From the Heart: Stories of Survival

• Cardiologist Tends to Young Man’s Heart and Peace of Mind
• Minimally Invasive Valve Surgery
• Providence Expertise with Cardiac Care Leads the Way for Pacemaker Patient 
• Bloodless Surgery: The Techniques First Used for Jehovah's Witnesses are Now Being Used to Help Other Patients
• Chest Pain: Fast Action Saves Lives 

Cardiologist Tends to Young Man’s Heart and Peace of Mind

As a program manager in Santa Clarita Valley’s aerospace industry, 43-year old Jack Kightlinger is a busy man.  In June 2007, Jack was so busy that he initially disregarded a common heart attack warning sign: a burning sensation in his chest.  “I felt pain, but it was nagging, not piercing, and sometimes it would go away completely,” Jack explains.  “I thought maybe I’d go to the hospital the next day if the pain was still there.”

Two days later, Jack finally went to a hospital emergency department near his home in Stevenson Ranch.  An electrocardiogram (ECG), however, did not show any serious abnormalities. Doctors sent Jack home with a prescription for Vicodin, but the medication did little to relieve the pain now expanding from his chest to his shoulders, arms and hands.  The next day, Jack sought help in a local doctor’s office, where a repeat ECG was unremarkable. .  His blood pressure and blood sugar, however, were extremely high, which prompted the physician to advise Jack to immediately return to the emergency department for further evaluation and treatment.  When Jack arrived, he was in the early phase of a heart attack as documented by a third ECG. 

“Jack’s heart had been sending warning signs in the days leading up to his attack,” explains interventional cardiologist Samuel Kojoglanian, MD, adding that the chest pain Jack experienced, also known as unstable angina, is often caused when a build up of fatty plaque in the coronary arteries restricts blood flow and oxygen to the heart.  “In a heart attack, the plaque actually ruptures and can create a complete blockage,” says Dr. Kojoglanian.  “Once that happens, we have about 90 minutes to open the clogged vessel in order to prevent permanent damage to the heart.”

Numerous clinical studies indicate that opening a clogged artery in the initial phase of a heart attack using angioplasty and stents minimizes damage to the heart muscle, reduces complications and produces better long-term outcomes.  Because the hospital closest to Jack’s home does not offer angioplasty, Jack needed to be transferred to nearest facility with the technology and expertise to provide this state-of-the-art treatment for heart attacks:  Providence Holy Cross Medical Center.

Providence Holy Cross Medical Center is among the top 10 percent nationally for performing angioplasty within 90 minutes of the arrival of heart attack patients, according to the Joint Commission for the Accreditation of Hospital Organizations (JCAHO).  In addition, the Los Angeles County Department of Health Services recently designated Providence Holy Cross Medical Center as a specialty center for treating acute heart attack patients.

Dr. Kojoglanian not only recommended that Jack be immediately transferred, he got in the ambulance and completely orchestrated Jack’s care during the ride and upon arrival at Providence Holy Cross Medical Center.   Less than 90 minutes after the onset of Jack’s heart attack, Dr. Kojoglanian successfully performed double vessel angioplasty, which stopped the heart attack in its tracks and started the healing process.

 “A heart attack is a life-threatening event for any patient, and the tools we have to diagnose the condition in the early phase of a heart attack are not 100 percent,” explains Dr. Kojoglanian.  “Jack demonstrated admirable persistence in seeking help.  I felt it was very important to be there by his side to ensure continuity of care for him.  I knew that we could prevent damage to his heart muscle and  preserve quality of life for this young man with his whole life ahead of him.”

Jack says he felt confident about the outcome from the moment he met Dr. Kojoglanian.  “I was never really scared, the whole time I was in the ambulance, the whole time I was in the hospital,” he recalls.  “I knew I was safe.”

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When 81-year old Edward Jones received his first heart valve surgery, he had only one option: traditional open heart surgery.  “The scar was this big, and I was down for six weeks,” says Jones, pointing to a long mark on his chest. 

Thirteen years later, Jones needed another heart valve repair.  This time doctors presented Jones with a more advanced option: minimally invasive heart valve surgery.   With this new surgical technique, doctors told Jones he could recover in about two weeks, rather than two months.  The busy, self-employed Sierra Madre resident – who lifts weights, plays tennis or walks every day – jumped at the chance to recover more quickly, and he says it was worth it.  “This time, I had no pain at all.”

Jones wasn’t the only heart patient interested in less pain and a speedy recovery.

“I was familiar with the more common procedure, but I thought this was probably a better way to go,” says 56-year old Peter Hargreaves of Burbank, the first to receive minimally invasive heart valve repair at Providence Saint Joseph Medical Center (PSJMC).  He was back on his feet just a few days after surgery.  “I had good mobility.  I was amazed.”

 “It really is the wave of the future in cardiac surgery,” says Eli R. Capouya, MD, a cardiac surgeon affiliated with PSJMC.  “Most of our patients have been discharged from the hospital within two to five days.  Instead of depending on others to help them with daily hygiene and household chores for a month or more, they’re able to resume their normal daily activities within a couple of weeks.  There’s also less scarring and pain and reduced risk of infection.”

The new, minimally invasive valve surgery allows surgeons to operate through a small opening, or “port”, in the chest wall between the ribs.  It involves many of the same steps as open heart surgery but eliminates one of the most painful steps – the need to open the chest through a 12- to 15-inch incision in the breastbone.  Instead, the cardiac surgeon makes one small incision approximately 4 inches in length above or below the right breast through which the valve surgery is performed.

Less than 20 hospitals in California routinely perform minimally invasive heart valve surgeries, and PSJMC is the only hospital in the San Fernando Valley to offer the surgery.  PSJMC cardiac surgeons lead the San Fernando Valley in performing minimally invasive heart surgeries, with nearly 500 performed to date.

It was that experience that convinced Hargreaves.  He proudly boasts that at his one-week follow up visit, he was able to grab his t-shirt at the waist and pull it up and over his head – a feat that is virtually unheard of with traditional open heart patients.  “Even my doctor was surprised.  If it was a gamble, it paid off.”

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A few months after 62-year-old Era Butler retired from a celebrated teaching career in her hometown of Perris, California, she had surgery to replace the battery in a pacemaker system used to regulate her heartbeat.   The pacemaker – which uses a small, battery-powered generator to deliver timed, electrical impulses to the heart muscle through tiny wire leads – had been implanted 12 years earlier when complications from an illness caused Butler’s heartbeat to become irregular.

Less than a week after the pacemaker battery replacement, Butler began suffering from fever, chills and body aches.  “I thought it was a flu virus,” says Butler’s daughter, Gloria Woolridge.  “I didn’t suspect it was the pacemaker until three weeks later.”

Physicians at the hospital near Butler’s home, where the procedure had been performed, ordered a series of tests and subsequently re-hospitalized Butler.  After determining that she had an infection, her doctors prescribed antibiotics.  Butler still failed to improve.  Her local physicians then determined that Butler’s pacemaker leads had been infected and transferred her to a tertiary health care facility in Los Angeles specializing in cardiac care.

Woolridge remembers the desperation both she and her mother felt.  “My mother said, ‘Gloria, it feels like something is munching on me right here,’ and then she pointed to her chest area near her heart and shoulder.  My mother said ‘There is something eating on me.  Honey, you’re my last hope.’  I knew that she needed help.”

However, physicians at the hospital told Butler they did not have the expertise or the technology to remove the leads and that the risk of surgery was prohibitive.  They planned to continue to treat Butler with antibiotics.  Butler’s daughter worried about this approach.  “I had done the research, and I thought, that’s not going to work.  She’s going to die,” says Woolridge.  Butler had developed an infection inside her heart.

Not willing to accept the death of her mother as a possible outcome, Woolridge began searching the Internet for treatment options.  “I felt as though I was in the midst of solving a puzzle, and I needed to find the missing piece,” explains Woolridge.

She soon discovered the “missing piece” for her mother was lead extraction surgery, a specialized procedure required when the pacemaker leads become damaged, infected or blocked by scar tissue.  Only a handful of physicians in the world perform the surgery.  Fortunately for Butler, one of those surgeons is Raymond Schaerf, MD, Chief of Staff at Providence Saint Joseph Medical Center in Burbank.

“Each case can be an adventure because you can never be sure exactly what’s going on inside the heart,” says Dr. Schaerf.  “Some of the patients have complex anatomy, including congenital heart disease, and some have actually had heart transplants.  Many of the defibrillator patients who require extractions have very weak hearts and require extensive monitoring.  They absolutely can’t tolerate having even a minor complication.”

Dr. Schaerf was among the first in the world to perform lead extraction surgery using an excimer laser.  To date, he has removed more than 1,000 leads, which makes him one of the most experienced lead extraction specialists not only in the U.S., but also in the world.  He is one of only a few physicians in California who routinely performs the procedure.

During the procedure, Dr. Schaerf uses a special wire to hook onto the inside of the lead, or places a snare through a vein to grasp the outside of the lead.  He then pushes a plastic tube with a laser over the lead to help separate it from the scar tissue connecting the lead to the veins and the heart.  The procedure is a very complex and high-risk operation that, on occasion, requires emergently opening the chest.

“When I first started doing lead extractions in 1979, the only operation available was an open heart procedure,” notes Dr. Schaerf.  “With the development of the new tools and advanced technology available at Providence Saint Joseph Medical Center (PSJMC), patients can often go home in one to two days and only have a standard pacemaker incision.”

But Dr. Schaerf is quick to point out that it is not only the technology that enables him to offer this state-of-the-art care to his patients.  “I’ve been very fortunate not only to have the available technology, but also a very strong team of nurses, surgery and radiology technicians, anesthesiologists, cardiologists, and infection disease experts,” he adds.

Gloria Woolridge considers all of it “a gift”:  the technology, the staff and Dr. Schaerf’s leadership, expertise and compassion.

“My mother is the center of our family.  She has a husband, two children, five grandchildren, many siblings.  She had just retired.  She wanted to live.  For her to go from no hope to surgery overnight… we’re still coming down from it.”

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Using the latest in state-of-the-art technologies, doctors are now able to perform surgery without the use of blood transfusions. Bloodless surgery allows patients to avoid any concerns over blood-borne diseases, adverse blood reactions or conflicts with religious beliefs.  Other benefits may include decreased chance of infections, fewer complications and faster healing times.

 “Through the years, we have implemented strict standards for screening donors for viral infections, testing blood and cross-matching to ensure that the recipient's immune system will not attack the donor blood,” notes cardiothoracic surgeon Ali Gheissari, MD.  “These medical advances have dramatically improved transfusion safety, which is important because blood may be necessary to save a patient’s life.  In some circumstances, however, we can use special techniques to avoid transfusion if that is what the patient prefers.”

For Charles Peterson, transfusions were not an option. Charles came to Providence Saint Joseph Medical Center in Burbank suffering from chest pains. “The doctor said he didn’t want to scare me — but I was in the middle of a heart attack,” Charles recalls. Doctors soon discovered he had five arteries almost totally blocked.

There was only one solution to restore blood flow to his heart – coronary artery bypass surgery. But Charles is a devout Jehovah’s Witness and the tenets of his faith do not allow him to accept any blood transfusions, which are often needed during heart surgery.

Various methods can be used to control blood loss during surgery.  Some cardiac surgeries may be performed using a minimally invasive approach, which allows surgeons to operate through a small incision in the chest wall rather than requiring a 12- to 15-inch incision in the breastbone.  Another option is hemodilution, a process in which one or two pints of blood are removed from a patient prior to surgery for use during surgery.  Additionally, patients can be given hormones to boost red blood cell and hemoglobin levels.

“Normally, if we know a Jehovah’s Witness patient is having surgery, we have time to give them hormones to increase their blood count,” recalls Dr. Gheissari.  “But Mr. Peterson had suffered several heart attacks and was very ill.  He needed the operation urgently.”

To minimize the risk of blood loss, Dr. Gheissari performed what is known as off-pump bypass surgery.  During conventional heart bypass surgery, a heart/lung machine (the pump) keeps the patient alive while the heart is stopped, but patients usually bleed more during surgery when the heart/lung machine is used.  Instead, Dr. Gheissari performed five bypasses while Mr. Peterson’s heart kept beating. “Only about 20 percent of surgeons in the U.S. perform surgery this way. We have the technology and the capability to do cases like Mr. Peterson’s because we do off-pump surgery and high risk heart surgery routinely.” Dr. Gheissari explains.

Dr. Gheissari says Peterson came through the operation well. “I have good blood flow going to my heart for the first time in years and I'm feeling stronger every day,” Charles adds.

“Bloodless surgery is another significant step in the evolution of cardiac surgery,” explains Dr. Gheissari.  “When we can use advanced medical techniques to satisfy diverse patient needs and preferences – we’re providing medical care of the highest quality.”

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The day Carolyn McCool experienced her first heart attack began just like any other day. The 55-year-old Canyon Country resident traveled to Burbank to handle the everyday tasks expected of her in her job as a receptionist for a large accounting firm. She had been running errands and eating lunch just hours before learning that what she thought was heartburn was actually an acute myocardial infarction (AMI), commonly known as a heart attack.

“I had indigestion and then I started to feel sick to my stomach,” she recalls. “But I had no idea I was having a heart attack. My boss saved my life by calling 911.”

McCool recalls very little of the ride to Providence Saint Joseph Medical Center, located less than three miles from her office. However, she remembers that everything happened quickly when she arrived at the emergency room.

“She had the typical symptoms of chest pain, and the EKG clearly indicated she was having a heart attack. It’s extremely important that she came in early,” says cardiologist Bharat Shah, MD, who determined that McCool needed to have her clogged artery opened with angioplasty. “With heart attack patients, time is muscle. Time is heart.”

Providence Saint Joseph and Providence Holy Cross Medical Centers have established specialized programs to ensure that every patient who appears to be having a heart attack receives treatment according to the most appropriate, advanced medical guidelines. Recent clinical studies indicate that heart attack patients whose clogged arteries are opened with angioplasty within 90 minutes of the beginning of the heart attack have better long-term outcomes than patients who receive angioplasty later than 90 minutes of the onset of the heart attack or patients who receive only drugs to treat the heart attack.

“Drug therapy won’t work in some patients. Even when it successfully opens the clogged artery, it sometimes causes undesirable side effects,” says interventional cardiologist William Gifford, M.D., Quality Director for the Chest Pain-Code AMI program at Providence Saint Joseph. “Angioplasty stops the heart attack in its tracks. It is a safer, more effective treatment for AMI.”

“Opening the occluded artery as soon as possible is critical to minimize permanent damage, long-term complications and death,” adds Ara Tilkian, M.D., Director of the Cardiology Program at Providence Holy Cross. Tilkian emphasizes that patients who suspect they are having a heart attack should immediately seek and receive emergency treatment. “All of our efforts are focused on achieving this goal as quickly and as safely as possible.”

McCool’s clogged artery was opened with angioplasty within 70 minutes from the time she arrived at the Providence Saint Joseph emergency department, something McCool is sure saved her life. “I could not have had better care.”

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