Structural Heart Care

This procedure is often referred to as a coronary angioplasty or stenting. This allows the cardiologist to reduce a blockage found in one or more of the coronary arteries.

What are the indications for the procedure?

This procedure is performed in a patient who has been found to have blockage in a coronary artery (the vessels providing blood to the heart muscle). In many cases this procedure is performed immediately after a cardiac catheterization, although in some instances it will be done as a separately scheduled procedure. PCI is most commonly indicated for relief of cardiac symptoms such as chest pain and shortness of breath. It is also performed when patients come through the emergency room with a heart attack to quickly restore blood flow to the heart muscle and limit damage.

How is it done?

When we’re ready to start you’ll be brought into (or remain in) the cardiac catheterization lab. You’ll receive some light sedation through your IV. Our goal is to make you comfortable without putting you all the way out. If, during the procedure, you find yourself anxious or uncomfortable just let us know and we can give you more medication. The procedure is typically painless except for some occasional brief (less than one minute) chest discomfort when inflating the balloons described below.

Through the sheath placed for the original angiogram we pass guiding catheters which are long flexible plastic tubes of various sizes and shapes that extend up to the opening of the coronary arteries. Through the guiding catheter we then pass a very thin wire into the artery and past the blockage we’ve identified. We can then pass small balloons over the wire and across the blockage where they are inflated to reduce the narrowing in the artery. Once the blockage is partially opened we insert another balloon that is wrapped with a very small stainless steel coil called a stent. As we inflate this balloon the stent expands and props open the vessel. The stent stays in place as we deflate and remove the balloon and the wire. There are two major types of stents and these are generally referred to as “bare metal” stents and “drug-eluting” stents. In most cases your doctor will have discussed the differences between these with you prior to the procedure. We’ll make the decision about which type of stent to use at the time of the procedure by taking multiple factors into consideration.

Once the procedure is finished, you will be taken to a hospital room to recover where you will spend the night. Because we use various medications that block blood clotting (so-called blood thinners) we may need to leave the sheath in place for several hours after the procedure. After the blood thinners have worn off, we have to seal the hole by holding pressure for 15-20 minutes and have you lie on your back for several hours. Occasionally we can use a device to close the hole we made in the artery so that you can get up and around sooner. Typically you’ll be dismissed the following day with instructions on how to take care of the access site and what activity you can pursue.

How do you prepare for the procedure?

PCI is done on both hospitalized and ambulatory patients. The preparation is the same as for a cardiac catheterization procedure.

Unless instructed otherwise you should be fasting on the morning of the procedure. In general we want you to take your usual morning medications with the exception of any we’ve told you not to take (please talk to our nurses or schedulers if you have any questions about this).

We do this procedure in the hospital at CUMC - Bergan Mercy, Midlands, and Lakeside. You’ll receive specific instructions on where to show up and what time to be there.

What are the risks of the procedure?

Because this is an invasive test there are certain grave risks that you need to be aware of. Fortunately we encounter these rarely. Bruising at the access site occurs in many people but very few of these will have enough bleeding into the groin that we have to surgically address this. The IV contrast can rarely cause an allergic-type reaction in people with a history of iodine allergy and can be harmful to patients with poor kidney function. The risk of death, significant heart attack or stroke is less than 1 in 100. There is a less than 1 in 200 chance of a complication that could result in the need for emergency open heart surgery.

This procedure (sometimes called a coronary angiogram, heart catheterization or, simply, a “cath”) is basically an x-ray of the heart while dye fills the coronary arteries. This allows the cardiologist to visualize the coronary arteries to evaluate possible blockage.

What are the indications for the procedure?

Most often we do this test when we suspect blockages in the arteries that feed the heart muscle (coronary artery disease). Patients will frequently have already undergone a screening stress test that turned out abnormal. We then follow this with the more definitive cardiac catheterization. Sometimes patients will describe chest symptoms that are so convincing of coronary artery disease that we bypass the stress test and go straight to cardiac catheterization. Also, when patients come through the emergency room with a heart attack we will proceed directly to cardiac catheterization.

How is it done?

When we’re ready to start you’ll be brought into the cardiac catheterization lab (much like an operating room with x-ray cameras) and you’ll lie on a table while our technicians prepare the area on your body where we’ll be working. In most patients we get access to the arterial system through the femoral artery in the right or left groin. In some cases we use the artery in the wrist or upper arm.

You’ll receive some light sedation through your IV. Our goal is to make you comfortable without putting you all the way out. If, during the procedure, you find yourself anxious just let us know and we can give you more medication. We then numb the skin with anesthetic (this is the only part that should be painful in any way) and place a sheath (much like an IV) into the artery.

Through the sheath we pass catheters of various sizes and shapes that extend up through the aorta and sit in the opening of the coronary arteries. We inject a small amount of iodine-based dye into the artery and film it with an x-ray camera. This allows us to see the arteries in great detail and we can tell you right away what we’ve found and what our recommendations are.

If the study is normal (no significant blockage) we remove the sheath and send you back to the recovery area. We frequently use a device to close the hole we made in the artery so that you can get up and around sooner. Sometimes we have to seal the hole by holding pressure for 15-20 minutes and have you lie on your back for several hours. Once you’ve recovered for a sufficient period you’ll be dismissed with instructions on how to take care of the access site and what activity you can pursue.

If we find blockage we can frequently fix it using a balloon catheter and stent. In this case we keep you in the hospital overnight for observation. Occasionally we find enough blockage in several vessels, or blockage in a high-risk region, that we need to recommend coronary artery bypass surgery. We generally dismiss you from the hospital that same day and have you visit one of our cardiovascular surgeons to discuss and arrange the surgery.

How do you prepare for the procedure?

Cardiac catheterization is done on both hospitalized and ambulatory patients. As an outpatient having this done electively you will first visit with the cardiologist in the office to go over the procedure and discuss the risks and alternatives. Since you will be asked to sign document of consent be sure to ask any question and raise any concern you may have. You will need to have basic blood work done and this can be drawn in the office.

Unless instructed otherwise you should be fasting on the morning of the procedure. In general we want you to take your usual morning medications with the exception of any we’ve told you not to take (please talk to our nurses or schedulers if you have any questions about this).

We do this procedure in the hospital at Nebraska Heart, Mercy Council Bluffs, Midlands, Creighton University Medical Center - Bergan Mercy, Immanuel and Lakeside and you’ll receive specific instructions on where to show up and what time to be there.

What are the risks of the procedure?

Because this is an invasive test there are certain grave risks that you need to be aware of. Fortunately we encounter these extremely rarely. The risk of death, heart attack or stroke is less than 1 in 1000. Bruising at the access site occurs in many people but very few of these will have enough bleeding into the groin that we have to surgically address this. The IV contrast can rarely cause an allergic-type reaction in people with a history of iodine allergy and can be harmful to patients with poor kidney function.

If you have a Coronary Artery Chronic Total Occlusion and your condition is limiting the quality of your life, there are options. The interventional cardiologists at CHI Health Creighton University Medical Center - Bergan Mercy and Nebraska Heart are using new technology to enable heart patients to regain good health and become active again. Before now, patients who suffered from chronic total occlusions–(CTOs in which arteries are 100 percent blocked for more than 90 days)–had to face invasive bypass surgery or resign themselves to limited activity.

Percutaneous Coronary Intervention

Percutaneous Coronary Intervention (PCI, formerly known as angioplasty with stent) is a new, minimally-invasive technique to open blocked arteries.

In PCI, cardiologists insert a catheter (a thin flexible tube) from the inguinal femoral (groin) artery or radial (wrist) artery up through blood vessels until it reaches the site of blockage. X-ray imaging is used to guide the catheter threading to the blockage. Once it has reached the blockage site, the balloon is inflated to open the artery, allowing blood to flow. A stent is usually placed at the site to keep the artery open.

The physicians on the medical staff at CHI Health Creighton University Medical Center - Bergan Mercy and Nebraska Heart are using state of the art technology and a hybrid approach to treat patients with coronary chronic total occlusion (CTO), complete or almost complete blockage of a coronary artery for 90 or more days.

Coronary CTOs are very common, occurring in as many as 30 percent of patients with significant coronary artery disease.

Additional CTO Statistics

• 15-30% of all positive heart catheterizations have CTOs
• In recent years success rate of a CTO procedure has increased from 50% to 90%
• 1/3 patients with coronary artery disease have CTO
• The team led by Dr. Agarwal in Omaha has performed 200 CTO procedures in the past 3 years

Coronary Artery Chronic Total Occlusion Symptoms

• Chest pain
• Pain in the upper body and arms, possibly concentrated on the left side
• Jaw pain
• Indigestion or choking feeling
• Nausea
• Dizziness or light-headedness
• Cold sweat
• Rapid or irregular heartbeat
• Unusual fatigue
• Shortness of breath
• Swelling in the feet 

Patients may be at increased risk for coronary CTO if they:

• Smoke or have daily exposure to second-hand smoke, at home or at work
• Past heart attack or known coronary artery disease
• Family history of heart disease
• High cholesterol
• Postmenopausal status (women)
• Taking birth control pills and smoking (women)
• Overweight
• Diabetes
• Hypertension (high blood pressure)
• A sedentary or inactive lifestyle
• Congestive Heart Failure

Treating CTO

Historically, patients with coronary CTO have been treated with medical therapy or through coronary artery bypass graft (CABG) rather than percutaneous coronary intervention (PCI). However, research has shown that patients with coronary CTO who receive PCI have experienced symptom relief almost immediately and increased chances of survival. 

SYNERGY Stent

The technology used in stents also has changed. CHI Health cardiologists are leading the way with a new FDA-approved SYNERGY coronary stent.

It's the first and only bio-absorbable polymer drug-eluting stent in the U.S., which means it slowly releases medication so scar tissue doesn’t grow in the artery lining. The stent helps promote good blood flow and faster healing. Patients also are able to stop using blood thinners sooner. And since the polymer coating disappears, the risk of complications such as vessel re-narrowing and blood clots is reduced.

What are heart valves?

Heart valves are flaps of inside lining of heart chambers. They are strategically located between the heart chambers. They open and close with each heart beat thus allowing blood to flow in forward direction. When valves do not work well, blood either leaks back into the chamber where it has just left or has difficulty flowing through it. In either condition the efficiency of heart function is limited; in turn your body does not get adequate blood circulation.
Your heart has four valves:

1. Aortic Valve
2. Mitral Valve
3. Tricuspid Valve
4. Pulmonary Valve

Even though each valve is an independent unit in it self, damage to one valve can over-burden the functioning of other valves, and in some situations make them dysfunctional.

Causes of valve damage

Valve tissue is thin, pliable but tough and resilient. It can withstand the rigorous demands of physical activity for the life of a person. However, there are certain conditions that can damage the valves, most commonly the following:

1. Congenital valve disease. A structural abnormality a person is born with. Depending upon the magnitude of defect the valve may need correction early in life or can come to the attention of physicians later in life.
   
2. Degenerative valve disease. Damage that has resulted from wear and tear. Just like your joints that develop arthritis with age, your valves can develop degenerative disease. The degenerative process makes the valves less pliable, stiff and, in extreme situations, replaces the whole valve with calcium.
   
3. Myxomatous valve disease. A condition resulting from weak valve tissue. The valve becomes too pliable and results in leakage.
   
4. Infection. Rheumatic heart disease and endocarditis are the two main conditions that results from infection.

Symptoms of valve disease

Efficient heart function is the result of strong heart muscle and well functioning valves that allow blood to move forward. When the valves are damaged your heart’s ability to pump the blood is impaired. Depending on the severity and duration of damage the symptoms could range from vague and subtle to life-threatening. Most common symptoms are:

1. Fatigue. This is by far the most common symptom. When the body and its essential organs do not get enough blood, especially upon exertion, you will feel fatigue. This lack of energy is subtle and frequently attributed to age, generalized deconditioning, lack of motivation or even depression. It is important that you discuss this with your doctor.
   
2. Shortness of breath at rest or with physical activity. If your heart cannot adequately pump blood to all body tissue you will have difficulty catching your breath and consequently limit your activity.
   
3. Palpitations. Damaged valves can stretch heart chambers or make heart muscle develop scars. In either situation the rhythmic beating of heart can be replaced with irregular beating. You may develop a racing heart or feel extra beats inside your chest. A common condition associated with valve abnormalities is atrial fibrillation. A life threatening situation called ventricular fibrillation can also result from scarred heart muscle.
   
4. Swollen feet, ankles and weight gain. Insufficient circulation can leave behind excess fluid to be accumulated in your ankles, feet or belly. You could feel heavy in your legs and tire easily. Fluid in belly can make you feel bloated and decrease your appetite.
   
5. Fainting. The inability of your heart to adjust to sudden changes in body position can result in sudden loss of consciousness.
   
6. Chest discomfort. Fullness or tightness in chest, especially with exercise, is a sign of heart in distress.

How is valve disease diagnosed?

1. Physical exam. If the valve problem is congenital (i.e. you are born with it) you may already know that you have a heart murmur that your physician has been hearing at each exam and following for any change. More commonly a valve problem is detected at routine physical exam or during a visit to the physician’s office for evaluation of symptoms related any of the symptoms noted above. A heart murmur is a sound generated from turbulence of blood as it passes through defective valve.
   
2. Echocardiogram. This is a test where ultrasound technology is used to provide still and moving images of the heart and the flow of blood. This is the most reliable test for the evaluation of valve function. It is a noninvasive and painless procedure.
   
3. Transesophageal echocardiogram (TEE). This is similar to a regular echocardiogram, except that the pictures of heart are taken with an ultrasound probe placed at the end of an endoscope. This procedure requires the passage of the probe into your swallowing tube (esophagus) while you are under sedation. We rely on TEE to provide vivid, detailed pictures of valve structure. Both regular and transesophageal echocardiogram studies will be performed on you if you need valve surgery.
   
4. Heart catheterization (coronary angiography). If your valve is damaged so much that you need surgery, you may be asked to undergo heart catheterization prior to valve surgery. This is a procedure where a small tube is threaded from the major artery in your groin up through the aorta and into the coronary arteries and the chambers of the heart. Direct pressure is measured inside heart chambers and coronary arteries are examined for the presence blockages. If your coronary arteries have any blockages you many need additional by-pass procedure during your valve surgery.

When is the valve surgery necessary?

Noticing a heart murmur or seeing a defective valve on echocardiogram is not a reason in itself to warrant heart surgery. The need for surgery depends on several factors such as the type of valve disease, the severity of the damage, your age and your medical history.

As a general rule you may need valve surgery if one or more of the following is present:

1. The valve dysfunction is impairing your heart’s ability to effectively pump blood during rest or exercise
2. The valve impairment is causing structural damage to your heart such as chamber weakening or enlargement
3. The leak across the valve is severe, even with out you feeling any symptoms. This is particularly true of the mitral valve.

Your family doctor and cardiologist will assess your valve condition and send you to a surgeon for further evaluation.

Repair or Replace?

Not all defective valves need to be replaced at surgery. As a general rule your surgeon will attempt to repair and preserve your own valve as the first option, as there are advantages to having your own valve left in place. Of the four valves, mitral and tricuspid valves are more amenable to repair, compared to aortic or pulmonary valves. Most often the probability of repairing the valve can be determined before the surgery. Sometimes, however, this decision can be reached only during surgery when the valve can be directly visualized.

If the valve surgery warrants replacement, there are two main groups to choose from.

1. Mechanical valves. Artificially made vales from pyrolite carbon, a light but strong and durable material.
   
   • Advantages: This valve is strong and does not yield to wear and tear of use. It lasts for the duration of person’s life and rarely needs repeat surgery.
   • Disadvantages. Since the valve is constructed out of an artificial material it has a tendency to form blood clots on its surface. Blood clots are dangerous both to the valve and to different body organs to which the clots can migrate, resulting in stroke, limb loss or even death. To prevent the blood clot formation, you will need the blood thinning medication Coumadin (warfarin) for life. Using a blood thinner requires the diligence of taking medication on time and frequent visits with your doctor to monitor the blood thinning levels. Your chance of being hospitalized for a bleeding complication is less than 2% per year of therapy. Coumadin is also known to cause birth defects and needs to be used in caution in patients of child bearing age. Despite these concerns, Coumadin is a very safe medication that has been successfully used for decades.
     
2. Tissue valves. As the name suggest these valves are made of natural tissue very often obtained from either cows or pigs. These valves can also be obtained as a donated body part from a deceased individual (this particular type of tissue graft is called a homograft). Tissue valves are soft, pliable and are subjected to wear and tear of use.
   
   • Advantages. Since the material is natural tissue there is decreased tendency to form blood clots and blood thinning medication is generally not necessary. This valve is most suitable for women of child bearing age, patients who are at increased risk of bleeding and will not be able to take blood thinner, and patients over the age of 65.
   • Disadvantages. The material these valves are made of is soft and has a tendency to wear out over time. These valves have been in use for over 20 years and it appears that, on average, a tissue valve can last from 10 to 15 years. When the valve fails, repeat surgery is needed.

The recommendations for replacement valve are clearer for patients who are less than 50 years old or over 65 years old. Younger patients benefit from mechanical valve as they will outlive the tissue valve. For patients between the ages of 50 and 65 years, the choice of replacement valve depend on several factors, including personal choice, longevity in family, previous heart surgery and associated medical conditions.

The multidisciplinary Left Atrial Appendage Closure (LAAC) team at the CHI Health Clinic Heart Institute has extensive experience in procedural treatment of cardiovascular arrhythmias. The LAAC team is part of the Structural Heart Clinic and has been trained to implant the FDA-approved LAAC devices. 

The Left Atrial Appendage (LAA) Closure Technology is a minimally invasive, advanced therapy used to treat some patients living with Atrial Fibrillation (AF) who are at increased risk for stroke. Patients who are implanted with a LAAC device are followed through the Arrhythmia Clinic at the CHI Health Clinic Heart Institute.

LAAC devices are umbrella-like devices that are placed using a catheter. They are FDA-approved LAA closure devices that effectively reduce stroke risk from thromboembolism from the left atrial appendage in patients with atrial fibrillation.

Benefits of Left Atrial Appendage Closure (LAAC)

• 72% reduction in major bleeding events (nosebleeds, stomach bleeds, brain bleeds)
• 78% reduction of stroke risk and an improved quality of life
• 95% implant success rate leading to faster recovery times
• 99% of patients are off blood thinners medications at 1 year

Structural Heart Clinic

The left atrial appendage closure device is one of several treatments available through the Structural Heart Clinic at the CHI Health Clinic Heart Institute. The clinic provides therapy options for patients with persistent or permanent AF who are difficult to treat or continue to experience symptoms.

A multidisciplinary team of electrophysiologists, cardiologists,  and nurse coordinators work with patients to determine the most appropriate and effective therapy to enhance quality of life. Nurse Coordinators assist patients throughout the course of care with work-up assessments, procedure planning, monitoring, and long-term follow up.

Contact Us

If your doctor is suggesting a consultation for Left Atrial Appendage Closure, request a referral to the CHI Health Clinic Heart Institute Structural Heart Clinic. You or your physician may contact us by calling (402) 717-7187 (Omaha) or (402) 328-3953 (Lincoln).

The mitral valve sits between the top and bottom chamber of the heart on the left side. It allows blood to flow from the left atrium into the left ventricle. It acts as a gate and should only allow blood to flow forward. Sometimes the blood flows back in to the left atrium because the valve doesn’t work properly. This backwards flow of blood is called mitral regurgitation.  

Symptoms of Mitral Regurgitation

Patients can become short of breath at rest and with exercise, develop swelling in their legs and ankles and have trouble doing their normal activities when they have mitral valve regurgitation. These symptoms are called heart failure. Most of the time the symptoms improve with the use of medication, like blood pressure medications and diuretics or water pills. However, some patients remain symptomatic and the only way to help their symptoms is to do surgery.

Mitral Regurgitation Diagnosis

Mitral regurgitation is diagnosed using an echocardiogram or a transesophageal echocardiogram (TEE). Your health care provider may have heard a murmur when listening to your heart and referred you for an echo. The echo is an ultrasound that allows us to look at the heart muscle, the valves of the heart and how blood flows through the heart. While you are lying down on a bed, we slide an ultrasound probe (special camera) across your chest with the help of clear gel. The cardiologist will look over the pictures and based on the pressures and flow of blood through the heart can diagnose mitral regurgitation.

Treatment: Mitral Transcatheter Edge-to-Edge Repair (TEER)

Mitral valve repair or replacement are the preferred ways of treating mitral regurgitation. This requires open heart surgery by a cardiothoracic surgeon and either a ring is placed around the valve to keep it from leaking or the valve is replaced with an artificial valve.

A “surgery without surgery” solution is a minimally invasive procedure called transcatheter mitral valve repair with one of two implantable devices. While one has been around for more than a decade, CHI Health was first in the region to implant a newer device in 2023. Both are essentially high-tech staples which help faulty leaflets of the mitral valve to close properly. 

The original device was indicated for patients who have severe, degenerative mitral valve disease (the valve itself doesn’t work) and who are not candidates for open heart surgery (prohibitive risk). In October 2013, the FDA approved the use of the device to treat patients with degenerative mitral valve regurgitation. Transcatheter or percutaneous mitral valve repair using the device is a minimally invasive procedure that is done with catheters or small tubes that are guided through the vein from the leg to the heart. 

A newer device was approved by the FDA in 2022 and found to be as effective as the previous device with a few subtle but important design advantages. It can be placed in valves that are leaking on the edges, which cannot be performed with the previous device. The newer device also has technical differences which can help surgeons navigate challenging anatomies. Its unique design features (larger size, center spacer, contoured paddles, unique material) may potentially treat leaky mitral valves better. 

CHI Health was chosen as one of few sites in the country to launch the new device because of our excellent track record of procedure success and outcomes for patients. CHI Health is also the first to perform the procedure among a wider network of CommonSpirit Health programs in California, Arizona, Texas, Washington and other states. 

The new device does not replace the previous device. The newer device has been studied only in primary mitral regurgitation, meaning damage that is identified as degenerative related to age or disease process. The previous device is used in both primary mitral regurgitation and secondary, meaning functional damage of unknown cause.

Procedure

A device is delivered to the heart through a small incision in the blood vessel in the leg. The heart continues to beat during the procedure and does not require a heart-lung bypass machine, which is common for open heart surgery. During the mitral valve repair procedure, a catheter (a thin, flexible plastic tube) is inserted through the patient’s skin in the groin area and is guided through the femoral vein to the affected area of the heart. Then, a catheter that holds the device goes in through the first catheter so that the device can be guided into place and attached to the leaflets of the mitral valve. Once the clip is properly placed and securely attached, it is deployed and the catheters are removed. A clip is placed on the leaky part of the mitral valve to prevent the valve from letting the blood flow backwards. It creates a figure 8 opening of the mitral valve.

Benefits

• No sternotomy or incision through the breast bone
• No heart lung bypass machine
• Shorter hospital stay
• Quicker recovery compared to open heart repair/replacement

The MitraClip improves valve closure and reduces backflow of blood. The heart returns to pumping blood to the body more efficiently, relieving the patient’s symptoms and improving their quality of life.

Risks

As with any catheter-based procedure there is a risk of bleeding, kidney damage, stroke and death. If there is damage caused to the mitral valve leaflet or to the heart itself, it may be necessary for the patient to have open heart surgery to make repairs. The cardiothoracic surgeon would perform the surgery.

Eligibility

If you have severe mitral regurgitation and are too sick for traditional mitral valve repair or replacement, and if medicine is not improving your life, you may be eligible for this procedure. The heart team can evaluate your symptoms and discuss your treatment options during a valve clinic visit.

Call the clinic with questions and to schedule your evaluation.

Omaha - (402) 398-5880

Lincoln - (402) 328-3881

CHI Health was the first in the region to perform transcatheter aortic valve replacement (TAVR) - the first in Nebraska was done at CHI Health Nebraska Heart. This new treatment is for patients with severe aortic stenosis (narrowing of the heart valve) who, because of multiple co-morbidities, are not well enough or at high risk for traditional open heart surgery. Up until now, the only treatment for severe aortic stenosis has been open heart aortic valve replacement surgery.

This less invasive procedure is done through a small incision in the groin using a catheter to transport the valve to the heart and then deploy without any incision in the chest wall.  This is the transfemoral approach. If the arteries of the groin are too small then we must do a transapical approach and make a small incision under the left breast area to place the valve with a catheter. The TAVR procedure is designed to replace the patient's diseased valve while the heart continues to beat – eliminating the need for use of a heart-lung machine.

Benefits of TAVR

• shorter procedure
• no sternotomy
• no heart lung machine
• shorter hospital stay than open heart surgery
• quicker recovery

How can I find out if I'm eligible for TAVR?

While up to 1.5 million people in the U.S. suffer from aortic stenosis (AS), approximately 500,000 within this group of patients suffer from severe aortic stenosis. If you have severe aortic stenosis and are too sick for open heart surgery and if medicine is not improving your health, you may be eligible for TAVR.  Our cardiologists will conduct a comprehensive evaluation to determine whether the procedure is an appropriate treatment option.

In certain cases, TAVR may not be an option because of co-existing medical conditions or disease processes that would prevent you from experiencing the expected benefits from the treatment or because the risks outweigh the benefits. Sometimes balloon aortic valvuloplasty can be performed to help relieve the symptoms of aortic stenosis. Your options will be discussed with you by the heart team.  For those who are candidates for TAVR, this treatment may provide relief from the often debilitating symptoms associated with severe aortic stenosis.

Call the clinic with questions and to schedule your evaluation.

Omaha - (402) 398-5880

Lincoln - (402) 328-3881

What is a VAD/LVAD?

An LVAD is a small pump that is surgically implanted inside the chest to help a weakened heart provide mechanical circulation of blood to the body. Unlike a heart transplant, an LVAD does not replace the heart, but instead helps a weakened heart do its job. The LVAD pulls blood from the lower chamber of the heart (left ventricle) and pushes it to the aorta, which carries the blood from the heart to the rest of the body. The LVAD is connected by a "driveline" to a control unit is outside the body. The control unit has a separate power unit and can be worn on a belt around your waist. The LVAD improves blood circulation, may relieve symptoms and allows patients to resume normal activity.

We are proud to offer a shared care model for LVAD needs. With this model of treatment, the CHI Health LVAD team works with the patient’s primary cardiologist in their community to provide the expertise necessary to help patients to return to their normal routine after surgery and makes ongoing follow-up care more convenient.

Types of LVAD Candidates

A VAD is considered in patients with end-stage heart failure - whether it is acute or chronic - when medical therapy is no longer working. There are three types of heart failure patients that are candidates for VAD/LVAD:

• Bridge-to-Transplant candidates are patients who are eligible for a heart transplant but have become too sick to wait until a suitable donor heart is available. The LVAD is temporary for them and provides enough blood flow to the body while they are waiting for a transplant. It may also allow patients to exercise so they are as physically fit as possible when it is time for their transplant.
• Bridge-to-Recovery is when LVADs are used to “rest” the native heart over a period of weeks to months, and is then removed. This holds the promise of permitting other treatments to restore the native heart to full function, avoiding the need for transplant.
• Destination Therapy candidates are patients who will have an LVAD as their permanent treatment for their heart failure. They have problems which make them unable to have a heart transplant or they do not want to receive a heart transplant. CHI Health offers a destination therapy program for LVADs.

Goals of LVAD Placement

1. Relief from Heart Failure:  Patients with an LVAD can expect an improvement in heart failure symptoms.
2. Improved Quality of Life:  Patients can expect to return to a more active lifestyle even though there are some restrictions (no swimming, contact sports or jumping). A doctor will explain exactly what activities can be performed with an LVAD.
3. A Longer Life:  Studies have shown that heart failure patients with LVADs have an improved survival rate compared to patients who only receive medical therapy for their heart failure. If your doctor recommends a VAD for you, it should be viewed as your BEST option for improving quality of life and living longer.

VAD Risks

As with any surgery, there are possible risks that go along with having a VAD. Possible risks include bleeding, infection, blood clots, stroke, kidney failure, or failure of the device. Your doctor will explain these risks and others that might apply.

Why Choose CHI Health Heart Institute for VAD Implantation?

Our expert multidisciplinary team provides a comprehensive health evaluation to determine whether a VAD is the right option for you. Our team of heart failure physicians, cardiac surgeons, advanced practice nurses, LVAD coordinators and other professionals is proud of our distinctions, which recognize CHI Health as an expert in the management of complex heart failure patients needing LVAD implantation.

The VAD team is committed to:

• Providing evidence-based heart disease care and a full range of advanced cardiac life support for people with acute and end-stage heart failure
• Educating patients about heart failure and helping with lifestyle changes: The VAD team teaches patients about their new VAD, taking care of incision sites, provides home care instructions and emphasizes the importance of nutrition and exercise. We reinforce existing healthy habits teach patients how to start new healthy behaviors and live a healthier lifestyle.

VAD Services

• Left Ventricular Assist Device (LVAD) implants
• Centrimag
• Impella
• CardioMEMS (remote access of pulmonary artery pressure)
• Tandem Heart
• Latitude Patients (remote monitoring of pacemakers and defibrillators) – More than 3,500 enrolled
• VAD interrogative resources across the region
• LUCAS Device
• CardioHelp