Health & Hope Spring 2018

Health & Hope is a newsletter designed to educate and inspire Western Montanans on life-saving procedures, community events and services to keep you and your family healthy.

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valve is implanted inside the old surgical valve, pushing it aside. A TEAM EFFORT "Brandon came to us, and as a team, we discussed the risks and possible outcomes of his treatment options," says Michael C. Reed, MD, an interven- tional cardiologist at IHI. "This would be the rst transcatheter tricuspid valve replacement we performed, and it was the rst in Montana. We performed the procedure Nov. 14, 2017, and Brandon's procedure was a total success. "It's important to emphasize," Dr. Reed adds, "that this procedure is not some- thing that's done by a single physician working in a vacuum. It's performed by Smaller Incisions, Quicker Recovery Heart surgery used to mean a large incision to open the chest and signi- cant downtime afterward. Now, there's a new option: A catheter (a thin, exible tube) can be threaded through a small incision in the groin, into an artery and up to the heart. This minimally invasive surgery helps people recover more quickly. Yet, not all patients qualify for the newer technique. "The heart team, the surgeons and cardiologists, along with other team members, work together to decide the best approach for each individual," says Joseph Schmoker, MD, medical director of cardiothoracic surgery at the International Heart Institute at Providence St. Patrick Hospital. "And if a patient is not a candidate for a catheter-based approach, he or she will have a safe surgery—possibly a minimally invasive approach, which results in a shorter hospital stay, less blood loss and quicker recovery." For example, with mitral valve prolapse, blood can leak back into the heart, possibly resulting in heart failure. Decades ago, these valves would be replaced with articial valves and a large surgical incision, but over time, mitral valve repair has evolved. "Leaving the patient's own native valve and structures benets the patient from the standpoint of preserv- ing normal geometry and function of the heart chamber," Dr. Schmoker says. Dr. Schmoker, an expert in minimally invasive heart surgery, is able to repair the mitral valve for good surgical candidates. A small incision is made in the patient's side, through a rib space, to repair the heart valve using special surgical instruments. "The goal is to prevent heart failure," Dr. Schmoker says, "and over time, patients should see a reduction in their symptoms, a normal quality of life and a normal life span." A Team Approach at the International Heart Institute It requires a village of doctors and providers to evaluate people with valvular heart disease to determine the best strategy to address their health concerns. Treatment can include medical therapy, percutaneous valve replacement, transcatheter valve replacement and open-heart surgery. For every valve implant that the International Heart Institute (IHI) performs for transcatheter or surgical intervention, there is a comprehensive evaluation with the heart team—interventional cardiologists, heart surgeons, imaging cardiologists, anesthesiologists, general cardiologists, radiologists and midlevel providers. They also include the referring doctor in the discussion. The team takes many considerations into account, whether it's the patient's social situation, frailty or other medical problems, and the patient's anatomy. It requires the input of all these disciplines to come up with a great result. Having a comprehensive heart program at IHI means people don't have to leave Montana to have advanced procedures. a large group of physicians including radiologists, anesthesiologists, surgeons, imaging cardiologists and interventional cardiologists. It really is a team effort." 'I HAVE MY LIFE BACK' With minimally invasive procedures, some people notice an immediate dif- ference, because the recovery is usually so swift. Patients can be walking the halls that day. They typically don't have any blood loss, and their symptoms can improve immediately. Brandon says he now is much better. "After feeling terrible for so long, I forgot what normal felt like," he says. "I'm not in pain, and I'm not always tired. I feel like I have my life back." M O N TA N A . P R O V I D E N C E . O R G 5

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