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Advancements in Cardiology

Dec 30, 2016, 12:10 PM by Nicole Young
Manufacturers of the world's most advanced heart devices are trusting Sansum Clinic's Drs. Joseph Aragon and Michael Shenoda with their technology, because of their long history of specialized education and patient success with complex procedures. "Not every physician is given the opportunity to put these in. You need extensive experience," explains Dr. Aragon, director of the structural heart program and chair of the cardiology department at Sansum Clinic.

Drs. Aragon, Shenoda, Shafer

Recently approved by the FDA, the Absorb™ dissolving heart stent and the Watchman™ implant for atrial fibrillation are two new technologies used by the doctors. Atrial fibrillation (afib) is a condition that causes an irregular and rapid heart rate due to blood clotting in the left atrial appendage (LAA). Clots can cause a stroke and often Afib patients require the use of blood thinner medication. But for some who have bleeding
complications, a long-term alternative to taking those drugs is necessary. For high-risk patients whose afib is not related to heart valve disease, the Watchman implant could be a solution. The one-time implant is the size of a quarter. It operates like a tiny umbrella, catching clots and working like a plug to seal off the LAA. In less than one hour, doctors can position the device in the heart through a small tube inserted in a leg vein, avoiding major surgery. Eventually, heart tissue grows over the Watchman and 90% of patients can stop medications within 45 days. Cottage Hospital is the only site between Los Angeles and the Bay Area with a Watchman program.

Watchman Device

Absorb Stent

The Absorb dissolving heart stent is considered one of the most important advances in the treatment of coronary artery disease in a decade. While most stents are made of metal, the Absorb is crafted from a material similar to dissolving sutures. It is inserted via a catheter, and once inside the heart, it props open the clogged artery, which can then heal and resume normal function. The stent completely disappears after about three years. "We have always been treating the obstruction, fixing the blockage. Now, we are actually treating the inside of the vessel," says Dr. Aragon.

The Aragon-Shenoda medical team was first on the central coast to enroll patients in clinical trials for Absorb. The physicians helped to make Santa Barbara one of the first locations in the nation to have the stent after FDA approval. "It helps in real world experience to know which patients will be good candidates for the procedure," notes Dr. Shenoda. When these devices are appropriate, the outcomes can be life-changing.

Seventy-four-year-old Sandra Nemeth wound up in the emergency room after she experienced tingling arms and chest pressure during a family hike. Since the symptoms were completely new, Sandra believed something she ate was the trouble. An exam by Dr. Aragon revealed that an artery in her heart was 90% blocked. Because of her active lifestyle complete with regular exercise and organic meals, she was shocked at her diagnosis. Luckily, she met a long list of criteria to receive the Absorb dissolvable stent. The size of her artery and its opening were perfect. Still, the thought of her first major
medical procedure in over 40 years was a little daunting. "I have never been to a hospital, other than to have my babies," she recounts. The Absorb option especially appealed to Sandra since there would be no substance left in her body, and she'd
eventually be free of medication. The next day, Dr. Aragon inserted the stent in Sandra's heart through a tube placed into her wrist. The entire procedure took 40 minutes, and
she was back at home within 36 hours, helping once again to care for her three grandchildren. It was as if nothing had ever happened on that hiking trail, minus her meeting with Dr. Aragon. "He made me feel totally comfortable. As bright as he is, he has such a nice bedside manner, and that's so important. So now, he is my cardiologist, he's my doctor and I have adopted him," she says laughing.

Sandra Nemeth

The rollout of these new instruments at select hospitals is deliberately slow, using only patients that match strict criteria and carefully-chosen doctors with the most training.
Independent oversight boards constantly monitor program progress, and the Sansum Clinic Cardiology Department participates in patient registries to share information on how patients with the devices around the country are faring. Drs. Aragon and Shenoda understand the need for scrutiny, as their early instruction at Cedars-Sinai Medical Center and UCLA placed them on the forefront of transcatheter technologies.
Because these devices need to be implanted in such a precise manner, an increasing number of structural heart interventions now require real-time imaging guidance. As medical director of the echocardiography lab at Cottage Hospital's Heart Valve
program, Sansum Clinic cardiologist Dr. Colin Shafer plays a critical role in device placement and immediate functional evaluation when these treatment options are used. The ability to track how the instruments are working with 3D imaging is key to their success.

The addition of Dr. Shafer three years ago was part of an overall strategy to build a highly-trained staff with nearly every specialty within cardiology. A gathering of physicians of this caliber is rarely seen outside of a large academic center. In addition, this level of advancement only happens when there is a unique partnership between doctors and the place where they treat their patients. Cottage Hospital made a significant investment to bring the equipment, facilities and program support to Santa Barbara. Sansum Clinic provided another piece of the puzzle - these fine doctors. Aragon and Shenoda aspire to always be investigating the latest technology in heart
health, and are hoping to embark soon on a new surgical technique to repair the heart's mitral valve. "We have 15 to 20 years of combined experience with these devices. We have brought these programs to Santa Barbara, and our patients can now participate in these clinical trials. That wasn't possible 10 years ago," says Dr. Aragon. "The entire department has grown and evolved. We've been very fortunate."