Texas Heart® Institute at St. Luke’s Episcopal Hospital First in Texas to Offer New Cardiology Procedure to Eliminate a Major Cause of Heart-Related Stroke
Suture Delivery Device Invented by THI/SLEH Physician
Texas Heart® Institute (THI) at St. Luke’s Episcopal Hospital (SLEH) is the first in Texas and one of only a few in the nation to treat patients with a new catheter-based procedure that uses sutures to tie off the left atrial appendage (LAA), which is known to be a major source of blood clots that may lead to stroke in patients with atrial fibrillation (AFib).
AFib is the most common cardiac arrhythmia (abnormal heart rhythm). It can result in fainting, chest discomfort and shortness of breath, and is known to be associated with an increased risk of stroke. The LAA is a 1- to 2-inch blind sac that extends from one of the top chambers of the heart. In AFib, the LAA stops rhythmically contracting and the now non-flowing blood inside can turn to clot (a gelatin-like substance). If pieces of the clot break off, they can be pumped to the brain and cause blockage of blood vessels and stroke. Approximately three million adults in the United States have been diagnosed with AFib, and AFib-related strokes account for about one-quarter of all strokes in the elderly.
The procedure involves the use of an instrument known as the LARIAT Suture Delivery Device. The LARIAT was invented by William E. “Billy” Cohn, MD, Director of Minimally Invasive Surgical Technology at THI at SLEH, who was looking for a method of closing the LAA without the need for major surgery. The procedure is performed in the cardiac catheterization lab under X-ray guidance and requires no incision. The LARIAT was cleared by the FDA for use in 2009 and is also approved in Europe.
“Nonsurgical options (performed percutaneously) generally mean less discomfort and more rapid recovery,” said Dr. Cohn. “That’s all very good for the patients, but in addition, it has the potential to decrease healthcare costs.”
Dr. Cohn expressed the hope that the procedure could lead to a permanent means of protecting patients who have AFib from stroke, especially those who are not able to take long-term anticoagulant (blood-thinning) medications, such as Coumadin.
During the procedure, a 3mm puncture hole is made in the pericardium surrounding the patient’s heart. Guide wires fitted with strong magnets are threaded through the hole and used to establish a track to the LAA. The cardiologist then uses the LARIAT to follow the track and slip a lasso (a pre-tied suture loop) over the LAA, which can then be tightened under X-ray and ultrasound guidance, occluding the blind sac.
The procedure was used for the first time this week at THI at SLEH in two patients who were considered high-risk and who had no other options. The procedure was performed by Jie Cheng, MD, with the assistance of Randy Lee, MD, from University of California, San Francisco, a cardiologist who helped develop the procedure. The procedures each took approximately one hour.
“Patients with AFib have limited options for long-term protection against stroke,” said Dr. Cheng. “This is particularly true for patients who may not be able to tolerate or who have had complications taking many of the available blood-thinning drugs. The ability to percutaneously close a known source of blood clots in patients with AFib offers an attractive option to those patients who possibly need it the most.”