Three hospitals in southwest Florida are competing for heart patients

Tom Sklodowski knew it was time for another operation after his breathing worsened and prevented him from exercising.

Born with a heart condition that resulted in three open heart surgeries and numerous hospitalizations over the years, the 68-year-old Naples retiree became the first person in Collier County to have the MitraClip procedure at the NCH Heart Institute on June 15 .

The minimally invasive procedure repairs a leaky mitral valve to restore normal blood flow to the heart. If left untreated, a mitral valve leak causes shortness of breath, fatigue, and other symptoms that affect the quality of life.

“It made an incredible difference in my breathing,” he said.

As part of the nonprofit NCH Healthcare System, the Heart Institute is expanding its cardiovascular services and has a prominent cardiologist previously at Cleveland Clinic Florida, Dr. Robert Cubeddu, who has been appointed President, will be discontinued effective June 1st.

It is part of a strategy NCH announced in April to transform its Heart Institute “into a premier travel destination for South Florida and beyond”.

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Heart disease was the third leading cause of death in both Collier and Lee counties and the second leading cause of death in the state in 2019, according to the state Department of Health. There were 799 cardiac deaths in Collier and 1,702 in Lee.

Nationwide heart disease is responsible for nearly 2 in 10 deaths; 47,044 people died of heart disease out of 207,000 deaths from all causes in 2019.

In addition to the MitraClip procedure, NCH’s Heart Institute added a new FDA-cleared procedure in February, intravascular lithotripsy, which uses sound pressure waves to treat hardened calcium deposits in arteries so stents can be implanted to improve blood flow.

NCH ​​launched its open heart surgery program in 1996, which meant that Collier residents no longer had to leave the community for the surgery. In July 2020, the Physicians Regional Healthcare System added open heart surgery to its Pine Ridge campus in north Naples.

In the past year, the NCH Heart Institute performed 441 open heart procedures. According to the NCH, the total number of cardiac exposures in fiscal 2020 was 3,375.

Cubeddu said NCH has built a strong foundation in its heart program that it will support as it grows.

“NCH is leveraging clinical research opportunities and has already invested in clinical trials and research, many of which are ongoing,” Cubeddu said in an email. “NCH uses cutting-edge technology and innovation, and at the same time we will encourage the conduct of medical-initiated studies through research grants and industry-sponsored studies.”

Lee County’s publicly operated Lee Health, likely NCH’s primary cardiac competitor, has performed 121 MitraClip procedures since the procedure began in 2016, according to Lee Health spokesman Jonathon Little. Lee Health is aware of the recently approved intravascular lithotripsy procedure to treat hardened calcium deposits in arteries.

“We are thoroughly reviewing all new procedures through the appropriate medical and scientific committees and are not currently offering the procedure,” said Little. “We will continue to review research and development for possible future use.”

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Dr. Richard Chazal, medical director of the Lee Health Cardiovascular Institute, said in an email that Lee Health has a sophisticated cardiac program that has served patients in southwest Florida for decades.

It performs more than 1,000 heart surgeries per year and the program offers specialties in minimally invasive surgeries, robotic surgeries, aortic valve replacement and mitral valve replacement procedures.

The end of July marks the one-year anniversary of the start of the heart center at Physicians Regional and more than 165 open heart operations were performed, said spokeswoman Brittney Thoman.

“Our expanded cardiac center includes advanced surgical equipment and technology that enables a range of interventional cardiac procedures, including minimally invasive cardiac procedures,” she said. “MitraClip will be joining Physicians Regional in the near future.”

Scott Lowe, chief executive officer of Physicians Regional, said expanding cardiac care is critical to keeping pace with growth in the community.

“Fast heart care is important in order to achieve the best possible result. We are excited to offer residents another option for heart care in our community, ”he said. “We built our heart program to provide our community with a facility that offers both high quality heart care and patient-centric customer service.”

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The patient experience

After his breathlessness worsened and his activities interfered with, Physicians Regional Sklodowski’s cardiologist sent him to the Cleveland Clinic Florida in Weston for tests that spring.

He suffered from mitral regurgitation, in which the mitral valve does not close properly and blood flows back to the heart.

The condition can cause serious problems to the heart and lungs, and over time, it can lead to heart failure, in which the heart cannot pump blood properly to meet the needs of the body.

The plan was for Cubeddu to perform the MitraClip procedure, a catheter-based procedure that involves placing a clip on the mitral valve to close it and clear regurgitation, at the Cleveland Clinic Florida. MitraClip was developed by Abbott Vascular Inc. and approved by the FDA in 2013.

“He said we have to use the big guns now,” said Sklodowski of his cardiologist, who suggested that he see Cubeddu at the Cleveland Clinic Florida. “For two years I couldn’t train like I used to.”

Sklodowski learned that Cubeddu was moving to the NCH Heart Institute, which is located in the NCH Baker Hospital near downtown Naples.

“I made an appointment straight away,” he says. “I wanted him to do it.”

Sklodowski spent one night in the NCH hospital after the procedure on June 15. He returns to old activities, including exercising and walking with his wife.

“Physically he looks better,” said his wife Helen Sklodowski.

He understands that NCH is focused on raising the bar on its cardiac program; He was satisfied with his result and praised the staff.

“I thought everyone was paying attention,” he said. “I have absolutely no complaints.”

Procedure for hardened calcium in arteries

The second procedure that NCH recently added at the Heart Center, intravascular lithotripsy, is minimally invasive with a catheter and uses sound pressure waves, also known as shock waves, to break down hardened calcium in arteries. The calcium deposits can prevent a stent from being implanted to open the artery and improve blood flow.

The system includes a novel application of lithotripsy that has been used to break up kidney stones for decades. It was developed by Shockwave Medical, based in California, and approved by the FDA in February.

In the clinical study of 384 heart patients with hardened calcium deposits, 92% of the treatment was successful and they were able to receive a stent to open an artery, according to the FDA.

Dr. Larry Leslie, an interventional cardiologist at the NCH and the first at the heart center to perform the procedure, said it was a good solution for treating hardened calcium deposits. Before this procedure, the standard was to use a drill-like approach that could perforate the vessel and cause complications, he said.

“This device is a lot safer,” said Leslie. “It takes seconds. It makes the calcium pliable so that you can deploy your stent. “

Leslie estimates that 1 in 8 patients have calcium deposits, in which the shock wave procedure can be beneficial.

It involves using a catheter and inflating a balloon to low pressure at the site of the calcium deposition and activating the sound pressure waves to break the calcium down. The balloon can then be expanded to deliver the stent.

With the shock waves, the broken calcium is pushed against the artery wall and the stent holds it there, Leslie said.

“It gives you the option to expand the balloon and deploy the stent the way you want,” he said. “This device is very good.”

Leslie said he doesn’t know until he starts a stent placement if the patient has hardened calcium deposits where he will be using the shock wave system. There are no patients whose state of health they would not take advantage of.

“You can use it for anyone,” he said.

See similar https://www.naplesnews.com/story/news/health/2021/07/02/3-lee-and-collier-hospitals-compete-cardiac-patients/7780610002/

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