20 Jan 2019 2018 a year for innovation at Conway Regional
by John Patton
Fifty-eight-year-old Anna Nappi was having trouble breathing and couldn’t walk when she was taken to Ozark Health Medical Center and later flown via helicopter to Conway Regional Medical Center.
Two blood clots were blocking the major blood supply to her lungs. Thanks to the new EKOS device, acquired by Conway Regional in 2018, she returned home in only five days.
The full name of the device is EKOS Acoustic Pulse Thrombolysis. During catheter-assisted thrombolysis treatment, a catheter is guided through blood vessels to the location of the blood clot. The catheter delivers medicine called thrombolytics to help dissolve the clot. The EKOS also delivers simultaneously ultrasound energy to mechanically dislodge and loosen up the clot to enable lower and safer doses of the thrombolytic drugs to be used.
Dr. Deepali Tukaye, an interventional cardiologist at Conway Regional, used the newly-acquired EKOS system to dissolve the clots using medicine that entered Nappi’s lungs through a small catheter inserted into her groin. She spent only five days in the Critical Care Unit before going home. “They took care of the blood clots in my lungs, and I have been doing well,” said Nappi. Her hospital stay would have been extended without the treatment.
Dr. Tyrone Lee, a Conway pulmonologist, said “The new procedure reduces an ICU stay by at least one day and the total hospital stay by at least two days.” Patients who are very short of breath with activity and requiring oxygen tend to benefit most from EKOS. The procedure decreases a patient’s chances of needing oxygen equipment at home. A team of physicians, including a cardiologist, pulmonologist, ER physician and a hospitalist, decide whether the patient will benefit from EKOS.”
In many ways, 2018 was a good year for innovation in Conway Regional’s cardiac services.
Tukaye has been using the EKOS device since April 2018, affecting the lives of six patients. Dr. Lensey Scott, another interventional cardiologist with Conway Regional, is also using the EKOS system.
“We want to make the community aware that in many instances there is no reason to go to Little Rock for life-saving technology,” said Tukaye.
Balloon procedure clearing blockage
Another example of new technology being used by cardiologists at Conway Regional is balloon aortic valvuloplasty (BAV). Tukaye led the Conway Regional heart team in successfully performing Conway’s first balloon aortic valvuloplasty procedure in December 2017. The procedure consists of the use of a tiny balloon catheter to widen an abnormal narrowing (stenosis) of the heart valve that has become stiff due to calcium buildup.
The procedure is used during emergencies for patients whose medical condition prevents treatment of blocked arteries using traditional, more invasive heart catheters. “This procedure is designed to give patients a window of opportunity for a valve replacement, without which aortic stenosis is a fatal condition,” said Tukaye. “BAV buys the patient time to get well and get treatment.”
The procedure improved the blood flow to the heart of the patient, Charlie Andrew, 91, of Conway, by 50 percent to aid his recovery so that he became healthy enough to tolerate a successful valve replacement.
The procedure also enabled Andrew to remain in Conway for his health care where it is carefully monitored by Scott.
Andrew’s wife, Kathleen, was so concerned for her husband’s health that she had family flying in to see him. Andrew, who leads a very active lifestyle, had begun falling. His third fall led to an injury and a trip to the Conway Regional Rehabilitation Hospital where a fourth fall occurred. The falls were the result of blood pressure and fainting episodes that were, in turn, caused by calcium build up in his aortic heart valve.
Tukaye spent about three hours with Andrew and his family, describing the procedure and addressing the risks. “She is very disciplined and talented,” said Andrew. “I’m not sure what we would have done if it hadn’t been for Dr. Tukaye and the staff here.” Kathleen was so impressed that she switched her heart care from Little Rock to Tukaye.
“I think this was another great step for Conway Regional’s heart care team,” said Tukaye, “and one more procedure that we are now offering exclusively to the community.” Since Andrew’s procedure, additional patients have been helped by the BAV device. In the past, these patients would have been transferred to Little Rock.
Another 2018 addition to the cardiovascular technology is the Micra® Transcatheter Pacing System (TPS), which is a new type of heart device that provides patients with the most advanced pacing technology at one-tenth the size of a traditional pacemaker. The system is manufactured by Medtronic.
The device offers multiple patient benefits in that it does not require cardiac wires (leads) or a surgical “pocket” under the skin to deliver a pacing therapy.
Comparable in size to a large vitamin, it is small enough to be delivered through a catheter and implanted directly into the heart with small tines, providing a safe alternative to conventional pacemakers without the complications associated with leads. The Micra TPS is also designed to automatically adjust pacing therapy based on a patient’s activity levels.
Mae Stephens, 87, of Conway became the first person in Faulkner County to receive the miniature pacemaker on June 12, 2018. The pacemaker was implanted by Don Steely, MD, an interventional cardiologist with the Conway Regional Cardiovascular Clinic. “I couldn’t imagine it being that small,” said Stephens, recalling her reaction when Steely showed her a display model of the pacemaker.
Sixteen Conway Regional patients had received the Micra pacemakers by the end of 2018. Tukaye has also begun training and expects to be implanting the pacemakers in 2019.
“We are blessed to have three interventional cardiologists who utilize new and innovative procedures,” said Scott Foley, director of cardiovascular services at Conway Regional Medical Center. “EKOS, balloon aortic valvuloplasty and micropacemakers are just the beginning for this group.”
Patient-friendly heart monitors
The latest innovation involves the monitoring of the heart itself.
The Conway Regional Cardiology Department has begun an innovative, patient-friendly ambulatory cardiac monitoring service that identifies arrhythmia (an irregular heart rate) sooner.
Traditional cardiac monitoring involves the use of uncomfortable electrodes, wires and a cumbersome monitor device. Patients must return their monitor to the noninvasive cardiology area for reading.
Those days are over. The new system is much smaller without the wires and electrodes. Patients simply drop a postage-paid box in the mail.
The new system, manufactured by Zio, is much smaller and does not require wires and electrodes. Patients simply remove the device when the monitoring period is over and drop it in a postage-paid box for mailing to be read by the physician. This enables patients to avoid the trip to deliver the device to the hospital.
“This patient-friendly monitoring device is increasing patient compliance and will increase the amount of data that our cardiologists have to analyze,” said Foley.
60 minutes or less
Conway Regional also received the Mission: Lifeline® Silver Plus Receiving Quality Achievement Award in 2018 for implementing specific quality improvement measures outlined by the American Heart Association for the treatment of patients who suffer severe heart attacks.
One of the major criteria in achieving the award is consistently averaging a door to treatment time that is less than 90 minutes. This rating refers to the time between contact with medical personnel (including the ambulance staff) and treating the patient for a heart attack.
Conway Regional averaged a door-to treatment time of 52 minutes in 2017, which was the best in Arkansas.