The procedure, transcatheter aortic valve replacement (TAVR), is designed for high-risk patients living with severe chest pain, congestive heart failure (including shortness of breath, fatigue, and edema) and other symptoms of aortic stenosis — an age-related heart disease developed when calcium deposits cause the aortic valve to narrow, forcing the heart to work harder to pump enough blood through the smaller opening.

“TAVR is definitely a game changer,” said Deepak Vivek, MD, interventional cardiologist and director, Orlando Health Heart Institute Heart Valve Center.  “These patients previously would have no hope for improvement. They would eventually succumb to their disease and their symptoms would not get better. There are really no medications available that would perform a long lasting benefit. By offering our patients TAVR it significantly improves their symptoms and prolongs their life expectancy.”

Irving DeKoff, the Orlando area Institute’s first patient to have the TAVR procedure, shares his story:

Prior to TAVR, patients would have little chance for relief from medical symptoms and improvement of quality of life.

“The hope is that we can give patients a valve that will function – making the heart’s workload be dramatically relieved so they can breathe better, stay out of the hospital and spend more time with their family, and with a rehabilitative effort regain some mobility and independence.” said Mark Sand, MD, cardiothoracic surgeon and chief of staff, Orlando Health.

The artificial valve, called the Sapien THV and manufactured by Edwards Lifesciences, is made of cow heart tissue and a polyethylene skirt and is supported with a stainless steel mesh frame. The medical team takes a new route to the narrowed heart valve by going through a leg artery instead of a chest incision with traditional open heart surgery.

“To put it in its simplest terms, it is a valve on a stick” said Jeffrey Bott, MD, cardiothoracic surgeon and chair, Thoracic Surgery at Orlando Regional Medical Center. “We are able to get access to a patient’s bloodstream through their groin and slide a new valve that is on the end of a catheter up into the aortic valve area. Before we deploy the new valve we use a balloon to expand the area. Once we deploy the new valve it is functional instantaneously.”

The new approach combines the expertise of various specialists, comprised of nearly 40 clinicians for each procedure.

“Collaboration on this program is essential and requires a multidisciplinary team,” said Barry Weinstock, interventional cardiologist, at the Orlando Health Heart Institute. “While the procedure sounds very simple it is actually relatively complex and requires a lot of people’s collaboration both in accessing the patients before ever starting the procedure and during the actual procedure itself.”

 For More Information on the TAVR Procedure, Please Call the Orlando Health Heart Institute: 321.841.6444

Doctors at the Orlando Health Heart Institute are taking a new route to a patient’s heart valve and giving new hope to patients once considered ‘too sick’ for surgery. Our cardiologists recently began using the first artificial heart valve approved by the FDA, to replace a narrowed heart valve by going through an artery in the patient’s leg instead of a traditional open heart surgery.

The procedure, transcatheter aortic valve replacement (TAVR), is designed for high-risk patients living with severe chest pain, congestive heart failure (including shortness of breath, fatigue, and edema) and other symptoms of aortic stenosis — an age-related heart disease developed when calcium deposits cause the aortic valve to narrow, forcing the heart to work harder to pump enough blood through the smaller opening.

“TAVR opens up the possibility of aortic valve replacement to patients previously considered inoperable and may prolong their life and improve their symptoms,” said Deepak Vivek, MD, Director, Orlando Health Heart Institute Heart Valve Center.  “For most patients, once symptoms from aortic stenosis develop, death occurs within a couple of years. Having an alternative to save lives and improve the quality of lives is vital to caring for patients with heart disease – which remains the leading cause of death for men and women in our country.”

Current research underscores the benefits to patients living with these symptoms.

“A recent trial (THE PARTNER TRIAL: Placement of Aortic Transcatheter Valve Trial) demonstrated that TAVR significantly reduces the risk of death and symptoms of congestive heart failure,” said Dr. Vivek.

Prior to TAVR, patients would have little chance for relief from medical symptoms and improvement of quality of life.

“Our goal is to help patients return to their level of functioning prior to developing aortic stenosis,” said Dr. Vivek.

The artificial valve, called the Sapien THV and manufactured by Edwards Lifesciences, is made of bovine cardiac tissue and a polyethylene skirt that is supported with a stainless steel mesh frame. To replace the diseased valve, the artificial valve is delivered through a catheter, inserted through a small cut in the leg. The new valve is released from the catheter, expanded with a balloon and is immediately functional.

See How the Transcatheter Aortic Valve Replacement Procedure Works:

“Offering TAVR is a collaborate and innovative approach, bringing together the expertise and experience of our doctors, nurses and other clinicians to provide the best care for our patients,” said Jeffrey Bott, MD, chair, Thoracic Surgery at Orlando Regional Medical Center. “The new approach is part of our continued efforts to provide effective alternative treatment options for patients who cannot undergo open heart surgery.”

The Heart Institute’s Valve Center is made up of cardiologists, cardiac surgeons, radiologists, anesthesiologists and other clinicians who work together to evaluate options to treat high-risk patients with aortic stenosis.

 For More Information on the TAVR Procedure, Please Call the Orlando Health Heart Institute: 321.841.6444

Device sands away plaque, may prevent heart attacks

Clinical trial at Orlando Regional Medical Center evaluates technology designed to restore blood flow to the heart.

ORLANDO, Fla. (November 16, 2011) — Drilling through concrete to create an opening may sound more like construction than medicine, but the approach is similar to what researchers at Orlando Regional Medical Center  (ORMC) are doing in a clinical trial to evaluate a device that breaks through hardened coronary arteries, in an effort to prevent heart attacks and relieve chest pain.

The study evaluates the effectiveness and safety of the Diamondback 360◦ orbital technology which uses a tiny, orbiting diamond-coated crown to gently sand away calcified plaque and restore blood flow.

“This device is the next generation in the removal of this type of severe calcification in coronary arteries,” said Barry Weinstock, MD, an interventional cardiologist at ORMC’s Cath Lab and principal investigator for the clinical trial at ORMC. “During the last 20 years, technology has continued to improve with balloon angioplasty, and stents to keep arteries open, but the technology to treat calcified plaque in the arteries has not kept up as much.”

The Diamondback’s diamond-coated crown orbits in the coronary arteries with speeds varying from 80,000 to 120,000 times per minute, breaking up the plaque along the way into microscopic particles which are digested and excreted.

“The result is similar to what happens when a tablespoon of sugar is dropped into boiling water, it disappears,” said Dr. Weinstock.

The procedure begins with a catheter inserted through an incision in the groin. Dye is injected to visualize the coronary arteries. A fine wire, the size of a strand of hair, is inserted into the artery through the catheter. The Diamondback catheter slides along the wire like a train on a track. Once the device removes the calcified plaque, a stent is typically placed to further open the artery and to minimize the chance of the artery re-clogging in the future.

Using orbital technology may mean better outcomes for patients.

“This new approach may be an effective, minimally invasive alternative for many patients who would otherwise require open-heart surgery,” said Dr. Weinstock. “Recovery from open heart or bypass surgery can take as long as a week or longer. Using the orbital device, most patients are back home the day after the procedure and at work the next day.”

Severely hardened coronary arteries, a type of atherosclerosis, can restrict blood flow causing chest pain and other symptoms such as shortness of breath.

“More concerning, the plaque can rupture causing a blood clot which can trigger a heart attack,” said Dr. Weinstock.

Because the condition develops over time, mild atherosclerosis may not have symptoms. Once an artery is more severely clogged and blood flow is more severely restricted, common symptoms are similar to those of a heart attack, including chest pain.

“Risk factors for the development of coronary artery disease include high cholesterol, high blood pressure, diabetes, a family history of early heart disease, and smoking,” said Dr. Weinstock. “Patients with kidney disease and/or diabetes as well as more elderly patients are more likely to have severely calcified plaque that may need to be treated with a device such as the Diamondback 360.”

ORMC currently uses orbital technology to treat peripheral arterial disease (PAD), a build-up of plaque in the leg arteries that can lead to severe and debilitating leg pain or even amputation. The device already approved by the U.S. Food and Drug Administration (FDA) to treat PAD, is an alternative for surgery or amputation.

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About Orlando Health

Orlando Health is a $1.7 billion not-for-profit health care organization and a community-based network of hospitals and care centers in the Orlando region.  The organization, which includes the area’s only Level One Trauma Centers for adults and pediatrics, is a statutory teaching hospital system that offers both specialty and community hospitals.  They are: Orlando Regional Medical Center; Arnold Palmer Hospital for Children; Winnie Palmer Hospital for Women & Babies; Dr. P. Phillips Hospital; South Seminole Hospital; South Lake Hospital (50 percent partnership); St. Cloud Regional Medical Center (20 percent partnership) and MD Anderson Cancer Center Orlando – the first affiliate of one of the nation’s premier cancer centers The University of Texas M. D. Anderson Cancer Center in Houston.  Orlando Health’s areas of clinical excellence are heart and vascular, cancer care, neurosciences, surgery, pediatric orthopedics and sports medicine, neonatology, and obstetrics and gynecology.

Orlando Health is Central Florida’s fifth largest employer with nearly 14,000 employees and more than 2,000 affiliated physicians, all of whom support our philosophy of providing high quality care and service when it matters most.  We prove this everyday with over 100,000 inpatient admissions and more than 600,000 outpatient visits each year.   In all, Orlando Health serves 1.6 million Central Florida residents and nearly 3,000 international patients annually.  Additionally, Orlando Health provides approximately $198 million in support of community health needs.  More information can be found at orlandohealth.com.

ORMC combines new minimally invasive heart surgery with EP lab procedure to relieve abnormal heart rhythm condition

New technique improves outcomes for healthy heartbeats.

ORLANDO, Fla. (April 26, 2011) — Surgeons and doctors at Orlando Regional Medical Center (ORMC) are bringing together the best of both worlds to treat patients with atrial fibrillation. Performing a new minimally invasive closed chest heart surgery, followed by an ablation procedure is giving patients a better chance at permanent relief from atrial fibrillation, an abnormal heart rhythm condition that causes fatigue and overall weakness that often results in a significant impact to quality of life — difficulty walking across the room or even preventing employment. ORMC is the first and only hospital in Orlando to offer the combined approach.  

The new care option, known as a convergent or hybrid approach, begins with a cardiothoracic surgeon navigating a special catheter to reach the back side of the heart. Once the surgeon reaches the heart, a special surgical tool burns the areas of the heart that cause the bad rhythms. The burns are made in the shape of a square, boxing in the source of the irregular heartbeats, preventing them from interfering with other areas of the heart and ultimately restoring a normal heartbeat. This approach treats the area from the outside of the heart.

Cardiothoracic surgeons Jeffrey Bott, MD, and Gregory Simmons, MD, are now able to treat areas of the heart that were unreachable before. The heart is accessed through a tiny incision in the upper abdomen, compared to a traditional open heart surgery chest incision. Patients have shorter hospital stays and a quicker, less painful recovery. Dr. Bott is thoracic surgery chair at ORMC and Dr. Simmons is a cardiothoracic surgeon at ORMC.

Once the closed chest heart surgery is complete, an electrophysiologist performs a mapping procedure to identify and treat any other problem areas from the inside of the heart.

Electrophysiologists Roland Filart, MD,  David Bello, MD, and Aurelio Duran, MD, insert a special catheter through the groin area to reach the upper chambers of the heart. Once inside the chambers, the area is isolated and the tissue where the bad rhythms occur is ablated or destroyed using radio frequency (heat) or a new Arctic Front technique that uses a coolant. Dr. Filart practices at ORMC, Dr. Bello is ORMC’s medical director of diagnostic cardiology and Dr. Duran is cardiology chair at ORMC.

Traditional heart surgery to treat the area or an ablation procedure alone may give patients approximately a 50 percent or higher chance of relief from atrial fibrillation. When the procedures are done together the effectiveness may increase significantly to 70 percent or higher, including less pain, smaller incisions, and a shorter hospital stay.

Combining the two approaches will mean better outcomes for our patients, decrease or end the need for future surgeries and procedures, and eliminate some long term medication use which can lead to more medical complications.

Atrial fibrillation affects millions of people in the United States. For patients with atrial fibrillation the heart’s electrical signals are out of sync and the muscles quiver instead of beating regularly and effectively.  For some the condition may come and go, or in other cases it is chronic and persistent. In some patients who suffer from atrial fibrillation, the upper chambers can start and stop on their own, for minutes or days at a time. Atrial fibrillation is also a condition that can lead to other serious health risks including stroke and congestive heart failure.

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About Orlando Health

Orlando Health is a $1.7 billion not-for-profit health care organization and a community-based network of hospitals and care centers in the Orlando region.  The organization, which includes the area’s only Level One Trauma Centers for adults and pediatrics, is a statutory teaching hospital system that offers both specialty and community hospitals.  They are: Orlando Regional Medical Center; Arnold Palmer Hospital for Children; Winnie Palmer Hospital for Women & Babies; Dr. P. Phillips Hospital; South Seminole Hospital; South Lake Hospital (50 percent partnership); St. Cloud Regional Medical Center (20 percent partnership) and MD Anderson Cancer Center Orlando – the first affiliate of one of the nation’s premier cancer centers The University of Texas M. D. Anderson Cancer Center in Houston.  Orlando Health’s areas of clinical excellence are heart and vascular, cancer care, neurosciences, surgery, pediatric orthopedics and sports medicine, neonatology, and obstetrics and gynecology.

Orlando Health is Central Florida’s fifth largest employer with nearly 14,000 employees and more than 2,000 affiliated physicians, all of whom support our philosophy of providing high quality care and service when it matters most.  We prove this everyday with over 100,000 inpatient admissions and more than 600,000 outpatient visits each year.   In all, Orlando Health serves 1.6 million Central Florida residents and nearly 3,000 international patients annually.  Additionally, Orlando Health provides approximately $198 million in support of community health needs.  More information can be found at orlandohealth.com.

Orlando Regional Medical Center is the first hospital in Florida to implant a new pacemaker designed for safe use during magnetic resonance imaging (MRI) scans often used to diagnose and treat conditions. Recently approved by the U.S. Food and Drug Administration, the Revo MRI™ SureScan® pacing system by Medtronic, is the first and only pacemaker in the U.S. specifically designed for use in an MRI environment and approved as MR-Conditional. MRI technology uses magnetic fields and radio frequencies to take pictures of organs, soft tissues and bone to help doctors diagnose and treat cancer, aneurysms, liver abnormalities, arthritis, and many other conditions.

ORMC uses first and only pacemaker system for use during MRI

New pacemaker gives patients access to critical diagnostic tool.

ORLANDO, Fla. (February 18, 2011) — Orlando Regional Medical Center is the first hospital in Florida to implant a new pacemaker designed for safe use during magnetic resonance imaging (MRI) scans often used to diagnose and treat conditions. Recently approved by the U.S. Food and Drug Administration, the Revo MRI™ SureScan® pacing system by Medtronic, is the first and only pacemaker in the U.S. specifically designed for use in an MRI environment and approved as MR-Conditional.

“The approval of this device is a major milestone in caring for patients’ heart conditions and other problems as well,” said David Bello, MD, an interventional electrophysiologist and ORMC’s medical director of diagnostic cardiology. “Previously, an entire segment of the population with pacemakers was unable to receive the medical imaging used to uncover and treat conditions outside of their heart problems.”

An estimated 5 million patients worldwide have a pacemaker or implantable cardioverter-defibrillator. Up to 75 percent of pacemaker patients will need an MRI at some point in their lifetime to diagnose another health condition. Medical imaging provided by MRIs can be used to diagnose cancer, aneurysms, liver abnormalities, arthritis, and many other conditions. MRI technology uses magnetic fields and radio frequencies to take pictures of organs, soft tissues and bone to help doctors diagnose medical conditions.

The Revo, like traditional pacemakers, uses electrical pulses to correct slow heart rhythms, but with a twist — it has an optional “SureScan” mode  that can be switched “on” for use during MRI to eliminate interference.

Before now, patients with pacemakers were not allowed to have MRIs because of potential serious side effects. For example, the magnet can interrupt the pacing and prevent the output of pacemakers, causing improper heart rhythm. Also, tips of the wires used to connect the pacemaker to the heart could heat up during the scan and burn heart tissue.

The new MRI compatible pacemaker also holds far-reaching future implications.

“The new device is significant to patients who may one day need a pacemaker and later an MRI to diagnose and treat another condition,” said Dr. Bello. “As the population ages, the need for pacemakers increases. The use of MRIs as a diagnostic tool also continues to grow.”

ORMC was also a site in the international multicenter study that contributed to the evaluation of patients leading to FDA approval of the new MRI compatible pacemaker.

 “Being a part of the trial was important in helping determine if patients with permanent pacemakers would be able to undergo routine MRI testing,” said Dr. Bello who was principal investigator for the study. “MRI scans are an important tool in helping doctors diagnose problems and develop treatment plans. We are honored to have been a part of helping widen the spectrum of diagnostic opportunities for patients today and in the future.”

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About Orlando Health

Orlando Health is a $1.7 billion not-for-profit health care organization and a community-based network of hospitals and care centers in the Orlando region.  The organization, which includes the area’s only Level One Trauma Centers for adults and pediatrics, is a statutory teaching hospital system that offers both specialty and community hospitals.  They are: Orlando Regional Medical Center; Arnold Palmer Hospital for Children; Winnie Palmer Hospital for Women & Babies; Dr. P. Phillips Hospital; South Seminole Hospital; South Lake Hospital (50 percent partnership); St. Cloud Regional Medical Center (20 percent partnership) and MD Anderson Cancer Center Orlando – the first affiliate of one of the nation’s premier cancer centers The University of Texas M. D. Anderson Cancer Center in Houston.  Orlando Health’s areas of clinical excellence are heart and vascular, cancer care, neurosciences, surgery, pediatric orthopedics and sports medicine, neonatology, and obstetrics and gynecology.

Orlando Health is Central Florida’s fifth largest employer with nearly 14,000 employees and more than 2,000 affiliated physicians, all of whom support our philosophy of providing high quality care and service when it matters most.  We prove this everyday with over 100,000 inpatient admissions and more than 600,000 outpatient visits each year.   In all, Orlando Health serves 1.6 million Central Florida residents and nearly 3,000 international patients annually.  Additionally, Orlando Health provides approximately $198 million in support of community health needs.  More information can be found at orlandohealth.com.