Minimally Invasive Procedure Improves Quality of Life For Heart Valve Patients
There is good news for people suffering from significant, severe and symptomatic aortic stenosis who are at
individually and decide on the best course of action. There are two interventionalists and a surgeon for every case. “Every patient is carefully assessed for lung
risk for complications associated with surgery. The minimally invasive transcatheter aortic valve replacement (TAVR) procedure can successfully replace the valve without the risks associated with fully invasive heart surgery. Aortic stenosis is a fairly common, yet serious, narrowing of the aortic valve that affects approximately 200,000 Americans each year. The narrowing, or stenosis, is the result of an accumulation of calcium deposits on the valve, which restricts blood flow to the body resulting in weakness, breathlessness, chest pain and palpitations. With the TAVR procedure, a new valve is inserted to replace the aortic valve using a catheter. In the 30- to 45-minute procedure, highly skilled NCH interventional cardiologists guide a catheter through an artery – usually entered through the leg – up to the heart. “If the patient is not a candidate, due to small arteries or other issues of the legs, we enter
function,” explains Dr. Leslie. “Carotid arteries are checked with ultrasound, and we do a head-to-toe CT scan, a heart echocardiogram and use
monitors to determine if the patient will need a pacemaker before the procedure.” Nurse practitioners act as procedure coordinators, and serve as a resource for patients. They answer patients’ questions and care for each patient before, during and after each procedure. In addition to the obvious benefit of a less-invasive valve replacement, there is also less recovery time and a quicker return to daily activities with a much better quality of life. “It's basically two days in the hospital, and a week later, you're back on the golf course – versus a week in the hospital, and six months before you’re back on the golf course,” shares Dr. Leslie. “It is a life-changing difference. At NCH, our success rate is excellent.” Dr. Larry Leslie Benefits of TAVR • Shorter recovery time • Less invasive than traditional open-heart surgery • Open to anyone with severe aortic stenosis • Candidates from 50 to 99 can be treated • Excellent success rate
trans-carotid; through the carotid artery in the neck,” explains Larry M. Leslie, MD, who has been a practicing interventional cardiologist at NCH Heart Institute since 2016. NCH is one of only a handful of centers nationwide to utilize what is considered an alternate access: the carotid artery. The size of the equipment has significantly improved in the last three years, and the TAVR procedure is now open to anyone, from low- to high-risk patients. The work-up for TAVR is much the same as for an open surgical replacement. “It's a comprehensive team approach with a multi-sub-specialty group,” says Dr. Leslie. Weekly conferences with the full team consider each case
For more information, contact the NCH Heart Institute at (239) 624-4200
Everything You Need to Know About CHOLESTEROL
We all know that high levels of cholesterol can lead to heart and vascular diseases. However, many of us do not fully understand how this waxy substance builds up in the bloodstream. Although cholesterol occurs naturally in both the human body and in food like cheese, meat and egg yolk, high levels of LDL, or “bad” cholesterol in the human body can deposit in our blood vessels and lead to serious health issues. “Moderation is always the key. Too much cholesterol increases the risk for heart attacks, strokes and other serious issues,” says Jeffrey Howland, MD, NCH Physician Group Internal Medicine. “To measure total bloodstream cholesterol, I order bloodwork – specifically a lipid panel – that measures HDL cholesterol, LDL cholesterol and triglyceride levels.” Dr. Howland explains that total cholesterol levels should be less than 200, with HDL or ‘good’ cholesterol levels above 50 as this is associated with lower health risks. LDL, or ‘bad’ cholesterol levels, should be less than 100, because higher levels indicate higher health risks. “But that varies depending on your medical condition,” he says, adding that for some individuals with certain cardiovascular risk factors, desirable LDL levels can fall into the less- than-70 range. Triglycerides, which are also part of the lipid panel blood test, are not a cholesterol at all, but a fat, explains Dr. Howland, and should measure no more than 150. Higher levels are
associated with higher risks of cardiovascular events, so if the results are elevated, a fibrate medication like fenofibrate or gemfibrozil, is prescribed, he says. Dr. Howland uses a risk calculator to determine whether medication – statins such as atorvastatin, rosuvastatin or simvastatin – are indicated.
“Age, family history, smoking and other health considerations are important to determine if medication will lower your cholesterol. I can try a few different ones to see what works best, since some medications affect the body and people in different ways,” he explains. If statins produce side effects, cardiologists may sometimes prescribe a PCSK9 inhibitor injection, like Repatha in select patients. “I practice shared decision-making with my patients,” shares Dr. Howland. “If they prefer treatment with or without medications, I counsel them on exercise and diet control. They must avoid foods like red meats, fried foods, cheeses, and foods high in carbohydrates or fats. They must also exercise regularly – like swimming, walking, or other low-impact exercises.” Ultimately, the patient needs to be willing to make these changes so they may achieve proper levels of cholesterol. Dr. Howland says these lifestyle changes are important on the path to a healthier life.
Risk factors ■ Age: Cholesterol levels tend to rise as you age ■ Weight: being overweight predisposes you to having higher cholesterol levels ■ Genetics: history of high blood cholesterol in other family members ■ Poor eating habits: consuming trans fats and saturated fats found in dairy, some meats, baked goods, fried foods ■ Lifestyle: little or no exercise, sitting all day and not moving around ■ Smoking: raises LDL (bad) cholesterol and lowers HDL (good) cholesterol Managing proper cholesterol levels ■ Take medications such as statins or fibrates as prescribed ■ Maintain a heart-healthy diet ■ Avoid fatty foods, fried foods, cheeses, high-carbohydrate foods, and processed foods ■ Participate in a regular exercise program
Dr. Howland, MD, NCH Physician Group Internal Medicine is accepting new patients at 311 9th St. North, Suite 300 in Naples. Call (239) 624-0940 to make an appointment
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