Clipped In

Top Hospitals and Healthcare 2016: VCU Pauley Heart Center treats patients with severe mitral regurgitation using an innovative cath lab procedure.

Zachary M. Gertz, M.D., Walter H.J. Paulsen, M.D. and Pranav R. Shah, M.D.

Photo by Allen Jones

A leaky mitral valve—located between the heart’s left atrium and left ventricle—can cause mitral regurgitation, a condition in which blood kicks back the wrong way, from the ventricle into the atrium. This can lead blood to pool in the body, and have serious consequences like heart failure and atrial fibrillation, says Dr. Zachary Gertz, interventional cardiologist and director of the Structural Heart Disease Program at Virginia Commonwealth University Pauley Heart Center.

“If the blood is not pumping forwards, it’s pumping backwards, so you end up with a lot of fluid in the lungs. You can end up short of breath, with swelling in the legs,” he says. “You get tired very easily, because when you exercise you can’t pump enough blood forward to satisfy your muscles and everything else in your body that needs blood and oxygen.” Patients with severe mitral regurgitation can be frequent visitors to intensive care units due to the excessive buildup of fluid.

For many years, mitral valves could only be repaired through open heart surgery, involving the use of a heart-lung bypass machine. However, a minimally invasive, FDA-approved therapy using a tiny clamp called a MitraClip is becoming more common for patients with severe mitral regurgitation. The intervention, available only to patients who are considered a prohibitive surgical risk, takes place in a cardiac catheterization laboratory instead of an operating room.

Here’s how it works: With the patient under general anesthesia, and guided by an echocardiogram, the cardiologist inserts the MitraClip through the groin using a catheter and leads it up to the heart. The cardiologist then clamps the clip onto the area of the mitral valve needing repair. Sometimes two clips are needed, depending upon the severity of the leak.

Gertz has been performing the intervention since November 2015, and is currently a primary investigator in the Clinical Outcomes Assessment of the MitraClip Percutaneous Therapy (COAPT) Trial, a national study to explore the use of the clips.

While surgery is still the preferred method for most mitral valve repair, he says, the cath lab therapy offers a “very low risk” option for those patients who qualify. The results can be life-changing.

One of Gertz’s elderly patients lost more than 40 pounds of fluid following MitraClip therapy. “She was thrilled with everything,” he says. “She’s doing her laundry; she’s going shopping at the store—whereas before she couldn’t go five steps without being short of breath.” PauleyHeart.vcu.edu


Cardiology News

In February, Dr. C. Michael Valentine, an interventional cardiologist at Centra Health in Lynchburg and a graduate of the University of Virginia School of Medicine, was appointed vice president of the board of trustees of the American College of Cardiology. Dr. Valentine has previously served as the organization’s treasurer and secretary, as well as chair of its board of governors and governor of the Virginia chapter. He is also co-chair of the ACC’s annual cardiovascular summit. 

Last summer, the American Heart Association awarded a $231,000 Scientist Development Grant to Dr. Rengasayee Veeraraghavan, a postdoctoral associate and researcher at the Virginia Tech Carilion Research Institute’s Center for Heart and Regenerative Medicine. The award provides funding over the next three years for Dr. Veeraraghavan to develop new therapies for treating abnormal heart rhythms.

In 2010, the UVA Health System implemented its Hospital-to-Home program for cardiac surgery patients. Nurse practitioners meet patients who have recently been hospitalized for heart failure in their homes within one week of being discharged to discuss medications and answer questions. Recent research has found that participants have a 43 percent improved chance of survival and a 29 percent reduction in readmission. Post-operation costs for patients and the hospital decreased by 75 percent.

Centra Southside Community Hospital in Farmville opened a new cardiac catheterization lab last spring. This new facility allows physicians to employ minimally invasive techniques to quickly restore bloodflow after a cardiac surgery. These improvements will shorten procedure times and reduce post-op hospital stays.


Cardiology Top Honors 2016


Sentara Heart Hospital
Norfolk, Sentara.com, 757-388-8000

Centra Southside
Farmville, CentraHealth.com, 434-392-8811

Clinch Valley Medical Center
Richlands, ClinchValleyMedicalCenter.com, 276-596-6000

Danville Regional Medical Center
Danville, DanvilleRegional.com, 434-799-2100

John Randolph and Henrico Doctors
Richmond, HCAVirginia.com, 804-541-1600, 804-289-4500

See all of our top hospitals for 2016, below.



Cancer
LewisGale Regional Cancer Center
UVA Cancer Center


Dermatology
Inova Melanoma and Skin Cancer Center


Diabetes
EVMS and Sentara Heart Hospital


Gastroenterology
Centra Lynchburg General Hospital


Geriatrics
Riverside Center for Excellence in Aging


Neurosurgery
Bon Secours St. Mary's


Orthopaedics
Carilion Clinic 
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