The cardiovascular team at Gates Vascular Institute last week completed its 200th procedure using the Watchman device, a permanent implant that prevents blood clots from escaping a small pouch along the heart and causing a stroke.
Those with atrial fibrillation – an irregular heartbeat, which, if left untreated over time, can result in death – have benefited from the procedure at GVI since early 2018. The minimally invasive surgery also is performed at the Catholic Health Heart Center in Mercy Hospital.
“This is a real big advancement in terms of the ability to reduce the risk of stroke in people who are at high risk of bleeding,” said Dr. Vijay Iyer, who directs structural heart interventions at Gates and the complex valve clinic at Buffalo General Medical Center.
Boston Scientific makes the Watchman, an umbrella-like device about the size of a quarter that specialists deploy through a catheter and into the heart. It unfurls to seal off the left atrial appendage. Blood can otherwise pool in this small pocket, spawn a blood clot and cause a stroke.
About 95% of strokes suffered by those with A-fib are caused by this phenomenon.
Researchers aren’t sure exactly what the left atrial appendage does, but believe it releases hormones, which it can continue to do after the procedure.
Before the Watchman, doctors needed to prescribe blood-thinning medication to those with A-fib to prevent blood from clotting in the left atrial appendage and potentially traveling to the head. This proved particularly problematic for those prescribed non-steroidal medications for arthritis or anti-platelet and anti-coagulant medications after getting a stent in a leg or near the heart, raising the prospect for significant bleeding that hampered quality of life – and potentially threatened survival, Iyer said.
“There really was no alternative to a blood thinner,” he said. “If people were either on blood thinners or if they could not tolerate a blood thinner, then they basically had to come off the blood thinner and just take aspirin, which we know doesn't give them the same degree of protection.”
Iyer, also chief of cardiovascular medicine in the University at Buffalo Jacobs School of Medicine & Biomedical Sciences, and two of his partners with Great Lakes Cardiovascular – Drs. Chee Kim and Ashish Bhatia – do the procedure at GVI. They have been able to successfully implant the device in 99% of patients, who generally go home the next day.
“We have not had a single patient need to go back on a blood thinner,” Iyer said. “Every one of them has done well.”
The doctors expect two other similar devices will become available in the next year.
About 2.5 million people in the U.S. have A-fib. Those at greatest risk have high blood pressure, are elderly or have had previous heart surgery, as well as people with severe sleep apnea and who are morbidly obese.