A week after a portion of his heart was pinched off, 71-year-old Bob Jones was "going full blast."
"I've been raking, and I've been shoveling and I've been hammering; I'm having a great time," said the Central Point resident. "I'm a little hard to keep down anyway."
Jones had been worried about his propensity for a stroke since he stopped taking blood thinners about two years ago. A diagnosis of atrial fibrillation — a heart arrhythmia known to cause blood clots — coupled with severe and chronic bleeding made Jones an ideal candidate for a new, trademarked procedure that seals off the left atrial appendage, a tiny, finger-shaped chamber to the heart that often harbors dangerous clots.
"I think it's a great step forward for patients who are at risk for stroke and have no other options," said Dr. Eric Pena of Southern Oregon Cardiology.
Pena is the first physician in Oregon to offer the LARIAT procedure since equipment manufacturer SentreHeart approached him with the technology late last year. Treating 10 patients with the minimally invasive procedure at Asante Rogue Regional Medical Center since February, Pena recently trained physicians for Providence St. Vincent Medical Center in Portland. Oregon Health & Science University since has used LARIAT as well, said Pena.
"Everybody in the community has to buy into it," he said.
The cardiac electrophysiologist said he worked for about three months to gain approval from the Rogue Valley's players in cardiac care. Because LARIAT still is considered "somewhat experimental," said Pena, part of his work entails collecting data on the procedure.
Although physicians for decades have been stitching the atrial appendage shut during open-heart surgery, their success rate has been about 80 percent compared with 95 percent for LARIAT, which uses catheters, said Pena. And although the atrial appendage doesn't contribute much to the heart's function, said Pena, it accounts for 90 percent of clots in diagnoses of atrial fibrillation, which affects more than 3 million Americans whose stroke risk is increased fivefold.
Among them is 74-year-old Grants Pass resident Paul Dean, the first LARIAT patient in Oregon. Because Dean, like Jones, experienced chronic bleeding from anticoagulant drugs, he was on Pena's list of patients who had run out of treatment avenues.
"What's worse: a bleed or a stroke?" asked Pena. "I was equally afraid of both."
So Pena kept Dean on blood thinners and crossed his fingers until he got the green light for LARIAT.
Subsequent patients have come from as far north as Roseburg and as far south as Northern California for the procedure, which keeps them in the hospital for just one day, compared with five days of hospitalization following open-heart surgery.
"It's like going into a dentist and having a tooth pulled — it's just that simple," said Jones.
Via two small incisions — one in the groin, the other under the rib cage — the LARIAT catheters connect magnetically inside the atrial appendage. The surgeon slips a snare over one catheter, opening or closing the loop until ultrasound confirms it's in just the right spot to suture, which is deployed remotely. The snare then is retracted and the suture cut free. After about a month without circulation, the finger-shaped atrial appendage becomes a ball of scar tissue and no longer constitutes a risk to patients, said Pena.
In Dean's case, the LARIAT procedure had the added benefit of nearly normalizing his heartbeat. Dean no longer takes blood thinners, nor has he experienced a bleeding episode, said Pena.
Minor, nuisance bleeding or the lifestyle restrictions that can come with taking blood thinners will not qualify someone for LARIAT, said Pena. Patients who take anticoagulants but still experience clots or who repeatedly fall down are likely to qualify, he said.
"It's almost a compassionate use."
Although Medicare hasn't approved the procedure, many health-insurance companies cover the LARIAT operation when it is deemed medically necessary, said RRMC spokesman Grant Walker. Both Dean and Jones, covered by CareSource and Health Net, respectively, said their insurance paid for LARIAT.
Reach Mail Tribune reporter Sarah Lemon at 541-776-4487 or email firstname.lastname@example.org.