Just several weeks ago, Mr. John Doe was admitted to Eastern New Mexico Medical Center with prolonged chest pain. Cardiac enzymes were elevated consistent with a small heart attack. Mr. Doe had undergone two coronary artery bypass graft surgeries in the past, the first 18 years ago and the second 10 years ago.
A coronary angiogram was done showing that the left pumping chamber of the heart, the ventricle, was severely damaged. Several bypass grafts were closed and there was severe and extensive coronary artery disease. The largest artery that was still open fed the bottom wall of the heart but had several short blockages that were more than 95 percent.
A cardiac surgeon in Lubbock was consulted who expressed the opinion that the patient was not a candidate for any further cardiac surgery.
The patient was now truly between a rock and a hard place. He was not a candidate for any further bypass surgery. However, if something was not done about the blocked artery feeding the bottom wall of the heart there was a high likelihood that it would close in the near future causing him to have a major heart attack that would probably kill him.
The consensus of the heart team at Eastern New Mexico Medical Center was that a coronary interventional procedure should be performed using our new Impella left ventricular support pump during the procedure. Without the pump in place, the procedure would be considered extremely high risk since the procedure would be done on the last remaining good artery.
In the past, a patient in this situation would have had to be transferred to either Albuquerque or Lubbock to undergo this type of high-risk interventional procedure.
After obtaining consent from the patient, the patient was brought to the cath lab. The Impella device was inserted across the aortic valve and the pump was turned on. Within a few minutes, the pump was driving 3.5 liters/minute of blood across the aortic valve, reducing the demand on the coronary circulation for blood.
Over the next 15 minutes, three different stents were placed in the right coronary artery, eliminating each of the different blockages. After final angiographic pictures were taken, the guidewires and guide catheters were removed. The Impella pump was weaned from the patient and removed.
Immediately following the procedure, the patient noted a significant improvement from the improved blood flow into the heart. Now the heart was pumping more strongly than was possible before the stents were placed. The patient noted a marked improvement in his shortness of breath and the disappearance of chest discomfort that he had been experiencing for several weeks. The patient was discharged to home the following day feeling markedly better.
This kind of procedure was not feasible in Roswell in the past. In the past, a patient with coronary problems this severe would have been transferred by helicopter to a tertiary care center for high-risk coronary intervention. The availability of this level of advanced cardiovascular treatment at Eastern New Mexico Medical Center is the end product of a large training program in the catheterization lab, together with ongoing support from the administration of Eastern New Mexico Medical Center to continue to upgrade the depth and sophistication of the cardiovascular service line at the hospital.
Ashley Rivers is a medical doctor for Eastern New Mexico Medical Group Heart, Vascular and Vein Specialists. The advice offered in this column is that of the author.