St. Mary’s Heart and Vascular Health Center to offer groundbreaking heart help
Sponsored content: By Nancy Lofholm for St. Mary’s Medical Center
For St. Mary’s Medical Center O utside the St. Mary’s wing that houses the office of Dr. Leonard Lapkin, M.D., backhoes and loaders are beginning the messy scraping and digging work of adding on a new wing. In early 2019, the St. Mary’s Center for Heart and Vascular Health will open on this spot.
Above the construction hubbub, Dr. Lapkin, a cardiac and thoracic surgeon, couldn’t be more excited about the promise this project brings.
“This is huge,” Lapkin says. “For a high acuity hospital like St. Mary’s, this is a really big deal.”
The nuts and bolts of the new building aren’t what interest Lapkin the most. For him, the real importance of the new facility lies in the plastic model of a human heart that he holds in his hands.
Using that model, he demonstrates the most significant technological advancement the new center will offer for those who come to St. Mary’s suffering the ill effects of heart valves that can no longer keep blood flowing properly. With a procedure called Transcatheter Aortic Valve Replacement, TAVR for short, specially trained cardiac surgeons, like Lapkin, will partner with interventional cardiologist Dr. Charlie Brunson to implant artificial valves in aortas without a patient having to go through open-heart surgery.
Lapkin directs a finger into a plastic artery that leads from the top to the interior of the model heart and shows how a catheter will be threaded into the heart — most often coming through an artery in the leg — and will deploy a ring-shaped valve made of bovine tissue. The right chamber of the heart will be stimulated with electricity to keep the heart still long enough for the delicate maneuver when the valve is released in the best position to function like the real thing.
The procedure will be aided by imaging devices that will allow the team of specialists to see precisely what they are doing using tools on the end of catheters. Imaging done prior to the procedure will have allowed for careful planning of the best way to do the procedure before the patient ever enters the operating room.
The patients will usually go home in a day or two without the debilitating recovery of openheart surgery and without having had to spend time on a heart-lung machine. Instead of a major scar splitting the chest, the patient will have tiny incisions in the groin and possibly in the right chest.
For the patient, the entire procedure won’t be much more complicated than having a coronary angioplasty and stent — a long-established procedure for unblocking arteries.
TAVR will take place in a special “hybrid” surgical room in the new center. That room will be much larger than standard operating rooms to accommodate a bigger team of specialists and the broader array of imaging equipment.
The extra equipment will include X-ray imaging, angiographic imaging with a catheter, and echocardiography ultrasound imaging. The arsenal of imaging devices will allow the specialists in the room to gain the clearest view possible inside a patient’s heart and arteries and, as a result, perform the most precise placement of instruments and valves.
“It will be right there in your face on giant monitors, and we will have all the people there to interpret exactly what you can see,” Lapkin explained.
Those “people” will include more than half a dozen
physicians and technicians. There will be the interventional cardiologist, a cardiac surgeon, a cardiac anesthesiologist, a non-invasive cardiologist specializing in echocardiography, and various nurses and technicians. Lapkin has the unusual distinction of being board-certified in three of the specialties that are involved in TAVR — thoracic surgery, (thoracic refers to the upper torso), surgical critical care, and general surgery. Lapkin is one of only a few surgeons in the country with this list of certifications.
Lapkin said he is looking forward to the increased collaboration and teamwork the new center will foster with various specialties. He describes TAVR and some of the other procedures that will be done in the new center as having carefully choreographed steps.
“Having a whole team inside an operating room is such a good thing. You learn, you grow and you find ways to streamline working together like that,” he said.
Lapkin calls the TAVR procedure the biggest advancement in heart disease treatment since the development of stents to prop open occluded, hardened or plaque-invaded arteries. These bio-prosthetic valves can be another near miracle for patients who have heart disease relating to the valves. But they can wear out just like human valves. That means they are best used in older patients who might look forward to 10 to 15 more years of life rather than 40 or 50. Some problems will still necessitate open-heart surgery and other procedures.
Some of those other procedures that will be done at the new Heart and Vascular Center will include placing stents and doing anti-fibrillation measures to keep hearts from beating wildly out of control and raising the risk of strokes. Patients with multiple heart maladies can have treatment for several or all in one session using the team approach in the center’s new hybrid operating room.
The specialist team will be performing TAVR procedures in St. Mary’s largest in-hospital cardiac catheter lab before the new center opens. The first TAVR procedures will take place in October. Also, while the center is under construction, St. Mary’s will be recruiting four new physicians — a cardiologist, a cardiac surgeon and two vascular surgeons.
Patients can self refer, ask their primary care physicians to refer, or ask their cardiologist for a referral to the program. The TAVR program will track patients who will be entered into a valve registry as part of the valve clinic. That registry will enable patients who have been diagnosed with problems such as heart murmurs to have their conditions tracked and monitored.
“We want to begin picking up problems before they are in the late stage and people are ending up in the emergency room,” Lapkin said.
PROFILE: Dr. Leonard Lapkin
Dr. Leonard Lapkin is a Magna cum Laude graduate of Duke University. He earned his medical degree from the University of Illinois and completed residencies at the University of Illinois/Cook County Hospital in Chicago and at the University of Southern California/ Los Angeles County Hospital. He completed a fellowship in Cardiac and Thoracic Transplantation at the University of Southern California.
He is certified by the American Board of Thoracic Surgery, the American Board of Surgery and the American Board of Surgery with a Certificate of Added Qualifications in Surgical Critical Care. He has completed extra training in numerous specialties including valve repairs, adult congenital transplantation, chest wall resections and vascular sleeve resections. Dr. Lapkin was five times chosen by his peers as a “Top Doc” in the Best Physicians listings in U.S. News & World Report and Money Magazine Special Healthcare Issue “Top 25 Heart Valve Replacement Surgery in the Nation 2011.”
Dr. Lapkin has practiced at St. Mary’s Hospital for six years. His wife, Dr. Patricia Lapkin, practices psychiatry in Grand Junction.