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Cardiac Interventional Procedures

Advanced Heart & Vascular Care

Angioplasty & Stenting

labAngioplasty is a procedure done by inflating a small balloon into the blocked artery. Once the catheter has been guided to the proper location in a coronary artery, the balloon is inflated. The pressure from the inflated balloon presses the plaque against the wall of the artery to improve blood flow.

Stenting usually is done along with angioplasty. Once the plaque is compressed using angioplasty, a small expandable wire tube called a stent is inserted into the artery to hold it open.

Atherectomy

Atherectomy may be done during cardiac catheterization to open a partially blocked coronary artery. Once the catheter reaches the narrowed portion of the artery, a cutting device, a whirling blade (such as a rotor blade), is used to remove the plaque.

Coronary Angioplasty

Angioplasty and related techniques are known as percutaneous coronary intervention (PCI). Angioplasty is a procedure in which a narrowed section of the coronary artery is dilated with a balloon catheter. Angioplasty is less invasive and has a shorter recovery time than bypass surgery, which is also done to increase blood flow to the heart muscle but requires open-heart surgery. Most of the time stents are placed during angioplasty.

After sedation, a thin flexible tube (catheter) is inserted through an artery in the groin or arm and carefully guided up the aorta into the blocked coronary artery. Cardiac catheterization, also called coronary angiography, is performed first to identify any blockages.

After angioplasty, you will be moved to our holding area or to the post coronary care unit. Your heart rate, pulse, and blood pressure will be closely monitored and the catheter insertion site checked for bleeding. You will have a large bandage or a compression device at your groin and the catheter insertion site to prevent bleeding. You will be instructed to keep your leg straight if the insertion site is at your groin.

You usually can start walking within 12 to 24 hours after angioplasty. The average hospital stay is 1 to 2 days for uncomplicated procedures. You may resume exercise and driving after several days.

Rotoblader

An atherectomy is an invasive cardiology interventional procedure used to remove plaque that has developed in the coronary arteries. The procedure utilizes the techniques of cardiac catheterization to deliver a catheter to the affected coronary artery. A device called a Rotoblader, which "borrows" its way through the plaque, is an effective atherectomy technique.

Using a special catheter inserted into the coronary artery, the rotoblader cuts its way into the plaque with a diamond tipped head, pulverizing it into microscopic pieces that float downstream and are disposed of by your body. The technique is most effective in calcified plaque or soft-stone consistency. There are several variants on the atherectomy (rotoblader) procedure. These procedures are named by the type of cutting device that is at the tip of the catheter such as rotational, directional and extraction.

Transcatheter Aortic Valve Replacement (TAVR)

heart diagramAn aortic stenosis is a form of heart disease. Over the years, the aortic heart valve, which allows oxygen-rich blood to flow out to the body, may become stiff and tight, usually from calcium deposits. This can cause fluid to back up into the lungs as well as lessen the blood flow out to the body.

Common symptoms are:

  • Shortness of breath
  • Fatigue
  • Difficulty walking short distances
  • Lightheadedness, dizziness, and fainting
  • Swollen ankles and feet
  • Rapid heartbeat
  • Chest pain
  • No longer being able to take part in physical activities you used to enjoy

Treatment Options
valveUntil recently, surgical valve replacement was the only treatment option for patients with aortic stenosis. However, a less invasive, catheter-based technique for replacing the diseased valve is now available called Transcatheter Aortic Valve Replacement or TAVR. During the TAVR procedure, a long tube, or catheter, is threaded into the heart via an artery, usually in the groin. The new tissue valve is crimped onto the catheter and over a balloon. With the guidance from X-ray and echocardiography, the new valve is guided to and deployed over the existing diseased valve. The new valve begins to work immediately relieving the symptoms of heart failure.

Recovery from TAVR
Recovery from TAVR is much quicker than with traditional open heart surgery. The hospital stay is generally about 2 days. Patients are instructed to not drive or lift anything heavier than 10 lbs. for 1 week. TAVR patients must premedicate with antibiotics prior to any dental work for the remainder of their life.

Specialized Heart Team Care
PVHMC is a leader in cardiac care. Hence, patients receive the same type of advanced care found at major academic medical centers – right in their own community. Our heart team is specially trained to provide expert technology-based care that is compassionate and patient-centered. Our program provides a dedicated Nurse Coordinator that will guide patients through every step of the process, before, during and after TAVR.

Work Required for TAVR
Several tests are required to make sure that TAVR is the right procedure for you.

  • Heart catheterization – to check for another cardiovascular disease
  • Echocardiogram – to determine your heart function and degree of aortic stenosis
  • Specialized CT – to determine the accessibility of the arteries in your groin and valve size
  • Carotid ultrasound – to check for potential stroke risk
  • Dental clearance – to prevent infection of your new valve
  • Cardiac surgeon consult – although TAVR is not a surgical procedure, a cardiac surgeon is present during the procedure and is required to evaluate your specific case

After TAVR
Besides your usual medications, most patients are required to take a blood thinner for 3 - 6 months and aspirin for life. Patients will also be encouraged to participate in Cardiac Rehab to further enhance the health and quality of life.

Benefits of TAVR
TAVR improves quality of life by alleviating the symptoms caused by aortic stenosis. Patients report almost immediate relief of shortness of breath, fatigue and chest pain. The short recovery time allows patients to quickly return to self-care and activities of daily living.

Follow up
PVHMC is committed to assuring the best care for our patients. Therefore, we coordinate the follow up with the TAVR cardiologist and Nurse Coordinator 1 week after returning home, 30 days and 1 year following your TAVR. We are just a phone call away–909.865.9858.

For more information on Pomona Valley Hospital Medical Center's Stead Heart & Vascular Center, please call 909.865.9858.