Dr. Heyrick
by Bob Waite
On Labor Day of 2008 I was rushed to the hospital with a heart attack. My LAD artery was blocked 100 percent. In no time at all skilled medical professionals had me prepped for angioplasty and stenting. A new kind of stent was placed in my artery. It was called a drug eluting stent because it allowed a medicine to slowly seep into the walls of my artery to slow the healing process so that scar tissue wouldn’t form and cause another blockage.
Alive and getting well I was grateful for this new technology that may keep me from another hospital stay or maybe even sudden death. But still I wondered what the long-term effects of this foreign object in my body would be. One thing was for certain, once stented always stented. That stent is a permanent part of my body. That is why when I heard about The Abbott Absorb GTI, I was elated.
The Abbott Absorb GTI dissolves like dissolving sutures. The Absorb device is called a bioresorbable vascular scaffold because like the scaffolds used to for building, a scaffold is a temporary structures. The Absorb GTI, unlike its metal counterparts, completely dissolves in three to five years. While in place it keeps the artery open and since it is also drug eluting, it prevents scaring.
“One of the great patient benefits is that the device is designed to restore normal function back to the artery once it has dissolved,” says Dr. George Heyrich, director of Interventional Cardiology and Structural Heart Disease at St. Mary. “And although complications with the metal stents are rare, the fact that nothing is left behind with this intervention reduces risks such as the formation of blood clots, and it allows for additional procedures to be performed in the treated vessel should another intervention be needed in the future.”
When the body absorbs the Abbot Absorb GTI, “the artery resumes normal vasomotion,” says Dr. Heyrick. It is as if the patient never had anything placed in the artery at all. The only traces left are little magnesium markers that can be seen with an x-ray, since neither CAT SCANs, MRIs nor x-rays can see the Absorb GTI itself. The markers allow the doctor to easily locate the device.
The Absorb bioresorbable vascular scaffold received FDA approval on July 5, 2016. In 2013, prior to FDA approval, St. Mary Medical Center was one of the hospitals chosen for national clinical trials of this new device. During the trials, the Absorb GTI was placed in patients ranging in ages from their 30s to 80s. Dr. George Heyrich, interventional cardiologist and director of the structural heart disease program at St. Mary says, “There is no age cutoff.”
Now St. Mary is the only hospital in our area that places the Absorb GTI. Dr. Hayrick says, “This whole experience is very rewarding. We have the best in our own backyard. This is a case where the community has it before the academic institutions.”
Only months after approval, these disappearing mesh tubes are being placed every week in patients who qualify. The Absorb GTI comes in limited sizes, so there are a few areas where it would not be able to be placed, but that will change over time, Dr. Heyrick expects. “This is the first generation,” he says.
Placement of the Absorb GTI requires better light inside the artery and hence St. Mary Hospital uses a new technology called optical coherence technology (OCT) to help guide the stent into place. “OCT,” Dr. Heyrick explains, “provides brighter lighting because light waves rather than sound waves are used to look into the artery. Also, there is the advantage of being able to use a smaller catheter.”
Dr. Heyrick along with others who were involved in the 2013 trial now train cardiologists and catheter lab staff about the system, making St. Mary Medical Center equipped with the people and the technology necessary to successfully place the Absorb GTI.
Cardiology at St. Mary Medical Center is always advancing. This is especially true in the treatment of structural heart disease. As director of Interventional Cardiology and Structural Heart Disease at St. Mary, Dr. Heyrich has also been involved in a new way of replacing a heart valve damaged by aortic stenosis but may not be suitable candidates for open heart surgery because of their age and other high and extreme risks. This new procedure, transcatheter aortic valve replacement, TAVR is effective and minimally invasive.
St. Mary medical writer Kathleen Smith explains, “Aortic stenosis is a common heart problem caused by a narrowing of the heart’s aortic valve due to excessive calcium deposited on the valve leaflets. When the valve narrows, it does not open or close properly, making the heart work harder to pump blood throughout the body. Eventually, this causes the heart to weaken and function poorly, which may lead to heart failure and increased risk for sudden cardiac death.”
Now a new catheter-expandable valve can be placed inside a diseased heart valve that previously had been replaced with a bioprosthetic heart valve. This technology is called the Core Valve System. The expandable valve becomes a valve within a malfunctioning replaced valve.
Kathleen Smith explains, “The valve device is typically inserted via an artery in the leg or upper chest, and then guided through the arteries into the heart. Once in place, the CoreValve System expands and takes over the original valve’s function to enable oxygen-rich blood to flow efficiently out of the heart.
“This new technology expands the TAVR eligibility for women and men in their 70s, 80s, or 90s; people whose heart valves are extremely narrowed and difficult to access due to advancing disease as well as individuals whose previous valve replacement is no longer functioning as intended.”
Age seems no obstacle to placement of this TAVR valve. “My oldest patient was 95,” Dr. Heyrick says. “I am proud that St. Mary Medical is among the first one hundred in the nation to perform these procedures.” Another example of St. Mary using advanced technology is the use of the WATCHMAN Left Atrial Appendage Closure Implant. Kathleen Smith quotes Dr. Richard Leshner, Chief of Cardiology at St. Mary who says, “We are excited to be the first in Bucks County to add this treatment option so that our cardiac patients do not have to travel far to receive the best and most advanced care."
The Watchman implant works by blocking the left atrial appendage, a small structure in the left atrium of the heart, from filling with blood and forming harmful blood clots which can then enter the blood stream and potentially cause a stroke. This eliminate or radically reduces the need for blood thinners.
In a minimally invasive procedure that takes about an hour, the WATCHMAN is inserted into a vein in the upper thigh via a catheter and skillfully guided through the veins until it gets to the heart. Once at the left atrial appendage, the device is deployed to cover the structural opening. Once implanted, the body forms a tissue lining around the device to cover and close the left atrial appendage. Blood thinners are continued for about six weeks post-surgery during the healing process.
All these amazing advances in cardiac care are even more amazing when we consider that they are here in Bucks County, at St. Mary Medical Center before they arrive at the big teaching hospitals in large cities. For more information on interventional cardiology and new technology that may help you live a longer and healthier life, contact St. Mary Medical Center at 215-710-2000 or visit http://www.stmaryhealthcare.org/heart.
Bob Waite is the editor of Bucks County Magazine and MONTC Homes, Gardens & Lifestyle.