Sentara Heart Valve and Structural Disease Center
Paul Mahoney, MD, Cardiologist
The Sentara Heart Valve and Structural Disease Center is the only program in Southeastern Virginia and Northeastern North Carolina focused on diagnosing and treating heart valve and structural heart disease.
The center offers the most innovative heart valve repair options available including the newest generation of valves that doctors implant through minimally invasive catheterization. The center was the first in the region to offer these advanced transcatheter cardiac treatments:
- MitraClip device for mitral valve repair
- Transcatheter aortic valve replacement (TAVR) for severe aortic stenosis
- WATCHMAN left atrial appendage closure device for atrial fibrillation
- Parachute investigational device for ischemic cardiomyopathy
In addition, the center continues to perform a high volume of other types of heart valve repair and replacement surgeries including percutaneous aortic and mitral balloon valvuloplasty, atrial septal and ventricular septal defect repairs, closures of paravalvular leaks, and as a result of the multidisciplinary approach, traditional aortic valve surgeries.
At the center, a program navigator guides first-time patients through the referral
and screening process. Upon completion, a team of interventional cardiologists, cardiothoracic surgeons and advanced practice clinicians work collaboratively to assess the patient’s condition and determine the most appropriate course of therapy or treatment. The result is an individualized disease management plan tailored specifically to a patient’s cardiac needs.
The program navigator and coordinators provide a single point of contact for referring physicians, providing updates on a patient’s progress and communicating follow-up care management upon the patient’s discharge from the center.
Rapidly growing advancements in minimally invasive heart surgery are yielding faster recoveries and improving patient satisfaction and comfort – all with less visible scarring. Because of these benefits, doctors at the center perform catheter-based heart procedures for most single-valve repairs and replacements whenever possible.
The center’s latest advancements include:
In June 2014, Sentara Heart was the first in the region to offer a first-of-its-kind device called the MitraClip to treat heart failure patients who have mitral regurgitation. Mitral regurgitation is the most common heart valve problem in the U.S., affecting approximately 4 million people. An estimated 50,000 Americans undergo mitral valve repair surgery every year. Because MitraClip is a minimally invasive catheter-based implant procedure, it is a welcome option for heart failure patients whose conditions are so severe that they cannot undergo open chest surgery.
MitraClip attaches to the mitral valve leaflets creating a double opening of the mitral valve. This allows for greater closure and reduces the leakiness of the valve. Sentara Heart doctors have performed 33 MitraClip procedures. Studies show that patients who receive MitraClip have fewer hospitalizations and enjoy an improved quality of life.
Sentara Heart also is participating in the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy (COAPT) clinical trial, a national study comparing the effectiveness of MitraClip to medical therapy for heart failure patients who are not candidates for traditional mitral valve surgery. Cardiologist Paul Mahoney, MD, is the study’s principal investigator.
Transcatheter Aortic Valve Replacement (TAVR)
Sentara Heart is proud to be one of a select group of distinguished heart centers across the country that helped pioneer transcatheter aortic valve replacement (TAVR), a minimally invasive treatment to replace diseased aortic valves. Since the program began in December of 2011, the center has completed 455 TAVR procedures—nearly 200 of them in 2015 alone.
TAVR is a highly innovative treatment for patients who suffer from severe aortic stenosis, a condition caused by a narrowing of the aortic valve due to calcium buildup. This restricted opening reduces blood flow leading to extreme fatigue, severe shortness of breath, and possible heart failure. Many patients who have severe aortic stenosis also have other health issues, like diabetes or lung disease, that make them high-risk candidates for open-heart valve replacement surgery. Because TAVR is a catheter-based procedure, it can be a good alternative for high-risk and elderly patients once considered inoperable.
With this minimally invasive procedure, doctors at Sentara Heart can repair the aortic valve without removing the old, damaged one. Instead, they use a catheter to place a balloon-expandable replacement valve into the heart. Most patients are often out of the ICU in a day and home within 72 hours.
Sentara Heart is participating in the PARTNER-II and SURTAVI clinical trials studying TAVR. Dr. Mahoney and cardiothoracic surgeon Joseph Newton, MD, are leading both studies.
TAVR Program Growth
For the past decade, Sentara Heart has been an active participant in clinical trials for the WATCHMAN left atrial appendage (LAA) closure device. Doctors at Sentara Heart have implanted 60 of the devices—25 of the catheter-based procedures took place after the FDA approved the WATCHMAN in March of 2015.
The WATCHMAN is a self-expanding device that seals off the LAA, a small pouch off the left side of the heart where blood clots can form in patients who have atrial fibrillation (Afib). At first, a mesh membrane on the device acts as a filter, allowing blood to flow through while stopping clots from entering the bloodstream where they can cause strokes. Eventually, heart tissue grows over the device, permanently sealing off the LAA.
LAA occlusion eliminates the risk of stroke without the need for blood thinners, which is great news for the many patients who are unable to take them due to side effects or bleeding risks. Most patients who receive the WATCHMAN go home within 24 hours and can stop taking blood thinners within two months.
Sentara Heart is one of 20 heart centers in the country enrolling patients in the PARACHUTE IV study to test the Parachute structural heart medical device for the treatment of patients with ischemic heart failure.
After a heart attack, the left ventricle of many patients often enlarges, leading to heart failure symptoms such as shortness of breath. Using minimally invasive heart catheterization, Sentara Heart doctors place the Parachute device inside of the heart to partition the damaged muscle, isolating the nonfunctional muscle segment from the functional segment. This reshaping of the left ventricle decreases the overall cardiac output and prevents further progression of chronic heart failure.
Since the study began in 2014, Sentara Heart doctors have implanted 10 of the devices. Allen Ciuffo, MD, a cardiologist with Sentara Cardiovascular Specialists, is the lead investigator.