Over the last decade, the development of life-saving procedures to treat heart disease and vascular disorders have minimized invasiveness and enabled faster and easier recovery while delivering optimal results. These innovative approaches are creating new options for patients who might not be candidates for open surgery, have failed initial therapies, or are seeking advanced treatments to improve their quality of life.
Atrial fibrillation (also called AFib or AF), is an abnormal heart rhythm. During AFib, the signal to start the heartbeat is disorganized, causing the upper chambers or atria of the heart to quiver or fibrillate. The contraction of the atria and the ventricles is no longer coordinated and the amount of blood pumped out to the body varies with each heartbeat. This can lead to blood pooling, increasing the risk of forming blood clots. These clots can then break off and lodge in an artery leading to the brain, which is why AFib significantly increases your risk for stroke.
It is important that your care team works with you to create a specific treatment plan for your AFib targeting stroke prevention, heart rate control and ultimately means to restore normal sinus rhythm. Beyond providing leading medical, ablative and surgical treatments, University Hospitals Harrington Heart & Vascular Institute experts also participate in investigational clinical trials evaluating new strategies, medicines and technologies for treating AFib.
Typically, medications are the initial treatment method for AFib and should be tailored to the individual patient. With all medications, you will need regular follow-up care for your AFib. Medications may include stroke prevention with blood thinners or anticoagulants with warfarin or another drug such as apixaban, rivaroxiban or dabigatran. Heart rhythm control may be achieved with medications (antiarrhythmic drugs), but often it requires AFib ablation.
For most individuals with persistent AFib or those whose symptoms do not improve with medications, the heart’s normal rhythm may be restored by delivering a controlled electric shock to the heart through special cardioversion pads that are applied to the chest and back under general anesthesia. This procedure is called electrical cardioversion, and it can help get the heart back into a normal rhythm. However, this may only have temporary results and AFib recurs.
Atrial Fibrillation Ablation
Atrial fibrillation (AFib or AF) ablation, also called pulmonary vein isolation (PVI), is a potential cure for AFib. The procedure does not necessarily require general anesthesia, and most patients are allowed to go home within 24 hours. AFib ablation is a minimally invasive option for symptomatic patients who failed or developed side effects to at least one antiarrhythmic medication. For some patients, ablation can be considered as the first line of treatment. Learn more about AF ablation at UH Harrington Heart & Vascular Institute.
Surgical Atrial Fibrillation Ablation – Maze Surgery
Patients who have conditions requiring heart surgery may benefit from surgical treatment of AFib in the same procedure. Maze surgery uses cuts or ablation to isolate the pulmonary veins to prevent AFib. Patients who have failed catheter ablation for AFib may also benefit from surgical ablation.
Atrioventricular Node Ablation and Pacemaker Implantation
Atrioventricular (AV) node ablation targets the AV node (the filter between the upper and lower heart chambers), which creates a heart block requiring a permanent pacemaker. This procedure does not cure AFib but may provide some relief of AFib symptoms and/or facilitate management of other medical problems.
Left Atrial Appendage Occlusion for Stroke Prevention without Long-Term Blood Thinners
The implantation of a left atrial appendage occlusion device may lower the risk of stroke in AFib patients. The left atrial appendage (LAA) originates in the left atrium of the heart and is where over 90 percent of stroke-causing clots that come from the heart are formed. The doctor implants a device to seal off the LAA, and it is left permanently fixed in the heart. Learn more about left atrial appendage closure at UH Harrington Heart & Vascular Institute.
Critical Limb Ischemia
Critical limb ischemia (CLI) is a severe blockage in the arteries of the lower extremities. It is an advanced stage of peripheral artery disease that significantly reduces blood flow and leads to severe pain in the feet or toes, even when there is no movement. Patients with this condition may also experience other CLI symptoms, including numbness in their feet, thickening of toenails, lack of a pulse in the legs or feet, non-healing wounds, foot ulcers or gangrene.
The main goal of critical limb ischemia treatment is to preserve the limb by re-establishing blood flow to the affected area. Some of the most effective treatment options for this condition are minimally invasive endovascular therapies such as:
Atherectomy: In a laser atherectomy, the tip of a laser probe vaporizes small pieces of plaque. A directional atherectomy involves using a catheter with a rotating blade to remove plaque.
Angioplasty: An angioplasty involves inserting a tiny balloon through a puncture in the groin. A saline solution inflates the balloon a few more times so that the artery can be opened.
Stents: After an artery has been opened through angioplasty, metal mesh tubes that provide support are left in place.
Revascularization: Blood flow is restored by opening the veins through stents, balloons or bypass around the blocked arteries in the leg.
If these treatments do not resolve blood flow significantly enough, a surgical procedure known as a bypass graft may be recommended. During a bypass graft, an artificial tube or vein from your body is used to route blood flow around your damaged artery to bring improved blood flow to the affected area.
Limb Salvage and Amputation Prevention Program
University Hospitals Harrington Heart & Vascular Institute offers a Limb Salvage Program, one of a select number of such centers in the United States. The program transforms the standard of care for “no option” critical limb ischemia (CLI) patients at risk of amputation. Our experts are national principal investigators for multiple clinical trials aimed at reducing leg amputations and preserving lower extremities, including:
LimFlow Percutaneous Deep Vein Arterialization (pDVA) System: This breakthrough first-in-humans clinical trial employs a novel proprietary technique to redirect blood from ischemic arteries into the tibial veins, providing a bypass around the blockage in the artery and resupplying oxygen to the surrounding tissue. Outcomes from the procedure include wound healing, limb salvage and remarkable changes in the vasculature of the foot. UH Harrington Heart & Vascular Institute is one of five centers nationally and the only center in Ohio offering LimFlow to end-stage CLI patients without options.
Biologic therapy: As an adjunctive therapy to revascularization, bioactive agents are injected into the foot to observe wound healing in a more timely fashion. The biologic stimulates and directs naturally occurring angiogenic factors in the body to the site of injury with the hope that new small blood vessels will build to improve perfusion.
Radial to peripheral (R2P) program: R2P allows complex procedures in the leg to be performed via the radial approach. The last five to 10 years have shown when patients are treated from the wrist, it is less risky and associated with less bleeding, and that patient satisfaction and quality of the procedure are higher than if done through the groin.
Heart failure occurs when the heart is unable to pump enough oxygenated blood to meet the needs of your body’s organs, and can lead to symptoms such as irregular heartbeats, shortness of breath, dizziness and swelling of the legs and ankles. The goals of heart failure treatment are to slow the progression of this disease, relieve symptoms, reduce the need for hospitalization and help you live a longer, healthier life.
Select national programs, such as UH Harrington Heart & Vascular Institute, offer access to clinical trials and lifesaving treatments like unique medications, implantation of mechanical circulatory and ventricular assist devices (VAD), and heart transplantation. A multidisciplinary team, which consists of cardiologists and surgeons who specialize in heart failure, will design a treatment plan that is ideal for your age, overall health, medical history, disease progression and preferences.
Heart failure treatment options include:
Angioplasty and stenting: Angioplasty and stent placement is a minimally invasive method of accessing blocked or clogged arteries and opening them to restore blood flow to the heart.
Coronary artery bypass graft surgery (CABG): If you have coronary artery disease, CABG can bypass the blocked portion of your coronary artery with a healthy blood vessel from another part of your body.
Heart transplant: The process of replacing a damaged heart with a healthy one from a donor is known as a heart transplant. Heart transplants are only recommended in the most severe cases of heart failure.
Heart valve repair or replacement: If one or more of your heart valves have to work harder to pump blood, they can become narrow and stiff or even leak. A valve repair or replacement may be necessary if this is the case.
Implantable cardiac defibrillators: Also, called ICD, this device is similar to a pacemaker, but larger. The difference is an ICD can send a low-energy shock to reset an abnormal heartbeat or send a higher-energy shock if an arrhythmia restricts the heart from pumping.
Medications: There are a variety of medications we may prescribe to treat heart failure. These medications may reduce the workload of the heart, increase heart strength, increase the pumping action of the heart and keep the heart’s rhythm regular.
Pacemakers: Pacemakers may be a viable treatment if your heart rate is irregular or too slow. Another specialized pacemaker, called a biventricular pacemaker, is used when ventricles are not in sync which can worsen heart failure.
Risk factor control: To prevent the worsening of heart failure, you may be encouraged to control heart attack risk factors by losing weight, sticking to a low-sodium diet, controlling your blood sugar and quitting smoking.
Transmyocardial laser revascularization (TMR): TMR is a new treatment that is performed to improve blood flow to areas of the heart that were not treated with angioplasty or surgery. It involves using special carbon dioxide to create small channels in the heart muscle.
Valve and Structural Heart Disease
Heart valve disease occurs when one or more of the valves in your heart cannot function properly. The heart’s valves normally assist in controlling the flow of blood through the chambers of the heart. When heart valve disease is present, a valve may be unable to close properly or open completely. This can force your heart to work harder every time it beats. Heart valve diseases include:
Often times, heart valve disease does not cause any symptoms and is diagnosed after a heart murmur is detected through a routine physical exam. However, if heart valve disease symptoms are present, they can include shortness of breath, chest pain or pressure, dizziness or fainting, weakness, a racing heartbeat and swelling of the feet, ankles or abdomen.
The main goals of treating heart valve disease include protecting the valves from further damage, reducing symptoms and repairing or replacing valves for long-term heart health. Innovations in heart valve treatment available only at select centers nationally, such as UH Harrington Heart & Vascular Institute based in Cleveland, Ohio, include:
Stentless aortic valve prostheses: These biologic (tissue) valves are equivalent to human valve transplants and exhibit excellent hemodynamics (blood flow). UH Harrington Heart & Vascular Institute has some of the greatest expertise with these valves in the world.
Mini-thoracotomy for valve repair and replacement, which enables surgery through an incision between the ribs without opening the sternum, or breastbone.
Pioneering procedures such as transcatheter mitral valve-in-ring, which enables minimally invasive treatment of dysfunctional, previously operated mitral valves with a transcatheter valve.
Transcatheter aortic valve replacement (TAVR), which uses local anesthesia and minimum sedation to enable replacement of the aortic valve with a catheter in a “talking and awake” patient. UH Harrington Heart & Vascular Institute is recognized as a national and international leader in optimal techniques for TAVR.
The APOLLO trial, investigating transcatheter mitral valve replacement (TMVR) for patients with severe mitral valve regurgitation. UH Harrington Heart & Vascular Institute is the only program in Northeast Ohio to offer this trial.