Heart disease may be one of the most common chronic diseases in America,
and while Torrance Memorial Medical Center’s
Lundquist Cardiovascular Institute sees thousands of cardiac patients every year, treating them is anything
but routine. The Institute strives to be on the cutting edge of innovative
treatments and often acts as a kind of training ground for new cardiovascular
technology and procedures. Minimally invasive treatments are on the forefront
of these advances, helping patients recover faster and giving new opportunities
for treatment where there once were none.
TAVR: OPENING UP OPTIONS
One of the areas in which minimally invasive techniques are changing the
way patients are treated is in the structural heart and valve program.
Structural heart disease relates to conditions resulting from abnormalities of the heart’s
structure. One type of structural heart disease called aortic stenosis
occurs when a valve is too narrow to allow blood to be pumped. This can
be due to calcium buildup or high cholesterol or may have been present
at birth. When a valve is left untreated, the heart can weaken and heart
failure may occur.
Treatment of aortic stenosis usually meansreplacingavalve, butoftenpatients
are not strong enough to undergo the rigors of open-heart surgery. A new,
minimally invasive technique called transcatheter aortic valve replacement (TAVR) allows patients to get a new valve without having to undergo open- heart surgery.
“Prior to TAVR, patients were sometimes relegated to palliative care
if considered high or prohibitive risk for conventional surgery,” says
J. Christopher Matchison, MD, a physician with the TAVR program. With TAVR, a catheter is inserted
into the groin or lower part of the heart, and an aortic valve is put
in the existing one, helping to expand the opening.
Recovery can be shorter and easier with the TAVR procedure, says Dr. Matchison.
“Last week, we operated on three women who went home two to three
Torrance Memorial has been doing TAVR since 2014 and has completed the
procedure on more than 100 patients, a volume not seen in many other hospitals.
Because of the long- running, well-established program, Torrance Memorial
provides training courses for other clinicians to learn the technique
and technology. Using closed-circuit video viewing, observers can interact
with doctors performing live cases.
Salman Azam, MD, a Torrance Memorial interventional cardiologist who helped launch the
TAVR program, notes that the training course is the only one in the country.
“We’ve done four courses over the last year and have more
planned for this year,” says Dr. Azam.
In addition to serving as a training ground for TAVR, the collaborative
approach to cardiac care makes Torrance Memorial unique, Dr. Azam notes.
“What distinguishes us is that we have a multi- disciplinary meeting
once a week where we review all high-risk and cardiac patients for TAVR
and other types of surgery.” This collaborative team decision-making
means patients receive the most appropriate course of care. “You
don’t see that type of conference at many other hospitals,”
notes Dr. Azam.
Decision-making is critical with TAVR, as the procedure currently requires
that the patient must be a high risk for open-heart surgery. As a result,
most of the patients receiving TAVR are older—the average age is
around 85. Yet, although the patient population is older, the TAVR program
at Torrance Memorial has had excellent results. “The outcomes are
superior to the national average,” says Dr. Azam.
And most importantly, the TAVR procedure is helping patients who otherwise
would have no options. Dr. Azam points to a 90-plus-year-old patient with
aortic stenosis. Once able to care for upwards of 200 bonsai trees in
his backyard, the patient started to develop worsening symptoms and could
no longer tend to his trees and had trouble with his regular activities.
The patient came to Torrance Memorial, where he was screened for TAVR.
After surgery, he was discharged and was back to pruning his trees.
“If it weren’t for TAVR, he wouldn’t have been a candidate
for open-heart surgery and would just have to live with the symptoms,”
says Dr. Azam.
THE EP: THE BEAT GOES ON
Arrhythmias are abnormalities of the electrical conduction of the heart that can cause
the heart to beat too fast, too slow or with irregularity. Drugs are often
the first treatment option, but may not always be enough to solve rhythm
disorders. Torrance Memorial’s
Heart Rhythm program specializes in the study, diagnosis, and treatment of arrhythmia, and
the program is unique in that there are four advanced electrophysiologists
(EPs)— cardiologists who specialize in the electrical conduction
of the heart—on staff who collaborate and work together to keep
the two electrophysiology labs running seamlessly, says
Erol Kosar, MD, one of the electrophysiologists in the Heart Rhythm program.
Dr. Kosar notes that in the last five years there “has been a real
surge in the technology advancements and the organizationof ourlab andstaff.”
Hecredits this to the medical center’s administration, which recognized
the demand for an arrhythmia center to deal with the unmet needs of the
local community and growing incidences of arrhythmias.
One of the people who benefited from this experience and technology was
Michelle Moreno, whose diagnosis of arrhythmia came somewhat as a relief.
The 47-year-old Torrance resident had suffered from what she thought were
panic attacks since she was 17. She had them on and off throughout her
life, and had mostly learned to live with their unpredictable onsets and
But more recently, the lightheadedness, rapid heart rate, and chest tightness
began seriously affecting her life. She remembers almost passing out in
the parking lot while walking to her classroom, where she taught third
grade. “I started using a cane because I would get so lightheaded.
I told the kids I hurt my leg and would have to pretend I was injured,”
It was hard to describe to colleagues and students what was happening,
because she wasn’t sure herself. “The lightheadedness would
come on instantaneously and out of nowhere,” says Moreno. Then came
the rapid and erratic heart beat. “It felt like my heart was slamming
through my chest, that if I looked down I would actually be able to see
it.” Her breathing would become labored and her chest would tighten.
Dizziness and a constant slamming in her chest would continue.
As her attacks became more frequent, Moreno eventually stopped teaching
and went on disability. Because her electrocardiograms (EKG) and
echocardiograms always showed that she had a healthy heart, Moreno continued to be told
they were panic attacks. “I tried a lot of medications and sometimes
had bad side effects from them.” They didn’t stop the attacks, however.
“I was getting them every week, sometimes more than once a week,
and then two to three times a day, sometimes lasting for five hours,”
says Moreno. Using her in-home heart rate monitor, Moreno sometimes measured
a heart rate of over 200 beats per minute (normal adult heart rate is
60 to 100 beats per minute).
During one of these five-hour attacks, she decided to go to urgent care.
There she told the physician, “I feel like I’m going crazy.”
In retrospect, her decision to seek help during an attack was one of the
best decisions she made.
This time her EKG was abnormal and clinicians couldn’t get an accurate
pulse reading because it was so erratic. They called an ambulance to take
her to the ER. When the doctors were able to review her EKG again, she
finally got a diagnosis: Supraventricular tachycardia or SVT.
Tachycardia happens when electrical signals in the heart’s upper
chamber fire irregularly. Torrance Memorial has a minimally invasive treatment
called cardiac ablation that can help reset the heart so normal rhythm
may occur. Moreno was referred to Dr. Kosar.
“Dr. Kosar described the procedure to me so I knew exactly what was
happening,” says Moreno. Doctors put a catheter in the groin, run
it up to the heart, send electrical shocks tothe heart to find out which
section is amiss, and then cauterize (seal) or freeze that part of the
heart so it ceases to cause the irregular rhythm. Once cauterized, they
send another round of electrical pulses to make sure it took.
Although the thought of having a heart procedure initially seemed intimidating,
Moreno eventually approached the procedure without fear.
“I wasveryconfident from the moment I met Dr. Kosar that he knew
what he was doing,” says Moreno. Dr. Kosar notes that the EP department
at Torrance Memorial has been performing catheter ablation for 15 years,
with an impressive success rate.
Because it was a minimally invasive procedure, it took just two hours.
The main recovery concern is the healing of the incision in the groin,
so Moreno was told not to lift or push anything over five pounds.
“It was an easy procedure and I trusted Dr. Kosar entirely. The nurses
were fantastic as well,” says Moreno, who lives just a couple of
miles from Torrance Memorial Medical Center.
Moreno notes just how hard going undiagnosed for so long was for her and
her family, including her husband and 18-year-old daughter. Being at home
on disability and unsure of what to do once those funds ran out was a
major source of stress, and the increasing frequency and severity of her
heart pounding left her feeling hopeless.
“Getting a diagnosis was great. It was like someone handing me an
answer,” says Moreno. “I had a two-hour procedure and feel
like I get to start all over again. “It’s an exciting moment
in life for me.”