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Approaching 100th WATCHMAN™

MHVI Most Experienced WATCHMAN™ Site on Mid-Atlantic Seaboard - Closing in on 100

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The results are in: MedStar Heart & Vascular Institute (MHVI) has implanted to date more of the stroke-reducing WATCHMAN devices than any other institution in the Mid-Atlantic region.

That’s actually no surprise, given MHVI’s history. MedStar Washington Hospital Center participated in several clinical trials in the spring of 2015 that contributed to the device’s FDA approval for commercial use. Within three months of WATCHMAN getting the green light, Sarfraz A. Durrani, MD, a Hospital Center cardiac electrophysiologist, performed the region’s first implant; three months later, John C. Wang, MD, chief of the Cardiovascular Catheterization Lab at MedStar Union Memorial Hospital, followed suit in Baltimore. Since then, the two sites have performed 92 procedures.

WATCHMAN is designed for certain patients with non-valvular atrial fibrillation who are also at high risk for both stroke and bleeding from long-term use of anti-coagulants. Essentially a mesh filter, it is placed in the opening of the left atrial appendage (LAA), the small sub-chamber responsible for the majority of A-fibrelated strokes. Within three to six months, scar tissue completely seals off the LAA, making WATCHMAN a viable alternative to indefinite blood-thinner therapy. However, potential candidates must be able to tolerate warfarin for at least 45 days post-procedure.

Now a new WATCHMAN clinical trial called ASAP TOO may change the blood-thinner requirement. Both hospitals are participating in the trial. “A previous trial suggested that a combination of aspirin and Plavix® could replace warfarin for patients who cannot tolerate it,” says cardiac electrophysiologist Manish Shah, MD, director of the Hospital Center’s Clinical Cardiac Electrophysiology Fellowship Training Program and principal investigator for the new trial. “With ASAP TOO, we’re evaluating whether aspirin plus Plavix works as well as warfarin.”

The Hospital Center is also the site for two trials of novel devices sponsored by different manufacturers. “Amulet” may provide an option for some patients whose LAA anatomy is not conducive to WATCHMAN. Another new device, “WaveCrest,” may allow patients to avoid the 45-day anti-coagulation regimen altogether.

“Competition to be a clinical trial site is fierce,” says Dr. Shah, who notes he and his associates are recruiting trial candidates now. “The fact that we’ll have three LAA closure studies running concurrently is a testament to MHVI’s great research infrastructure and safety record.” If the trials are successful, the new devices could fill a unique niche, and expand the number of patients who may be eligible for implant. Neither would be available commercially, however, for at least three to four years. Meanwhile, MHVI’s volume and expertise with WATCHMAN continue to grow. And with experienced sites in Baltimore and Washington, access to the sophisticated procedure is growing as well, to the delight of patients and physicians alike. “Nothing is more gratifying than telling patients they can come off warfarin for good,” says Dr. Wang. “They’re so incredibly grateful.”


The Body Politic of Cardiovascular Care

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Stuart F. Seides, MD, Physician Executive Director, MHVI

The heart is fundamental to dozens of familiar English idioms. It has been used to describe our innermost feelings and spirit, as well as a vital center of thought—the core and crux of ideas. During the last decade, MedStar Heart & Vascular Institute (MHVI) has built upon its strong core of cardiovascular services at MedStar Washington Hospital Center—the “heart” of our network of care; the critical mass of talent, technology and innovation from which the entire network draws strength. In this issue of Cardiovascular Physician, we’ve highlighted a wide spectrum of clinical services, research and expertise that characterized both the “heart” and the “circulation” that constitute the extended scope of MHVI. These stories demonstrate how we’re building strength through care collaboration and integration. We’ve created a diverse and interconnected system of cardiovascular ervices from disease risk modification to rehabilitation. And we assembled teams of vascular and cardiac specialists and subspecialists who work hand-in-hand to produce the best results for our patients.

Constructing the Core: Our systemic approach recognizes the inextricable link between diseases of the heart and vascular systems and understands that today’s quality patient care depends on the streamlined delivery of services from multiple disciplines. On the pages of this newsletter, you will read about the Aortic Center’s multidisciplinary approach to diagnosis and treatment of thoracic and abdominal aortic diseases, which provides patients with significant benefits. Co-directed by Vascular Surgeon Edward Woo, MD, and Cardiac Surgeon Christian Shults, MD, the center allows multiple specialists to consult with one another during a single appointment— saving patients precious time and giving them the benefit of a studied collaborative viewpoint. You will also read about the newly consolidated Department of Critical Care, structured to encourage professional collaboration across individual subspecialties when caring for our sickest and most challenging patients. The state-of-the-art Cardiovascular ICU responds to the needs of patients who often depend on complex technology and require both critical care and cardiovascular expertise.

Vital Connections: Of course, we know if it is to be truly viable, the heart must work in concert with a system of vascular pathways— the conduits through which our resources move in and out. We’ve been busy building these, as well. We’re leveraging the breadth of the MedStar Health system by tapping into its growing network of ambulatory care centers. In September, cardiology and vascular specialists began providing services at the new MedStar Lafayette Centre in downtown D.C. This state-of-the-art, 97,500 square foot facility is bringing convenient and comprehensive services to thousands of area residents who live and work in and around the city center.

This issue of the newsletter also highlights our efforts to regionalize MHVI’s highly sophisticated cardiac imaging services, which are now being offered at MedStar Union Memo- rial Hospital in Baltimore, Md., and Med- Star Georgetown University Hospital in D.C. We’re commit- ted to efficiently providing access to these resource and expertise-intense services. All of these initiatives—and more—boost our belief that a strong center and robust internal and external connections foster innovation, spur discovery and increase access to highly specialized care in our larger community. The MHVI network’s “heart”and the lifelines through which its services flow have been thoughtfully designed to serve us well now and to sustain us in the future.