It has been over six years since my arrival to Sheridan and just over four years since our Cardiac Catheterization lab opened. Since that time my partner, Dr. Joseph Garcia, and I have placed more than 300 stents and treated 70 acute myocardial infarctions with acute coronary intervention. These procedures have likely saved many lives and have definitely limited the amount of myocardial (heart) damage, which is tantamount to improving future symptoms and prognoses.
In addition, we have placed more than 200 pacemakers and performed many other new procedures, such as, biventricular pacemakers, defibrillator placements and transesophageal echocardiograms along with new and aggressive treatments of congestive heart failure and even some congenital heart disease.
Nationwide, newer cardiac procedures have become available over the last 10 years with some being experimental and some still in their infancy. Several other of these procedures have become main stream. For example, treating severe aortic valve stenosis using a catheter based approach, which involves placing a bio-prosthetic tissue valve mounted on a stent platform inside the dysfunctional valve. This procedure basically pushes the old valve aside and introduces a new valve into its lumen, thereby effectively improving valve function. While first only used for patients at extreme risk for the open surgical procedure, it has been found to be so effective that it is now being done fairly routinely for patients with lesser risks.
In addition, electrophysiology treatment has improved to the point that treatment of atrial fibrillation with ablation is often done to potentially “cure” this rhythm, resulting in cure rates of up to 70 percent. This improvement is fairly significant since atrial fibrillation is the most common type of arrhythmia to cause hospital admission and potential stroke. This treatment is not intended for everyone suffering from arrhythmias, but does offer a very helpful addition to cardiac care.
Cardiac treatment has also moved forward with the evolution of miniaturized catheters, stents, and other devices. These advancements are aimed at causing less surgical trauma along with less morbidity and mortality. Pacemakers and devices to measure blood flow have become miniaturized enough to be placed directly into the heart. Some defibrillators can even be placed subcutaneously without the need for indwelling venous wires, which can lead to infection and/or clotting. Another new device (Watchman) can be placed into a particular area of the heart that is prone to the formation of blood clots in atrial fibrillation. Closing off this area diminishes the risk of stroke in patients who are not candidates for anticoagulation. A mitral valve clip has also been developed to help decrease the extent of valvular regurgitation.
Overall, I am extremely happy to have picked cardiology as a career choice and am excited about the continued evolution of devices and our ability to improve survival and quality of life. I am also thankful to Sheridan Memorial Hospital for allowing me the opportunity to live and practice cardiology in Sheridan.
Michael W. Brennan, MD, is a cardiologist at Sheridan Memorial Hospital’s Big Horn Heart Center.