AFib-related strokes.”

“AFib may be asympomatic or symptoms show up intermittently, and because they come and go many people don’t take them seriously,” Dr. Spokoyny explained. “We need to spread the word that you shouldn’t ignore the butterfly feeling in your chest or dismiss the occasional fatigue or shortness of breath you experience.” When diagnosed, AFib is treatable with medication or medical procedures, including surgery, to reduce your risk of stroke.

High blood pressure

High blood pressure increases the strain on blood vessels transporting blood throughout your body. When blood is routinely pumped through arteries at a higher than optimal pressure, the arteries may become weakened or narrowed, creating conditions where they burst or clog more easily.

Dr. Spokoyny reminds patients that high blood pressure is the single most important risk factor for stroke. “About three out of four people who have a stroke for the first time have high blood pressure.” High blood pressure often presents along with atrial fibrillation. The good news is that blood pressure can be managed with lifestyle changes and medications.

Expertise in action

Not-for-profit Sutter Health encourages doctors to work across specialties to ensure that patients receive high quality, coordinated care. Sutter includes sixteen Primary Stroke Centers across its integrated network.

After Saving Teen’s Life, School Nurse Pleads for Training

Posted on Feb 7, 2020 in Cardiac, Pediatric Care, Scroll Images, Sutter Medical Center, Sacramento, Uncategorized

SACRAMENTO, Calif. – Kathy Papa, a school nurse with the Live Oak Unified School District, spreads her duties among five schools. It was luck – some may say fate or providence – that she was at Live Oak High School just after lunch on Jan. 13 when she got a call to go to English teacher Dani Fernandez’s classroom.

Use of AED
Pediatric electrophysiologist Dr. Oleg Kovalenko of Sutter Children’s Center demostrates how to use an AED.

When she arrived, she found 14-year-old Annalese Contreras slumped in her desk in full cardiac arrest, not breathing and without a pulse. Having been a hospital registered nurse, Kathy knew immediately what was wrong and what needed to be done, but never did she think she’d come upon this situation outside the hospital without a skilled team to assist her.

Kathy immediately sprung into action, starting rescue breaths, directing the 911 call, having two classmates get Annalese out of the desk and onto the floor so compressions could be started, and sending Fernandez to get the school’s portable defibrillator, called an AED. The school had it for years, but it had never been used. After a few successions of CPR, the AED arrived and Kathy applied the pads. The second shock did the trick and Annalese’s heart was back beating. She was then stabilized by EMTs and airlifted to the Sutter Medical Center Children’s Center. 

Annalese suffered cardiac arrest due to ventricular fibrillation, an event that is often fatal. Thanks to Kathy’s heroics and the care she received at the Sutter Children’s Center, Annalese is alive and now recuperating at home. Sutter Children’s Center pediatric electrophysiologist Oleg Kovalenko, M.D., pinpointed her ventricular arrhythmia and Annalese had a defibrillator called an ICD implanted by Sutter electrophysiologist Jonathan Man, M.D., to shock her heart into the correct rhythm when it detects irregular heartbeats.

“Cardiac arrest is an electrical abnormality in the heart. It leads to sudden death in many, many cases and leads to 2,000 deaths a year in children,” said Dr. Kovalenko, Sutter Medical Center’s medical director of pediatric electrophysiology. “In cardiac arrest, there’s no blood flow to your brain and your organs, and the longer a patient stays in this condition, the less chance of survival,” he said, noting that usually that’s just three to five minutes. “The only way to fix it is to shock.”

Annalese Contreras, center, was saved by school nurse Kathy Papa, left, who received the Heartsaver Hero Award from Liam Connelly of the American Heart Association.

Thankfully, Annalese received those shocks within a few minutes. For her efforts, Papa received a Heartsaver Hero Award from the American Heart Association. The AHA and Sutter Medical Center physicians urged all schools to have an AED on-site and train staff on CPR and how to use the defibrillator. Papa started working at the school district in 2019 and already had classes set up to train staff on both, and this event has made it even more important in the staff’s eyes.

As Dan Falco, co-medical director of the Sutter Medical Center Children’s Center said, “That school nurse is the real hero here.” However, Papa was quick to point out that the quick action on the part of Fernandez and the two classmates got Annalese out of the desk are heroes, too.

Annalese’s parents are so grateful to the school and Sutter Children’s Center staff for saving their daughter’s life that they traveled from Live Oak to the hospital to thank them personally and shared their thanks publicly through the media.

“I’d just like to give thanks to everybody – the school, the nurse, the emergency room, the ambulance, the helicopter, the EMS and the hospital – because if it wasn’t for all of them, my daughter wouldn’t be here today,” said Annalese’s father, Felipe Contreras. “I consider all you guys heroes.”

As for Papa, she had a plea: “I want the public to be aware that anyone can save a life, and it just takes a day of training or even just a few hours so that you know what to do in case of an emergency. And,” she said, holding up a portable AED, “this awesome device saves lives. And we all can see that that has happened.”

Here is a video of this story from Fox 40 in Sacramento.

Helping Mind the Gap on Cardiovascular Diseases

Posted on Feb 7, 2020 in Alta Bates Summit Medical Center, California Pacific Medical Center, Cardiac, Expanding Access, Innovation, Quality, Research, Scroll Images, Sutter Medical Center of Santa Rosa, Sutter Medical Center, Sacramento, Sutter Medical Foundation, Sutter Roseville Medical Center

Heart valve imaging
Heart valve imaging

Lifesavers appear in big sizes and small. For patient Adam Livingstone, rescue was a dime-sized clip that restored his heart’s normal rhythm and size. For months, Livingstone had been experiencing shortness of breath, chest pain and fatigue. Diagnosed with mitral valve regurgitation, a minimally invasive procedure to repair the valve was performed at Sutter Medical Center, Sacramento—one of Sutter’s sites where researchers evaluate new devices for treating damaged or diseased heart valves.

The Heart’s Finely Orchestrated Blood Flow

Heart valves
Heart valves

Like a musical conductor, the heart oversees rhythm and flow, circulating blood to each of its chambers in a coordinated, unidirectional symphony.

THE MITRAL VALVE

Mitral regurgitation, the most common type of heart valve disorder, occurs when blood leaks backward through the mitral valve when the left ventricle closes.

Some patients undergo non-surgical heart valve repair with transcatheter mitral valve repair (TMVR) with MitraClip®.2 During the procedure, doctors thread a catheter into a large leg vein reaching the heart. Then a dime-sized clip clamps the improperly working valve, allowing it to close more tightly with less backward blood flow.

“Some research participants recover faster and resume normal activities within a week of the procedure, and may not require lifelong anticoagulant medications, repeat surgeries, or re-hospitalization,” says David Roberts, M.D., FACC, FSCAI, medical director of cardiovascular services at Sutter in the Valley Area.

A new clinical trial at Sutter called PASCAL CLASP IID/IIF will test the safety and effectiveness of TMVR with the PASCAL Transcatheter Valve Repair System® compared with MitraClip® in patients with mitral regurgitation.3

For patients with severe mitral regurgitation, Sutter’s CPMC seeks to enroll patients in a clinical trial called SM3, which assesses the safety and efficacy of the SAPIEN M3 System™.4

“In this study, we are evaluating a new type of mitral valve that may provide a minimally invasive alternative to surgery for high-risk patients with severe mitral valve disease,” says David Daniels, M.D., co-director of Sutter’s Structural Heart Program in the Bay Area, and principal investigator of the SM3 clinical trial at Sutter.

Some patients develop mitral valve disease when calcium deposits accumulate on the fibrous ring attached to the mitral valve leaflets. For these patients with mitral annular calcification (MAC), Sutter will begin offering enrollment in the Summit clinical trial, which will test the safety and effectiveness of the Tendyne™ transcatheter mitral valve.5

“Previous approaches to treat patients with MAC have mainly involved the off-label use of transcatheter aortic valves,” says Dr. Roberts. “But this strategy may lead to residual mitral regurgitation and the need for open-heart surgery. Sutter’s participation in Summit may lead to novel ways to care for this hard-to-treat subset of patients.”

THE TRICUSPID AND AORTIC VALVES

Although a skilled conductor, sometimes the heart needs help to maintain proper blood flow for musical perfection. To the rescue: Sutter researchers test interventional devices designed to treat patients with diseased or damaged tricuspid and aortic valves.

In one new clinical trial, Sutter researchers will collect information about treatment for severe aortic regurgitation, a condition typically treated with aortic valve replacement surgery.

This study will examine the use of TAVR (Transcatheter Aortic Valve Replacement), a minimally invasive procedure designed to replace the aortic valve inside the heart. In this study, TAVR will be performed using the JenaValve™ Pericardial TAVR System, designed to help treat patients with severe aortic regurgitation or severe aortic stenosis.6

“Until now, all commercially available TAVR valves have focused on aortic stenosis, or a restricted valve,” says Dr. Daniels, co-principal investigator of the TAVR with JenaValve™ clinical trial at Sutter. “The JenaValve™ may allow researchers to treat patients with a leaky valve in the absence of any calcium. Currently these patients are only candidates for open-heart surgery.”

Additionally, Sutter researchers at CPMC and Sutter Medical Center are seeking to enroll patients who have tricuspid regurgitation in a clinical trial called TRILUMINATE.

The TRILUMINATE study will evaluate the safety and effectiveness of the Tricuspid Valve Repair System™ (TVRS) for treating moderate or severe tricuspid regurgitation in patients currently on medical management and who are deemed appropriate for percutaneous transcatheter intervention.7

  • Learn more about Sutter cardiovascular diseases research and clinical trials.
  • If you are suffering from mitral or tricuspid valve regurgitation, aortic valve stenosis or other heart valve disorder, talk to your cardiologist to see if research participation and/or valve replacement or repair is right for you.

References:

  1. American Heart Association.
  2. MitraClip™ is manufactured by Abbott Medical Devices.
  3. The PASCAL clinical trial is sponsored by Edwards Life Sciences, makers of the Transcatheter Valve Repair System®.
  4. The S3 clinical trial is sponsored by Edwards Life Sciences, makers of the SAPIEN M3 System™.
  5. The Summit clinical trial is sponsored by Abbott Medical Devices, makers of the Tendyne System™.
  6. The JenaValve™ clinical trial is sponsored by JenaValve Technology, Inc., makers of the Pericardial Transcatheter Aortic Valve Replacement (TAVR) System.
  7. The TRILUMINATE clinical trial is sponsored by Abbott Medical Devices, makers of the Tricuspid Valve Repair System™.

A Hearty Milestone for Sacramento: Over 1,000 Lives Saved with TAVRs

Posted on Dec 17, 2019 in Affiliates, Cardiac, Scroll Images, Sutter Medical Center, Sacramento, Uncategorized

A few months ago, 87-year-old Margie Malaspino wouldn’t have been able to play Mrs. Santa for her local Soroptimist event. She was in heart failure due to a constricted aortic heart valve, called aortic stenosis.

“I tired out too easy,” she says. “I had no energy to even walk across the house.” And, way too little energy to play Mrs. Santa for children.

But all that changed by the time Malaspino’s role as Mrs. Santa came earlier this month. She was full of life and all smiles, thanks to a minimally invasive valve replacement known as a TAVR – transcatheter aortic valve replacement – that was performed at Sutter Medical Center, Sacramento. The hospital was one of the first TAVR centers in the nation, first implanting one in 2012, and in October 2019 became the first center in the Central Valley to perform 1,000 TAVR procedures. Sutter Medical Center, Sacramento has performed the most TAVRs in the greater region and is in the top five in the state, according to the TAVR’s maker, Edwards Lifesciences.

TAVR is performed without the need for open-heart surgery to replace a narrowed aortic valve. A team of interventional cardiologists and heart surgeons work side-by-side to thread a catheter containing the new valve through a vein and expanding it once it’s in place. It originally was used just in older patients – usually those in their 80s and 90s – and others who may be too weak to have an open-chest surgery. Just this year, it was approved by the FDA for standard-risk patients, too.

The TAVR team at Sutter Medical Center, Sacramento has since pioneered several improvements to the TAVR procedure. Among them: In 2015 the team was the first in Sacramento and one of the first nationally to perform TAVR using conscious sedation rather than general anesthesia, providing inherent benefits to these elderly and frail patients, and in 2018 the team was the first in the Central Valley to perform an innovative catheter procedure called BASILICA followed by a TAVR, successfully preventing an often-fatal complication of a valve-in-valve replacement.

“We are so proud to be able to give people their lives back with this procedure,” said Thomas Rhodes, R.N., administrative director of cardiovascular services at Sutter Medical Center. “Margaret’s story is one of many successes that we love to hear. We have an incredible team devoted to improving our patients’ lives.”

Just two weeks after the procedure, Margie was back on the go, thanks to the team at Sutter Medical Center. Not only did she play Mrs. Santa, she is back calling bingo at least once a month and going out with her friends to dance and listen to music.

“She has a better social life than I do,” said her granddaughter, Erica. “She runs circles around her five great-grandsons.”

Margie Malaspino didn’t miss a beat as she once again played Mrs. Santa at her Soroptimist event in Jackson, Calif.

Sacramentan Still Going Strong 25 Years After Heart Transplant

Posted on Nov 1, 2019 in Cardiac, Quality, Scroll Images, Sutter Medical Center, Sacramento

SACRAMENTO, Calif. – When Mick Doughty, 68, was put on the heart transplant list in the 1990s, Sutter pioneering heart surgeon Paul Kelly, M.D., said a new heart would extend Mick’s life by 10 years … 20 years at the most.

“I told him, ‘Oh, I’ve got to beat that.’” Doughty says with a smile.

It’s now been 25 years since his transplant, and Doughty credits his longevity to the incredible care he’s received at Sutter Medical Center, close to his home in Sacramento.

To celebrate Doughty’s milestone, the Sutter Heart Transplant Program at Sutter Medical Center, Sacramento, threw the native Irishman a party and presented him with a few gifts, including a new “Irish ticker” to replace the one that was taken out: a pocket watch from Ireland.

During the event, which also featured talks by Dr. Kelly – who began Sacramento’s only heart transplant program in 1989 – and the current medical and surgical directors of the program, John Chin, M.D., and Robert Kincade, M.D., Mick entertained the audience with funny stories in his Irish brogue. The physicians say that Mick has done everything he’s had to do to ensure a long life, and that includes his sense of humor.

“He does everything he is supposed to do” to keep himself healthy, says Dr. Kincade. “And he’s just a character, he’s the life of the party.”

The Sutter Medical Center, Sacramento Heart Transplant Program, the only heart transplant center in the Central Valley, has consistently shown quality measures that are among the best in the nation, and Doughty’s longevity is living proof of that quality.

In the 30 years, the cardiac surgeons, cardiologists and care teams at Sutter Medical Center have transplanted 216 heart patients throughout Northern California to incredible success. Doughty is one of a handful of their patients who have reached the 25-year mark. According to the National Institutes of Health, the average life expectancy for a heart transplant is 9.16 years, and a relative few live past 20 years with a new heart. With his active lifestyle, Doughty believes he’ll outlive the current Guinness world record holder, who lived 34 years with his new heart.

“People ask me all the time how I’m feeling, and I say, ‘Never better,’” Doughty says.

“That’s what it’s all about, giving people back their lives, and giving people a quality of life,” says Dr. Chin. “It’s very, very gratifying. It’s why we do this.”

When asked what 25 more years of life have given him, Doughty started to list off a number of family and professional events, including his 25th wedding anniversary, his children’s graduations, his son’s wedding, being named “Sacramento’s Financial Planner of the Year.” Then he paused and said, “You know what, I think it’s the day to day, waking up every morning, living life – that is as important as all the milestones.” View a news story on Doughty’s party by clicking here.

Mick Doughty, center, thanks Drs. Paul Kelly and John Chin for the heart transplant that has extended his life for 25 years … and counting.

Keeping pace with cardiovascular diseases research

Posted on Sep 3, 2019 in Affiliates, California Pacific Medical Center, Cardiac, Expanding Access, Innovation, Research, Scroll Images

SAN FRANCISCO – For many people, a quickened heart beat is a normal physiologic response to physical activity or stress. But for at least 2.7 million Americans with atrial fibrillation, an abnormal or irregular heartbeat can lead to blood clots, stroke, heart failure, and other heart-related complications if left untreated. Learn how research at Sutter is helping guide and inform care for patients with this cardiovascular disease.

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