Joey Wahler (Host): It's a crucial specialty within cardiology, so we're discussing what structural heart specialists do. Our guest, Dr. Omid Fatemi, he's an interventional cardiologist and he's Medical Director of Cardiac, Cath, and Structural Heart Services for Community Memorial Healthcare. This is Wise and Well, presented by Community Memorial Healthcare.

Thanks for listening. I'm Joey Wahler. Hi there, Dr. Fatemi. Thanks for joining us.

Omid Fatemi, MD: Hi, Joey. Thanks for having me.

Host: Great to have you aboard. So first, in a nutshell, what's an interventional cardiologist compared with a "regular cardiologist", if you will, and what role do you and yours play on a patient's care team?

Omid Fatemi, MD: Thank you for the question, Joey. I think it's an important one. General cardiologists are doctors, physicians, who specialize in heart disease. They've gone through their internal medicine training and they know internal medicine very well. And then, they do several years of extra training to know about the heart and the systems within the heart.

When you break down the heart, I like to think of it as smaller subsets of systems, where there's plumbing and electricity. And I'm somewhat of a plumber of the heart. So, I work on coronary arteries, and I work on heart valves, and I fix holes in the heart. And I do that through interventional procedures that are largely minimally invasive, that don't require open heart surgery. And I use technological advancements to intervene on problems of the heart and create fixes where there weren't before.

Host: Gotcha. Love the analogy, by the way. It definitely works. So, that being said, what education and training does a specialist such as yourself need, and how would you say your own background prepared you for, if not also pointed you toward an interest in structural heart work?

Omid Fatemi, MD: To get to this point, after college, you do four years of medical school, you do three, or in some cases, four years of internal medicine. I did a fourth year where I did an extra year where I was a chief resident and I taught the other residents. Then, you do at least three years of cardiology to learn specifically about cardiology and then you do an extra year or two of training in interventional and structural heart.

For me personally, I knew from a young age I wanted to be a physician as I was exposed to it from my father who was a cancer doctor. And then when I went through the medical school and early training, it was difficult for me to decide whether I wanted to be a surgeon or an internist. And I thought interventional cardiology was kind of the perfect marriage of procedures and the medical knowledge from internal medicine that I really enjoyed. And that's what led me down that path.

Host: So, your dad was a doctor. It seems quite often that happens, right? That a child who has a parent that's already a physician, that's a big factor in like father, like son in this case, right?

Omid Fatemi, MD: Absolutely, it is. I saw who he was and how he helped people and his philosophy on life and thinking about doing things for the greater good. That really affected me from a young age. And I saw that it gave him a purpose and I really admired that about him, so I use that to kind of motivate myself to go through the years of training and the years of studying to get to this point.

Host: That's awesome. So, why would you say structural heart procedures are so important in cardiology for those not as familiar with them. And what are some of the main procedures that you and yours typically perform and if you could give us, please, an idea of what each one involves?

Omid Fatemi, MD: Sure. So, to take little bit of a step back, interventional cardiology first started as a way to fix or to work on coronary artery disease. In layman's terms, what we would do is we would take catheters to the heart and the arteries that sit on top of the heart, and we would open up blockages in those arteries. And the blockages, if they happen suddenly, a blockage in the coronary arteries, that's a heart attack. And so, that's where interventional cardiologists did the majority of their work.

As technology advanced, other problems, structural problems, started to become more readily defined and more easily accessible through minimally invasive procedures. The hot button topic of structural heart is the TAVR procedure, the aortic valve replacement that's minimally invasive. What we do with a TAVR procedure is we replace someone's aortic valve. An aortic valve is the main heart, the main valve of the heart that degenerates over time. The way you think of it is the valve of the heart is like a door. And when you get older, the door can wear down.

There's two problems that can happen with a door. It either doesn't open well or it doesn't close well. Aortic stenosis is when that door does not open well. And so, your heart tries to pump and tries to pump blood to the rest of your body, but the door doesn't open well enough to get blood to the rest of your body. And people can get symptoms like passing out, like heart failure, shortness of breath, chest pains, or angina. And it used to be to fix that problem, you'd have to do an open heart surgery, where you'd cut someone's breastbone, you'd fillet out the old valve and sew in a new heart valve. Over the course of the last 20 and more closely about 10 years, it's become the TAVR procedure rather than open heart surgeries. And instead of opening someone's chest, you put them under twilight anesthesia, you poke a hole in the artery of their leg, take a catheter up to their heart, place a new heart valve in the place of the old heart valve. And there's an immediate new heart valve and new heart valve function that takes place. You take the catheters out, you wake them up from anesthesia. And oftentimes, they can go home the next day. And sometimes we can even have patients go home the same day, and their heart valves are improved right away.

There's several other procedures which we do. That's the big one that people think about, but there's procedures where we repair a leaky mitral valve, called the mitral clip procedure. There's a procedure where we can take patients off of blood thinners for AFib called the Watchman or left atrial appendage occlusion. And we can fix holes in people's hearts like PFOs, ASDs, and VSDs, where all these procedures used to require open heart surgery, and now they require minimally invasive procedures through the artery and vein in the leg. And oftentimes, you don't even need general anesthesia, you usually get a twilight anesthesia.

Host: And so, to go back to the first one you mentioned, the TAVR, which is an acronym, I guess it's TAVR, which stands for what actually?

Omid Fatemi, MD: So, TAVR is the way that we replace the heart valve. The acronym stands for transcatheter aortic valve replacement. So, what's involved is that, instead of having you go through general anesthesia and getting breathing tube and cutting the breast bone with a bone saw and laying out the aortic valve, you use a small needle and gain access through the artery and the leg. And then, you take catheters up and replace the valve with catheters. And then once the catheters come out, you just put a small stitch into that artery and close up the artery right then and there. We used to use the term SAVR for surgical aortic valve replacement and just a fancy way of saying we don't open the chest. We do it through a small incision through the leg rather than using knives or using blades to make big incisions and cut your breastbone.

Host: So when you say minimally invasive with regard to that procedure, you're not kidding because you're talking about going in through the leg, as you said, not even opening up the chest.

Omid Fatemi, MD: No, no, it's a very, very small incision. It's amazing that you can take a big heart valve and go through a small incision in the leg.

Host: So, when usually, doctor, does a structural heart specialist like yourself get involved in a patient's care, at what stage? And how are those conditions that you're going to zero in on diagnosed, actually?

Omid Fatemi, MD: Usually, those patients are seen by their primary care physicians, and then oftentimes even a general cardiologist. It's kind of an interesting point in technology because a lot of times I describe what I do as fixing problems that arise as a product of our success. People are living longer and healthy lives and their valves wear down due to long healthy lives.

And so, they can present to their physician, their primary care physician, or even their cardiologist with non-specific symptoms like, "I feel like I'm slowing down," or "I feel fatigued, or I just don't have the same get up and go. Or it can be more specific. The primary care physician can hear a heart murmur and say, "Boy, this doesn't sound right," or "I'm getting chest pains or shortness of breath." and that can prompt a visit to their cardiologist. When I hear things like, "Doc, I'm getting older," "Doc, I don't have the same desire to do things," it changes the way I think about that. Because oftentimes we would say, "Okay, someone's getting older. This is a natural aging process," but it makes me think there are things that are within our control that limit our activity and make us "feel like we're getting older," when in fact it's a reversible problem that we can address. And a lot of times after we replace someone's aortic valve or fix their mitral valve, they come back and say, "You know, it wasn't just getting older. I had a problem. And I feel better and I'm able to be active. I'm able to get back to the activities I love doing." And that's a big part of this structural heart paradigm that's changed how we approach the aging process.

Host: So, in other words, the person has gotten older, but they don't necessarily have to feel older, right?

Omid Fatemi, MD: Correct.

Host: So, Community Memorial Hospital in Ventura, they've been on the forefront of advancements in heart and vascular treatments. What would you say sets this program apart from others and how has it evolved over time?

Omid Fatemi, MD: I think we've had a fairly rapid evolution. We've been doing structural heart procedures for about five years now, and we've done about a thousand structural heart procedures over that time. The individualistic nature of how we approach this is very unique. The fact that we can do, and we do the same things that big academics and tertiary care centers do in Los Angeles or all the big cities. But we do it in the convenience of a person's own neighborhood, their own backyard, so to speak, adds a level of comfort to people that's very important.

Before we had this program up and running, a lot of our patients would have to go to Los Angeles, and going to Los Angeles to a big academic center is difficult. It's difficult to get there, it's difficult to stay there, it's difficult for the families to help manage the travel to and for, to and from those places. But now, we, with the doctors in the community, can provide the care for the patients that's the most advanced care. There's things that we do here that only academic centers used to do, and now we're doing it here.

Aside from that, it's the relationships that we have with our patients, but with each other. I can say that I've scrubbed in on these cases with the same team and the same surgeons and the same techs and nurses for hundreds of procedures, so there's a rhythm to the procedure that makes it flow very, very well and it's beneficial for the patients and makes it smooth and quick for them as well.

Host: That's great to hear. And so in summary, when you go to work each day, personally, what would you say excites you the most about the Structural Heart Program at Community Memorial?

Omid Fatemi, MD: The fact that we're so progressive, we're always thinking about what are we doing well, what do we need to improve on, and what can we do to serve our community and make sure that we're getting the best care for our patients. And I take a lot of pride in that. I take a lot of pride in keeping our patients local and making sure that we are doing the best that we can for our patients and that they get the same and even better care here locally than they would anywhere else in the world.

I really think it's a gem of a place for that reason. There's things that I've talked to my colleagues at academic centers about what we're doing, and they're often very surprised at how much we're able to do and what we're able to do at our local center.

Host: Well, folks, we trust you're now more familiar with structural heart procedures. Dr. Omid Fatemi, thanks so much again.

Omid Fatemi, MD: Thank you. Have a great day.

Host: And for more information, please visit mycmh.org and search Structural Heart Care. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler. And thanks again for listening to Wise and Well, presented by Community Memorial Healthcare.