The best treatment for heart disease is to stop it from occurring in the first place. New advancements in heart care are happening every day at Rochester Regional Health.
Listen as Jeremiah P. Depta, MD explains that these new developments are giving patients chances to live longer, healthier lives.
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Advancements in Heart Care at Rochester Regional
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Learn more about Jeremiah P. Depta, MD
Jeremiah P. Depta, MD
A graduate of Chicago Medical School/Rosalind Franklin University of Medicine and Science, Jeremiah P. Depta, MD completed his internship and residency in Internal Medicine at Cleveland Clinic, where he also served as a Chief Medical Resident. He completed his Cardiology fellowship at Washington University in St Louis/Barnes Jewish Hospital. He completed fellowships in Interventional Cardiology and Structural, Valvular, and Peripheral Vascular Intervention at Brigham and Women's Hospital/Harvard Medical School. He joined the staff at Sands-Constellation Heart Institute/Rochester General Hospital in 2015 and is the Director of the Advanced Valvular and Structural Heart Disease Program.Learn more about Jeremiah P. Depta, MD
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Advancements in Heart Care at Rochester Regional
Bill Klaproth (Host): Heart disease remains the leading cause of death for both US men and women, so what are some of the advancements in heart health care? Here to tell us more is Dr. Jeremiah Depta of Rochester Regional Health. Dr. Depta, thanks for your time. It sounds like we’re making new roads in heart health care. Can you tell us about some of these new procedures?
Dr. Jeremiah Depta (Guest): Absolutely, thanks for having me on today. We’re really at a revolution in the way we’re able to deliver heart care to our patients. Today I’d like to discuss some of the specific procedures that have recently been approved for use in patients but are really changing the paradigm in how we’re practicing medicine. The first procedure is something called a transcatheter aortic valve replacement, and that’s known by the acronym TAVR, which again is T-A-V-R. It is a procedure that we are able to replace the aortic valve without having to perform open-heart surgery. It is performed on patients who have a condition called aortic stenosis, specifically people who have severe aortic stenosis. What that condition is, is when the aortic valve became calcified and stiffened and does not open properly, this causes patients to be very symptomatic where they would develop fatigue, tiredness, feeling out of breath, chest discomfort, sometimes lightheadedness when they are doing their activities. It’s a progressive condition; it gets worse over time, and there’s really no medical therapy for it. It’s also associated with a high risk of death, meaning once you have severe, symptomatic aortic stenosis, your lifespan is limited. In the general population, about half the people will not survive beyond the first one to two years after diagnosis. Traditionally, the only option people would have, would be open-heart surgery. More recently we are now able to replace this valve without any surgery at all, and that’s what the procedure called TAVR does. Specifically, this procedure – in the overwhelming majority of people – we get access into the arteries in the leg, again, not having to use any cutting or to use any surgical technique, we’re able to get access to the arteries and then deliver a new heart valve and essentially put a heart valve where their heart valve is. From that standpoint, the old one just gets pushed up to the side. The procedure takes about one to two hours. We do it both on awake patients or people who are under general anesthesia and within four hours of the procedure, patients are up ambulating around. Here at Rochester Regional, about half of our patients will leave the day after the procedure and about 90-95% will leave within two days with very minimal recovery from that standpoint.
Bill: Well that is amazing. No open heart surgery and you’re able to replace that valve with such a minimally invasive procedure, the patient is up and walking that afternoon, able to leave the next day.
Well, that is amazing, the TAVR procedure, being able to replace an aortic valve with a minimally invasive procedure, amazing. The patient is up and around moving later that day, able to go home, in most cases, the next day. That’s terrific. When you talk about stenosis, you’re talking about hardening of the arteries, right? The plaque build-up? That’s not good, and that not only promotes heart failure but also stroke, too, so being able to do that in such a quick fashion is absolutely amazing. Can most people get that, or are there certain people that only qualify for a TAVR procedure?
Dr. Depta: Yes, that’s a good question, and I’ll just clarify that the TAVR procedure is meant to be done on the valve, so it’s definitely a hardening or calcification, but it’s not of the arteries, it’s actually of the valve itself. The valve is what the heart is to push blood out of to go to the entire body, but in a similar light, it’s in the same pathway of what we commonly think of hardening of the arteries. Specific to patient selection, initially, the procedure was only approved for patients who are the highest risk for open-heart surgery, but more recently, it’s now able to be performed on people who are an intermediate risk. That qualifies about half of the people who would typically undergo open-heart surgery are now able to get this procedure. How we assess this – when patients get referred for TAVR, we do a comprehensive assessment, we do a CT scan on the same day that we meet them, and we are able to assess not only their risk for open-heart surgery, we’re able to review all their medical history in detail, get CT scan imaging to see if the arteries in the legs are large enough to get the valve up to the heart and then put everything together in conjunction with our cardiac surgeons to try to determine what is the best strategy for that patient to get their valve replaced.
Bill: That is amazing and with proper lifestyle changes, then, what is the efficacy of that valve replacement? How long will that last?
Dr. Depta: The efficacy is currently on par for surgical valves. Though being a new technology, there’s not studies beyond ten to fifteen years. In the United States, there’s five-year data showing the valves work as good as surgical valves and then if you look in Europe where they’ve been doing this for longer, there's data out to eight to eleven years and again – sorry, that’s in Europe and Canada. The currently available evidence, we have no indication that these valves don’t work as well as surgical valves.
Bill: Right, and Dr. Depta, can you share any other new procedures that are available now that are helping with heart healthcare?
Dr. Depta: Yes, there’s also something called the Watchman Device. This is a device that is more recent, available nationally for about the last 12 to 18 months. Specifically, it’s designed for people who have atrial fibrillation. Atrial fibrillation is a condition where the top part of the heart, called the atria, do not beat properly. Because of that, what happens is, the blood will pool and become stagnant at the top part of the heart, and that, unfortunately, can lead to clots in the upper part of the heart that can break loose and go anywhere in the body. Most importantly, we’re worried would it go up to the brain and cause a stroke? Traditionally, the upfront treatment was to be put on blood thinners. The unfortunate thing is there are a lot of patients who cannot tolerate long-term therapy with an oral anticoagulant, and that can be for various reasons. The most common one is the obvious one, which is bleeding that patients either have a history of bleeding on blood thinners or without blood thinners, or they might have had a serious brain bleed. It could also be somebody who’s very prone to falls, and being on a blood thinner may be risky. There are various reasons where long-term treatment with blood thinners may not be the best option. Specifically, the Watchman Device basically plugs the area of the heart that the vast majority of clot comes from and that’s specifically called the left atrial appendage. It’s a finger-like projection off the atria on the left side of the heart. What we do is essentially put a plug there that occludes blood from going in there. Patients will have to be on blood thinners for 45 days, but the procedure is performed in one to two hours. They’re put under general anesthesia, but they’re able to leave the day after the procedure. The success rates are very high for this procedure. It’s anywhere from 92-98% success rates that were able to occlude it. As I mentioned, patients will have to stay on their blood thinner for 45 days, although there is some flexibility in that and then we do an ultrasound of the heart at 45 days to make sure the device is doing what it’s supposed to do, and then people come off their blood thinners. The cool thing is when they looked at patients who could not tolerate long-term oral anticoagulation or blood thinners -- several large trials looked at randomizing, meaning taking one population and giving them the device, the other population, putting them on Warfarin -- they found dramatic reductions in the risk of bleeding with the device which is actually translated into a reduction in mortality, meaning death from that standpoint. It’s all due to the prevention of the bleeding events that happen from blood thinners. The people who would qualify for this procedure would be people who, again, have atrial fibrillation, are at a higher risk for stroke, but cannot tolerate the long-term therapy with blood thinners.
Bill: Dr. Depta, thanks for sharing information on those two devices. The TAVR procedure for those people that have stenosis of the aortic valve, and the Watchman Device treating people with A-Fib. Just terrific advancements and thank you, so much for sharing those with us. If you can just wrap it up for us, why should someone choose Rochester Regional for their heart health needs?
Dr. Depta: Rochester Regional really is able to offer the latest technology that is available in cardiology. There is really not a single procedure that is performed in the United States that is not offered here. We have had excellent outcomes and are able to provide the same care locally that you would receive at any of the top medical centers in the United States from that standpoint.
Bill: Well that’s great information and thank you, so much for sharing that with us. You’re listening to Rock Your Health Radio with Rochester Regional Health. For more information, you can go to RochesterRegional.org, that’s RochesterRegional.org. I’m Bill Klaproth, thanks for listening.
Advancements in Heart Care at Rochester Regional
Bill Klaproth (Host): Heart disease remains the leading cause of death for both US men and women, so what are some of the advancements in heart health care? Here to tell us more is Dr. Jeremiah Depta of Rochester Regional Health. Dr. Depta, thanks for your time. It sounds like we’re making new roads in heart health care. Can you tell us about some of these new procedures?
Dr. Jeremiah Depta (Guest): Absolutely, thanks for having me on today. We’re really at a revolution in the way we’re able to deliver heart care to our patients. Today I’d like to discuss some of the specific procedures that have recently been approved for use in patients but are really changing the paradigm in how we’re practicing medicine. The first procedure is something called a transcatheter aortic valve replacement, and that’s known by the acronym TAVR, which again is T-A-V-R. It is a procedure that we are able to replace the aortic valve without having to perform open-heart surgery. It is performed on patients who have a condition called aortic stenosis, specifically people who have severe aortic stenosis. What that condition is, is when the aortic valve became calcified and stiffened and does not open properly, this causes patients to be very symptomatic where they would develop fatigue, tiredness, feeling out of breath, chest discomfort, sometimes lightheadedness when they are doing their activities. It’s a progressive condition; it gets worse over time, and there’s really no medical therapy for it. It’s also associated with a high risk of death, meaning once you have severe, symptomatic aortic stenosis, your lifespan is limited. In the general population, about half the people will not survive beyond the first one to two years after diagnosis. Traditionally, the only option people would have, would be open-heart surgery. More recently we are now able to replace this valve without any surgery at all, and that’s what the procedure called TAVR does. Specifically, this procedure – in the overwhelming majority of people – we get access into the arteries in the leg, again, not having to use any cutting or to use any surgical technique, we’re able to get access to the arteries and then deliver a new heart valve and essentially put a heart valve where their heart valve is. From that standpoint, the old one just gets pushed up to the side. The procedure takes about one to two hours. We do it both on awake patients or people who are under general anesthesia and within four hours of the procedure, patients are up ambulating around. Here at Rochester Regional, about half of our patients will leave the day after the procedure and about 90-95% will leave within two days with very minimal recovery from that standpoint.
Bill: Well that is amazing. No open heart surgery and you’re able to replace that valve with such a minimally invasive procedure, the patient is up and walking that afternoon, able to leave the next day.
Well, that is amazing, the TAVR procedure, being able to replace an aortic valve with a minimally invasive procedure, amazing. The patient is up and around moving later that day, able to go home, in most cases, the next day. That’s terrific. When you talk about stenosis, you’re talking about hardening of the arteries, right? The plaque build-up? That’s not good, and that not only promotes heart failure but also stroke, too, so being able to do that in such a quick fashion is absolutely amazing. Can most people get that, or are there certain people that only qualify for a TAVR procedure?
Dr. Depta: Yes, that’s a good question, and I’ll just clarify that the TAVR procedure is meant to be done on the valve, so it’s definitely a hardening or calcification, but it’s not of the arteries, it’s actually of the valve itself. The valve is what the heart is to push blood out of to go to the entire body, but in a similar light, it’s in the same pathway of what we commonly think of hardening of the arteries. Specific to patient selection, initially, the procedure was only approved for patients who are the highest risk for open-heart surgery, but more recently, it’s now able to be performed on people who are an intermediate risk. That qualifies about half of the people who would typically undergo open-heart surgery are now able to get this procedure. How we assess this – when patients get referred for TAVR, we do a comprehensive assessment, we do a CT scan on the same day that we meet them, and we are able to assess not only their risk for open-heart surgery, we’re able to review all their medical history in detail, get CT scan imaging to see if the arteries in the legs are large enough to get the valve up to the heart and then put everything together in conjunction with our cardiac surgeons to try to determine what is the best strategy for that patient to get their valve replaced.
Bill: That is amazing and with proper lifestyle changes, then, what is the efficacy of that valve replacement? How long will that last?
Dr. Depta: The efficacy is currently on par for surgical valves. Though being a new technology, there’s not studies beyond ten to fifteen years. In the United States, there’s five-year data showing the valves work as good as surgical valves and then if you look in Europe where they’ve been doing this for longer, there's data out to eight to eleven years and again – sorry, that’s in Europe and Canada. The currently available evidence, we have no indication that these valves don’t work as well as surgical valves.
Bill: Right, and Dr. Depta, can you share any other new procedures that are available now that are helping with heart healthcare?
Dr. Depta: Yes, there’s also something called the Watchman Device. This is a device that is more recent, available nationally for about the last 12 to 18 months. Specifically, it’s designed for people who have atrial fibrillation. Atrial fibrillation is a condition where the top part of the heart, called the atria, do not beat properly. Because of that, what happens is, the blood will pool and become stagnant at the top part of the heart, and that, unfortunately, can lead to clots in the upper part of the heart that can break loose and go anywhere in the body. Most importantly, we’re worried would it go up to the brain and cause a stroke? Traditionally, the upfront treatment was to be put on blood thinners. The unfortunate thing is there are a lot of patients who cannot tolerate long-term therapy with an oral anticoagulant, and that can be for various reasons. The most common one is the obvious one, which is bleeding that patients either have a history of bleeding on blood thinners or without blood thinners, or they might have had a serious brain bleed. It could also be somebody who’s very prone to falls, and being on a blood thinner may be risky. There are various reasons where long-term treatment with blood thinners may not be the best option. Specifically, the Watchman Device basically plugs the area of the heart that the vast majority of clot comes from and that’s specifically called the left atrial appendage. It’s a finger-like projection off the atria on the left side of the heart. What we do is essentially put a plug there that occludes blood from going in there. Patients will have to be on blood thinners for 45 days, but the procedure is performed in one to two hours. They’re put under general anesthesia, but they’re able to leave the day after the procedure. The success rates are very high for this procedure. It’s anywhere from 92-98% success rates that were able to occlude it. As I mentioned, patients will have to stay on their blood thinner for 45 days, although there is some flexibility in that and then we do an ultrasound of the heart at 45 days to make sure the device is doing what it’s supposed to do, and then people come off their blood thinners. The cool thing is when they looked at patients who could not tolerate long-term oral anticoagulation or blood thinners -- several large trials looked at randomizing, meaning taking one population and giving them the device, the other population, putting them on Warfarin -- they found dramatic reductions in the risk of bleeding with the device which is actually translated into a reduction in mortality, meaning death from that standpoint. It’s all due to the prevention of the bleeding events that happen from blood thinners. The people who would qualify for this procedure would be people who, again, have atrial fibrillation, are at a higher risk for stroke, but cannot tolerate the long-term therapy with blood thinners.
Bill: Dr. Depta, thanks for sharing information on those two devices. The TAVR procedure for those people that have stenosis of the aortic valve, and the Watchman Device treating people with A-Fib. Just terrific advancements and thank you, so much for sharing those with us. If you can just wrap it up for us, why should someone choose Rochester Regional for their heart health needs?
Dr. Depta: Rochester Regional really is able to offer the latest technology that is available in cardiology. There is really not a single procedure that is performed in the United States that is not offered here. We have had excellent outcomes and are able to provide the same care locally that you would receive at any of the top medical centers in the United States from that standpoint.
Bill: Well that’s great information and thank you, so much for sharing that with us. You’re listening to Rock Your Health Radio with Rochester Regional Health. For more information, you can go to RochesterRegional.org, that’s RochesterRegional.org. I’m Bill Klaproth, thanks for listening.