Structural heart

Structural heart care in Idaho Falls

With a robust cardiac care program made up of physicians who specialize in structural heart procedures, Eastern Idaho Regional Medical Center (EIRMC) offers comprehensive evaluations and treatment options for patients with valve disease or other structural heart abnormalities.

For more information about our available structural heart service, call us at (208) 529-7893.

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Renowned structural heart care

Eastern Idaho Regional Medical Center was named a “Top 50 Cardiovascular Hospital” in the U.S. by IBM Watson Health™. The organization studied performance metrics from 989 U.S. hospitals, and identified top-tier facilities for inpatient cardiology services, with EIRMC being one of them.

One of the services impacting our high-performance ranking is structural heart care. Structural heart complications involve the heart's structural anatomy, including valves, chambers, walls and pockets. If these components retain damage or have inherent birth abnormalities, blood flow can be affected, possibly leading to heart failure, a cerebrovascular accident (stroke) or cardiac arrest.

EIRMC is the only provider of structural heart care and valve disease treatment for the entire southeast Idaho region, as well as western Wyoming and southern Montana.

What is a structural heart problem?

While structural heart complications can sometimes show no early warning signs, chest pain and fatigue are common red flags.

For the heart to pump blood in the appropriate direction effectively, four valves must open and close in harmony: the aortic, mitral, tricuspid, and pulmonic valves. If they begin malfunctioning, significant problems can arise, and medical and surgical intervention may be required.

While some cases still require open heart surgery, minimally invasive cardiac catheterization makes care easier for many patients. With fewer complications, quicker recoveries and great future quality of life, several types of catheter aortic replacement therapy are becoming the new normal for structural heart care. The primary treatment employed at EIRMC is TAVR (transcatheter aortic valve replacement).

TAVR treatment for aortic stenosis

Aortic stenosis occurs when the aortic valve narrows or doesn't open fully, reducing or blocking oxygen-rich blood flow from your heart to the rest of your body. As a result, patients can experience shortness of breath, fatigue, passing out and chest pain or pressure.

Until now, patients with severe aortic stenosis have had to give up much of what makes life enjoyable. But TAVR, still a relatively new aortic stenosis treatment, allows patients to maintain a high quality of life while managing the severe issues with aortic stenosis. After the TAVR procedure, patients usually feel minimal to no pain, improved breathing. They can soon exercise and resume a healthier lifestyle.

TAVR is a minimally invasive catheter procedure delivered through the skin to replace the aortic valve. EIRMC is one of only five hospitals within 190 miles approved to perform this cutting-edge procedure. It has proven highly beneficial for patients previously considered too high a risk for invasive heart surgery.

How it works

A TAVR procedure only takes around two hours and patients typically stay at the hospital for one to two nights afterward. Follow-up care usually involves 30-day and one-year echocardiograms and routine cardiology visits with the implanting physician.

The procedure is accomplished via a team of heart surgeons and interventional cardiologists who insert a balloon-expandable heart valve into the heart through a catheter placed at the side of the narrowed valve. When in position, the new valve expands and pushes the old valve leaflets out of the way, allowing the tissue in the replacement valve to take over regulating blood flow. In doing so, blood flow is immediately improved.

Before TAVR, replacing the valve was done through open heart surgery, or for some, a minimally invasive surgery through the ribs.

Is TAVR an option for you?

TAVR provides another option for intermediate to high-risk patients or otherwise not a good candidate for open-heart surgery. Doctors thoroughly evaluate patients to determine if they qualify. Some may have coexisting medical conditions or disease processes that would prevent them from benefitting as expected. While minimally invasive, TAVR is a significant procedure involving either general anesthesia or moderate sedation. Specific patient contraindications and potential adverse effects are always taken into account, including risks of death, stroke, arterial damage, major bleeding, and other life-threatening events.

Seeing as the Food and Drug Administration (FDA) only approved TAVR for high-risk patients in 2011 and moderate-risk patients in 2016, the total longevity of the new valve’s function is not yet known. For these reasons, our team carefully assesses the risks and benefits, then discusses them with the patient to decide their treatment plan.

Other structural heart services

Outside of TAVR for the aortic valve, EIRMC offers numerous options for patients experiencing structural heart complications involving other critical cardiac structures. These procedures vary in intensity, and subsequent hospital stays can range from a few hours to a few days.

Transcatheter mitral valve repair (TMVr)

EIRMC is the first hospital in Eastern Idaho to offer transcatheter mitral valve repair — less invasive treatment for severe mitral valve regurgitation. This is when the mitral valve doesn't close tightly enough, allowing blood to flow backward into your heart. TMVr is often recommended to mitral valve regurgitation patients at elevated risk for traditional open heart valve surgery.

TMVr is performed through a small puncture in the groin where a catheter is inserted into the femoral vein. The steerable, guiding catheter is advanced into the left atrium, where the clip or clips are attached to the valve's leaflets, reducing mitral regurgitation.

The procedure typically takes around three hours and is followed by one to two nights in the hospital. The follow-up care plan includes 30-day and one-year echocardiograms and visits with the implanting physician, as well as routine cardiology visits.

Transcatheter mitral valve replacement (TMVR)

TMVR is a less invasive treatment for severe mitral valve regurgitation or mitral stenosis, a narrowing of the mitral valve. Especially in the setting of prior mitral valve replacement, the new valve can be deployed using a catheter from the femoral vein to replace the poorly functioning mitral valve. A transcatheter mitral valve replacement takes precisely as long as a TMVR procedure. It carries with it the same length of hospital stay and the same follow-up care regimen.

Left atrial appendage occlusion (LAAO)

LAAO is a treatment offered to patients with atrial fibrillation or an irregular heartbeat. Specifically, LAAO is mainly geared towards atrial fibrillation patients treated with blood thinners to reduce the risk of stroke but who are no longer a good candidate for them. The LAA is a small sac-like appendage in the upper left chamber of the heart. During an LAAO procedure, the atrial appendage is sealed with a catheter using the femoral vein in the groin. In doing so, this reduces the risk of stroke without a long-term need for blood thinners.

The procedure only takes about one hour, requires merely an overnight hospital stay for monitoring and has a follow-up care plan that includes taking a blood thinner and aspirin for about 45 days. After a time, if the heart's lining has not grown over the left LAA, you would need to continue taking warfarin and aspirin. This is confirmed at your 45-day postoperative transesophageal echocardiogram.

Atrial septal defect (ASD) closure

An ASD is a hole in the wall that divides the two upper chambers of the heart. An ASD causes blood to flow through the defect, causing more blood than usual to pass into the right chamber, increasing pressure on the right-side heart and pulmonary arteries. This is called a left-to-right shunt.

Treatment of ASD depends on any other congenital heart abnormalities and the size and type of the abnormality. ASD repair or closure may often be performed through a catheter procedure.

The procedure takes approximately an hour, allows an overnight, if not same-day, discharge and requires a six-month echocardiogram, moving to yearly afterward.

Patent foramen ovale (PFO) closure

A patent foramen ovale (PFO) is a hole between the heart's upper chambers that didn't correctly close after birth. If this causes an issue, a catheter procedure can be performed to plug the hole. Doing so, the catheter is inserted into a vein in the groin. It guides a device into place with the imaging assistance of an echocardiogram. This can be performed with conscious sedation or general anesthesia.

Regardless of sedation methods, the procedure has the same length, hospital stay and follow-up care regimen as an ASD closure.

Paravalvular leak (PVL) closure

A PVL is a leaking hole that appears next to a previous valve replacement. When significant, a catheter procedure can be performed to plug this hole. The catheter is inserted into an artery or vein through the groin. It guides a device into place with the imaging assistance of an echocardiogram. This is performed using general anesthesia.

The procedure takes about an hour, has an overnight or same-day discharge and warrants a one-month echocardiogram, moving to as needed after that.

Complex coronary intervention

When appropriate, complex coronary interventions can be performed using catheters to avoid open heart surgery. Using specialized equipment, additional techniques include an atherectomy or adopting a sharp blade on the edge of a catheter to remove plaque from a blood vessel. Another complex coronary intervention accomplished with catheters is chronic total occlusion (CTO) interventions. This occurs when there is a partial or complete blockage of one or more coronary arteries due to plaque buildup. When this happens, blood flow to the heart is compromised.

In a catheter-driven CTO intervention, an interventional cardiologist places a small mesh tube into the blocked artery to widen and support the arterial wall. As a result, normal blood flow is restored. Usually, complex coronary interventions require overnight hospital stays, at least for monitoring. The operational times and follow-up care plans vary based on the patient and procedure.