Cardiac Cath Lab: Pioneering Non-Surgical Heart Solutions

The last 70 years have seen revolutionary advances in cardiac care — from the first open heart surgery in 1955 and coronary angioplasty in 1977 to implantable defibrillators in 1980 and coronary stents in 1987. With each advancement came improved outcomes and considerably less-invasive procedures to achieve those results.

According to Dr. Andrew M. Goldsweig, MD, MS, FACC, FSCAI, FSVM, RPVI, the director of Baystate Health’s Cardiac Catheterization Laboratory and Cardiovascular Clinical Research Program, “Thanks to continued research and development in medical devices and techniques, the speed and magnitude of advances in cardiac care continues to accelerate. Today, surgery isn’t a first-line consideration for the majority of cardiac issues we treat at Baystate.” Instead, Goldsweig says, conditions like blocked or leaky valves, holes in the heart, and narrowed arteries are treated in a cardiac catheterization laboratory (cath lab) using interventional cardiology.

What is a Cath Lab?

The cardiac catheterization laboratory or cath lab is a non-surgical treatment room with the latest technology that allows our experts to provide minimally-invasive and life-saving procedures as alternatives to (and sometimes improvements over!) open heart surgery.

The only full-service interventional cardiac cath lab in western Massachusetts, Baystate Health’s Cardiac Catheterization Laboratory performs around 2,000 heart interventions every year, including:

• Angioplasty and stenting
• Left atrial appendage closure
• Patent foramen ovale closure
• Transcatheter aortic valve replacement (TAVR)

“We’re absolutely on the cutting edge of cath lab treatments,” said Goldsweig, “We’re able to provide our patients with the same options and level of expertise available at the nation’s major heart centers.”

What is Interventional Cardiology?

A non-surgical option, interventional cardiology (IC) uses small flexible tubes called catheters inserted through blood vessels to diagnose and treat heart and blood vessel conditions. Goldsweig says, “IC is truly a game changing—and life-saving—advancement that allows us to treat patients more effectively and less invasively. This is especially critical for those who, by virtue of their age or general health, aren’t candidates for major surgery.”

What Does Interventional Cardiology Treat?

Among the most common conditions treated using IC at Baystate Health’s Cardiac Catheterization Laboratory are:

• Coronary artery disease
• Atrial fibrillation Patent foramen ovale
• Aortic valve stenosis

Here’s a quick overview of how several major interventional cardiology treatment options work and their benefits.

Atrial Fibrillation

A condition experienced by 25% of people in the U.S. in their lifetime, atrial fibrillation (AFib) is an irregular, and often rapid, heartbeat. During AFib, the heart's upper chambers beat out of sync with the lower heart chambers. The out-of-rhythm chambers can interfere with healthy blood flow through the heart. Blood that doesn’t move can pool and clot. In fact, AFib increases a person’s risk of stroke by five times.

In the past, AFib could only be treated with a lifelong course of blood thinners to prevent clotting. However, research showed that less than 50% of with AFib actually took and tolerated blood thinners. In addition to the high cost of medication, some individuals couldn’t take them due to bleeding concerns or interactions with other medications. Furthermore, many active individuals preferred not to risk the excessive bruising or bleeding that might occur should they fall while skiing, mountain biking, or participating in other active hobbies.

The now widely-accepted alternative to blood thinners is to seal off the small area of the heart where clots form.

As Goldsweig explains, “Because AFib-induced clots form in the left atrial appendage of the heart, medical researchers developed left atrial appendage occlusion (LAAO) devices to close off the area to pooling blood and clots. Using a catheter and echocardiography imaging (an ultrasound of the heart), the device is guided to the left atrial appendage and pushed out of the catheter so it expands to fill and close off the area.”

Goldsweig notes the procedure takes about 40-45 minutes and most patients go home the same day. Baystate Health’s Cardiac Catheterization Laboratory currently performs the procedure using two different devices, with slightly different shapes and sizes for different heart shapes. These devices include the Watchman (Boston Scientific) and Amulet (Abbott). Baystate is also participating in the global CONFORM trial of a new LAAO device.

“Patients are able to stop taking blood thinners immediately, and the heart essentially heals over the device in about 45 days,” he says, “Plus, the risk of stroke after the device is implanted is as low or lower than it is when blood thinners are used.”

Patent Foramen Ovale

Best described as a hole in the central wall of the heart, patent foramen ovale (PFO) is a very common condition—in fact, everyone has a PFO at birth. For most people (75%), the hole closes naturally soon after birth. But for the remaining 25%, the PFO can lead to an increased risk of stroke as it allows small clots in the veins to “sneak” through to the arterial system and travel on to the brain. Very often, a stroke is what leads to the diagnosis of a PFO.

But thanks to advances in research and medical device development, Baystate Health’s Cardiac Catheterization Laboratory can close the hole without surgery using a PFO occluder.

Implanted via a catheter, the occluder is a self-expanding double-disc device. The first disc is expanded on one side of the opening, and the second on the opposite side. The discs are squeezed together to fully secure the opening and prevent clots from passing through to the arterial system. In addition to using the Amplatzer PFO Occluder (Abbott) and Gore Cardioform, Baystate is also participating in the OCCLUFLEX trial of a new PFO closure device.

Goldsweig says, “Not only is it an easy procedure to undergo—typically done in 40 minutes or less, a ten-year study involving 1,000 patients demonstrated the PFO occluder is considerably more effective at preventing strokes than the often-prescribed anticlotting medications.”

Mitral Valve Regurgitation

One of the most common types of heart valve disease, mitral valve regurgitation, is essentially a leaky valve between the left chambers of the heart. In a normal heart, the flaps of the valve are tethered to the heart so they open and close fully. If the tethers tear due to heart damage or age, it prevents the valve from closing normally, allowing blood to flow backwards. In severe cases, it can reduce the amount of blood moving through the heart and to the rest of the body, which can lead to chronic fatigue, shortness of breath, and heart failure.

In the past, mitral valve regurgitation could only be addressed through open heart surgery. But today, a new procedure called mitral transcatheter edge-to-edge repair (MTEER) allows doctors to address the leak using a catheter.

Goldsweig explains: “Using a catheter, we’re able to guide a clip to the leaking valve. Echocardiogram imaging allows us to see specifically where the leak is occurring so we can precisely position the clip to join the two sides of the affected valve area together. The properly functioning parts of the valve aren’t impacted by the clip, so blood continues to move freely, but without backflow.” This procedure is performed with the MitraClip device (Abbott).

Goldsweig notes the benefits of the clip are appreciated immediately by the patient, and research has shown that the rate of death in patients who received the clip versus those who did not was reduced by more than one third.

Aortic Valve Stenosis

Another common heart valve problem, aortic valve stenosis affects millions of people in the U.S., especially those age 65 and older.

Brought on by a stiffening or calcification of the aortic valve, the condition forces the heart to work harder to push blood to the rest of the body. Over time, patients may experience chest pain, shortness of breath, and fainting, all of which point to heart failure. Left untreated, the average life expectancy from the time of symptom onset is three years. While current medications can help with symptoms, they cannot address the stiffening of the valve.

Open heart surgery is an option for addressing the issue, but many patients with aortic valve stenosis are not great candidates for surgery due to their advanced age. However, a minimally-invasive, non-surgical procedure called transcatheter aortic valve replacement (TAVR) has been shown to be as effective as surgery and is much better tolerated.

Performed at Baystate Health’s Cardiac Catheterization Laboratory, TAVR involves using a catheter to deliver a valve replacement device to the aortic valve. Made from supple animal tissue, the replacement valve is inserted and secured in the damaged valve and immediately takes over the task of efficiently moving blood through the heart. Baystate is participating in the EXPAND TAVR II trial, which offers valve replacement to patients with less severe valve blockages who have symptoms despite medication treatment.

“TAVR is now the standard of care for aortic valve stenosis,” says Goldsweig. “It offers results that can beat open heart surgery and is generally accomplished in just an hour with the patient only being required to stay one night in the hospital versus four to five days. Overall recovery is also much easier on patients.”

Advancing Cardiac Care Through Research and Practice

Baystate Health’s Cardiac Catheterization Laboratory is actively involved in research and clinical trials related to cardiac devices and treatments. Heart disease continues to be the leading cause of death in the U.S., but with continued advancements in cardiac care, there are more options than ever to combat the effects of heart disease.