Heart disease and stroke are still the number 1 and number 4 leading causes of death in the United States, but there's encouraging news on some fronts of the battle. 

"The death rate from heart disease and stroke has declined over the last couple of decades, thanks in part to continuing advances in cardiac care and technology," says Mark Goodwin, M.D., medical director of Edward Hospital's Cardiac Catheterization Lab and interventional cardiologist with Midwest Heart-Advocate Medical Group.

Patients at Edward Hospital and Elmhurst Hospital, part of Edward-Elmhurst Health, are benefiting from some of the latest of these developments, including new options for certain patients with painfully blocked leg arteries, leaky heart valves and advanced aortic stenosis, a dangerous narrowing of the aortic valve that affects blood flow.

Tests showed Channahon resident Mary Ellen Bonsignore, 87, had severe aortic stenosis caused by an age-related build-up of calcium. She needed a new aortic valve but wasn't a candidate for the traditional open heart valve replacement surgery or transcatheter aortic valve replacement (TAVR), in which the patient's cardiovascular system is accessed through an artery in the groin. The blockage in Bonsignore's arteries made them too small to accommodate a catheter.

Dr. Goodwin determined she was a candidate for an innovative type of valve replacement called transcaval TAVR. Bonsignore would be only the 80th person in the world to undergo this procedure.

Transcaval TAVR

In the transcaval approach, the doctor gains access by threading a guide wire through a vein, rather than an artery, in the leg. The wire and a small catheter travel toward the abdominal area where the catheter creates a passageway between the body's now-dilated main vein and main artery. This makes it possible for a sheath containing the new valve to pass all the way from the groin vein to the heart where the replacement takes place.

In February 2015, Bonsignore underwent the 2.5 hour transcaval TAVR procedure, performed by a team of about 15 physicians and other health care professionals led by Dr. Goodwin. Among other physicians on the team were Bryan Foy, M.D., medical director of cardiac surgery at Edward Heart Hospital and cardiothoracic surgeon with Cardiac Surgery Associates, and Stanley Clark, M.D., a cardiologist with Midwest Heart-Advocate Medical Group, who operated the imaging technology that guides and monitors the procedure.

"Mrs. Bonsignore was sitting up the same night as the procedure,” says Dr. Goodwin. “Most people needing a valve replacement can be helped with a traditional TAVR. But for the subset with aortic stenosis who aren't candidates for that, the transcaval approach offers a safe alternative. And it's one that didn't exist a year or two ago."

Bonsignore's husband Patrick says, "Mary Ellen had an option (for treatment). I'm grateful that Dr. Goodwin stays on top of the latest technology."

Here are other cardiac care innovations now available at Edward:

MitraClip

In March 2015, Edward became the first community hospital in the Chicago area to use the catheter-based MitraClip Percutaneous Mitral Valve Repair System to treat patients with severe mitral regurgitation (MR). This serious condition occurs when a weakened mitral valve allows blood to leak backward into the heart, forcing it to pump the extra blood.

In the past, open heart surgery to repair or replace the valve was the only alternative if medications weren't working. The MitraClip, which was FDA-approved in 2008, provides a much less invasive option for MR sufferers who are too sick for open heart surgery. The physician delivers the device via catheter to the left ventricle of the heart, where the clip is positioned so it can grasp the valve's leaflets and control the flow of blood.

Dr. Goodwin and the cardiac team performed valve repairs using MitraClip on two women in their 80s. He says, "Both patients were discharged to home within a week without complications and are doing well."

The procedure has been shown to control MR, improve cardiac function and reduce hospitalizations for heart failure.

IN.PACT

Edward is among the first hospitals in the country to offer a breakthrough approach in the treatment of peripheral artery disease (PAD) in the upper leg. This common condition, which significantly increases the risk of heart attack and stroke, results from plaque build-up in the arteries in the leg. Traditional treatment involves angioplasty using a plain balloon-tipped catheter that's threaded through the body to the site of the blockage.

In December 2014, the FDA approved the IN.PACT Admiral drug-coated balloon for use in this type of procedure in the upper leg. The balloon delivers a drug to the artery walls to help prevent the artery from narrowing again. In February 2015, Dr. Goodwin and the cardiac team performed an angioplasty at Edward using IN.PACT on a patient with PAD in his upper leg. Edward also had been a site for an IN.PACT clinical trial.

Studies demonstrated significantly better outcomes with the IN.PACT drug-coated balloon, compared to the plain balloon, for treatment of PAD in the upper leg. There also is less need for stenting and repeat procedures. 

"In the past, there was a high rate of re-narrowing in the artery within a couple of years,” says Dr. Goodwin. “With the drug-coated balloon, that rate falls to less than 20 percent."

Learn more about cardiac care at Edward-Elmhurst Health.

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