Structural Heart Disease


John Messenger, MD

Director, Interventional CardiologyClinical Director, Heart & Vascular Center

The University of Colorado is a n‚Äčational leader in the percutaneous and surgical management of complex structural heart disease. It is obvious that this broad area of cardiovascular care is becoming an increasingly important area of in the field of cardiac intervention and we are proud to have become an established national leader in this rapidly expanding field. The Structural Heart Disease Program at the University of Colorado Hospital is multi-dimensional and heavily relies on a team approach including experts from Interventional Cardiology, Advanced Cardiac Imaging, Cardiac Surgery, and Electrophysiology as well as a dedicated team of nurses and skilled technicians. The program is largely referral-based so seamless communication between our providers and referring physicians remains critical and is greatly emphasized.

Edwards SAPIEN TranscatheterSignature components of the program include transcatheter valve replacement, mitral and aortic valvuloplasty, and percutaneous closure of PFO, ASD, VSD and paravalvular leaks. UCH is far and away the highest volume center in the region for these complex procedures and is among the highest volume centers in the nation. Because the indications for many of these advanced structural heart disease therapies are in evolution, we pride ourselves on being involved a number of high-profile mult‚Äči-center clinical trials (e.g., PARTNER II, COAPT, ACP Pivotal Trial, REDUCE) and as a result many patients may qualify for and be offered consideration of enrollment into on-going clinical studies as a therapeutic option. In addition, procedures performed using both experimental devices in compassionate care protocols and those devices that already have FDA approval are also performed and offered to patients. Patients being considered for an advanced transcatheter structural heart procedure will undergo a thorough clinical evaluation (which his many cases may include advanced non-invasive imaging – 3D TEE and/or CTA) to both determine candidacy and also optimize the chances of a successful outcome.

MitraClip Mitral Valve RepairThe Structural Heart Disease Program at UCH is a national leader in both surgical and transcatheter valve repair. Our surgeons (in particular David Fullerton, Chief of Cardiac Surgery, and Joseph Cleveland, Surgical Director of the Cardiac Transplantation) are skilled in surgical aortic and mitral valve replacement/repair procedures. Transcatheter aortic valve replacement (TAVR) is currently available for patients with severe aortic stenosis (Figure 1), and UCH is proud to offer multiple aortic valve therapies to qualifying patients (TAVR using the FDA-approved Edwards SAPIEN transcatheter heart valve [THV], TAVR using the second generation Edwards SAPIEN XT THV via enrollment into the PARTNER II clinical trial, surgical aortic valve replacement, and palliative balloon aortic valvuloplasty). In addition, percutaneous mitral valve procedures ranging from balloon mitral valvuloplasty for severe mitral stenosis to percutaneous repair using the MitraClip edge-to-edge repair device (Figure 2) for severe mitral regurgitation are also performed at UCH.

Finally, UCH is in the unique position to offer patients with non-valvular atrial fibrillation the treatment option of left atrial appendage (LAA) occlusion therapy using one of several technologies, potentially eradicating the need for long-term anticoagulation in this select group of patients.

As should be evident from this brief overview of the Structural Heart Disease Program at UCH, a cutting-edge program in structural heart disease requires outstanding cross-disciplinary working relationships, state-of-the-art cardiac imaging technology, and a dedication to clinical research to continue advancing this rapidly evolving field. The Structural Heart Disease Program is fortunate that this interactive culture, technologically robust infrastructure, and commitment to scientific exploration are all alive and well at UCH.

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Cardiology (SOM)

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