April 24, 2014
Capital Regional Medical Center First in U.S. to Use New Medical Device Expertise, Technology, and Timing Saves Lives at CRMC
L-R: Moses deGraft-Johnson, MD, Margie Allen, Ajay Mhatre, MD
Tallahassee, FL – For a 79-year-old Perry woman, medical expertise, technology, and timing came together for a life-saving procedure at Capital Regional Medical Center (CRMC). Margie Allen was enjoying a day of gardening in late February when she said her heart started pounding. “I knew something was wrong so I went inside, cleaned up, and went to the hospital,” she said. The Perry hospital began tests that quickly revealed a significant problem in Margie's aorta and a transfer by ambulance to Tallahassee was put in motion.
When she arrived at CRMC's Emergency Department, she was suffering from a rapid heart rate and complaining of severe pain between her shoulders. Physicians and nurses worked quickly to stabilize her condition and begin tests to determine the cause of her symptoms and what they discovered led to a creative solution and the use of a new medical device for the first time in the United States.
As test results were made available, two of CRMC's highly skilled cardiac experts were called in to examine Margie and devise a treatment plan. “What we discovered was a penetrating ulcer within the wall of her thoracic aorta,” said Ajay Mhatre, MD, an Interventional Cardiologist with Capital Regional Cardiology Associates. “Without treatment there is a significant risk of rupture or dissection of the aorta which is life-threatening.” But that wasn't the biggest challenge Dr. Mhatre and his colleague Moses deGraft–Johnson, MD, a Cardiovascular and Thoracic Surgeon, found after a CAT Scan. “She had a rare abnormality in her anatomy that made a traditional thoracic stent graft placement impossible,” said Dr. Mhatre.
“Because of her internal anatomy – a rarity seen in very few patients – and the location of the ulcer, putting the graft in using traditional methods would have covered the blood vessel supply to her left arm,” said Dr. deGraft–Johnson. “We need about two centimeters of good artery and a normal wall for the graft so it won't move once inserted.” The main arteries leading to both of the her arms were at an angle that simply didn't allow the specialists to take a traditional approach.
Enter timing and technology. Just days prior to the Margie's arrival at Capital Regional, Medtronic, Inc. received approval from the U.S. Food and Drug Administration for the Valiant Captivia Thoracic Stent Graft System to be used in the treatment of this type of aortic condition. Medtronic had expanded the system with tapered pieces that provided greater flexibility in the stent configuration to address a wider range of patient anatomies. “This was much better for her,” said Dr. Mhatre. “It was sized correctly and was better to use the tapered stent rather than the traditional one–size tube.”
But the challenge remained that her anatomy didn't lend itself to a standard procedure. “We had to take special measures to provide blood–low to both arms,” said Dr. deGraft–Johnson. Over a two–day period prior to the stent placement, Dr. deGraft–Johnson 're–routed’ the patient's left and right arteries and connected them directly to the carotid artery. “If we had not performed the subclavian bypass surgeries first, the placement of the stent to repair the ulcer would have cut off circulation to both arms.” On day three of her stay at Capital Regional Medical Center, Dr. Mhatre successfully inserted the new stent, making him the first physician to implant the Valiant® FreeFlo Tapered device in the United States.
“When the doctors told me I needed to have three surgeries, I didn't know if I could do it,” said Margie. “But I came through it, thank God.” Not only did she make it through those three surgeries, Margie says she really didn't suffer from pain afterwards. “They gave me pain medication but I never took it. They were very good doctors and took wonderful care of me. The hospital was so good and I couldn't have asked for better nurses. I would recommend Capital Regional to everyone.” Now the active senior says she feels great and is looking forward to planting a vegetable garden this Spring.
For this patient and others who are faced with life-threatening cardiac, vascular, and thoracic disease, Capital Regional's highly skilled medical team offers new hope for effective treatment close to home. When Dr. Mhatre and Dr. deGraft-Johnson joined the medical staff less than a year ago, they brought with them the ability to provide a level of care that historically has not been available in the Tallahassee area.
“While this patient was very unique and certainly being the first in the United States to use this new device is noteworthy, over the last few months we have seen a growing number of patients who would have been transferred to another city for emergency surgery to repair thoracic ulcers and aneurisms,” said Dr. deGraft-Johnson. “The community is very fortunate that CRMC is committed to bringing this level of care to the area because many of the patients we've seen would not have survived had we not been able to treat them here.”
Dr. Ajay Umesh Mhatre joined Capital Regional Cardiology Associates as an Interventional Cardiologist. He was born in north Florida and completed his undergraduate degree at the University of Florida, and Doctor of Medicine at Florida State University. Dr. Mhatre has completed fellowships in Interventional Cardiology at the University of Arkansas, and most recently at Phoenix Heart Center in Arizona.
Dr. Moses deGraft-Johnson completed advanced training in the highly specialized field of Cardiovascular and Thoracic Foregut Surgery and served as a fellow in Cardiovascular Pathology at the Dr. Jesse E. Edwards Registry of Cardiovascular Disease at the world renowned C. Walton Lillehei Heart Institute at the University of Minnesota. With many years of experience as a Cardiovascular and Thoracic Foregut Surgeon, Dr. deGraft-Johnson brings to Capital Regional Medical Center innovations in performing cardiac surgery, vascular hybrid procedures and complex aortic aneurysm repair with endovascular approach. Dr. deGraft-Johnson gained national recognition for performing the first open heart surgery in the U.S Virgin Islands territory in 2010 as part of the ongoing efforts to improve healthcare access in the developing world.