Getting Deep - Norfolk Sentara is testing a new hybrid procedfure to get hearts beating normally




New Hybrid Procedure being tested at Norfolk Sentara to get hearts beating normally again.

A new heart surgery now being tested at Sentara Heart Hospital in Norfolk may give hope to people living with atrial fibrillation— irregular heart beat.

The new hybrid operation is called DEEP for dual epicardial/endocardial procedure. DEEP restores a normal heart rhythm by combining aspects of two procedures— open-heart surgery performed in a traditional operating room and a less invasive procedure done in a heart catheterization lab. The goal is realizing strengths of both procedures while eliminating weaknesses, says cardiothoracic surgeon Dr. Jonathan Philpott, director of the new Sentara Heart Arrhythmia Center in Norfolk.

The center is now one of only six heart hospitals nationwide participating in FDA trials to determine the safety and efficacy of DEEP, which was pioneered in Holland. The first procedure in the United States was performed by Philpott, cardiologist Dr. Ian Woollett, and cardiologist Dr. John Onufer, the center’s medical director of cardiac electrophysiology.

Between 2.2 million and 5.5 million people in the United States have atrial fibrillation, often called a-fib, Philpott says. That’s when the top part of the heart quivers irregularly, faster than the bottom part of the heart can keep up, he says. Some people with a-fib have no symptoms. For some, the heart returns to regular beating on its own after an episode. But for others, the condition defines and limits their lives.

“They have shortness of breath, fatigue,” Philpott says. “A lot of them don’t even want to get off the couch. Their heartbeat jumps all over the place. It creates a huge amount of anxiety. Every moment, they’re thinking their heart is going to stop. These folks are in and out of the ER pretty frequently.” If the condition worsens, episodes last longer and the heart does not return to a regular rhythm on its own. To restore a normal heartbeat, medical personnel must either give the patient a drug or shock the heart externally, Philpott says. If those treatments don’t work, the next options are heart catheterization, then open-heart maze surgery, and possibly a heart transplant.

In a heart cath, a specially trained cardiologist threads a catheter into the patient’s heart to destroy the abnormal heart tissue and direct the heart’s electrical impulses on a normal path.

The strengths of the heart cath include: The cardiologist can test and fix small leaks during the procedure. A heart cath also is minimally invasive—patients recover much faster than from the open-heart
surgery. The drawback: “Catheter ablation works about 50 percent of the time,” Philpott says. “If they do it three times, they get to an 80 percent success rate.” By comparison, the maze surgery is about 94 percent effective, says Philpott, who regularly performs the operation. The cardiac surgeon creates scar tissue, called ablation lines, to redirect the heart’s electric signals through a maze from the upper heart to the lower heart. But there are several drawbacks to this procedure too. First, the procedure is very invasive—the patient’s chest is opened and the patient is placed on a heart/lung machine during the operation. There’s no way for the surgeon to check the ablation lines during surgery. Recovery is slow. It takes patients three to six weeks to get over being on the heart lung machine. Because of the chest incision, they also can’t lift anything heavier than five pounds for three months, Philpott says. “We’re hoping to leverage the strengths of both procedures and get rid of the weaknesses,” Philpott says. During the new DEEP, the cardiologist and cardiac surgeon work together. They access the heart by going through the patient’s ribs instead of opening up the chest and stopping the heart. The cardiac surgeon puts in the maze ablation lines that can be done on the outside of the heart. Meantime, the cardiologist puts in the ablations inside the heart that the surgeon can’t get to. Before finishing, the cardiologist tests the lines and the team retouches any that need extra attention. Philpott, careful not to raise hopes too high, says he is cautiously optimistic about DEEP. But he liked what he heard from patients after their surgeries. “They were asking things I never hear (after maze surgery): ‘Doctor, can I go back to work? Doc, can I run on the treadmill?’”

The key will be how well patients are doing a year, five years after DEEP, Philpott says. “We’re hoping the hybrid procedure will have similar results to the open surgical procedure with a shorter hospital stay and less stress on the patient,” he says.

Meantime, the goal of the center is to provide one place where patients suffering from a-fib or other heart rhythm problems can come for information and treatment, Philpott says. “Patients who have a-fib are extremely frustrated,” he says. “At the center, they can come and talk to experts, find out exactly what the success rates are nationally and with our center. We plan to track and publish our results.” Patients hearing about DEEP have been requesting to become part of the trial. Philpott hopes to get FDA approval to add patients.

“This is a glimpse into the future,” Philpott says. “We’re not looking for a quick fix. We’re looking for something enduring.”

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