John Moriarty gave his patient a choice. Dunlap could have open-heart
surgery or undergo a new minimally invasive procedure using a device
called AngioVac to vacuum the massive clot out of his heart. The catch?
The procedure had never been successfully performed in California.
new grandfather, Dunlap didn't hesitate to choose the second option and
underwent the procedure on Aug. 14. A week later, he was home, full of
energy and eager to play on the floor with his 9-month-old grandson.
how it worked: A team of UCLA interventional radiologists and
cardiovascular surgeons slid a tiny camera down Dunlap's esophagus to
visually monitor his heart. Next, they guided a coiled hose through his
neck artery and plugged one end into his heart, against the clot. They
threaded the other end through a vein at the groin and hooked the hose
up to a powerful heart-bypass device in the operating room to create
"Once in place, the AngioVac quickly sucked the deadly
clot out of Mr. Dunlap's heart and filtered out the solid tissue," said
Moriarty, a UCLA interventional radiologist with expertise in clot
removal and cardiovascular imaging. "The system then restored the
cleansed blood through a blood vessel near the groin, eliminating the
need for a blood transfusion."
The procedure lasted three hours.
Doctors observed Dunlap for three days in intensive care before
transferring him to the hospital's cardiac ward and then discharging him
four days later.
Open-heart surgery takes twice as long to
perform and often requires the surgeon to divide the breastbone
lengthwise down the middle and spread the halves apart to access the
heart. After the heart is repaired, surgeons use wires to hold the
breastbone and ribs in place as they heal. The procedure can necessitate
extended rehabilitation before the patient makes a full recovery.
a clot from within the heart used to require open-heart surgery,
resulting in longer hospitalization, recovery and rehabilitation times
compared to the minimally invasive approach provided by the AngioVac
system," said Dr. Murray Kwon, a UCLA cardiothoracic surgeon who
collaborated on Dunlap's procedure.
Similarly, a clot-busting
drug known as a tPA typically takes three to four days to work. In
Dunlap's case, his physicians tried tPA first, but it failed due to the
clot's large size and density.
"The AngioVac was the last resort
for Mr. Dunlap," said Moriarty. "The clot clogged his heart chamber
like a wad of gum in a pipe. Every moment that passed increased the risk
that the clot would migrate to his lungs and kill him. We couldn't have
asked for a better outcome."
"I'm thrilled that I didn't have
to go through open-heart surgery," said Dunlap, a resident of Newbury
Park, Calif., who is the father of two adult sons. "This procedure is a
great option for the older, frail person who wouldn't survive open-heart
surgery. Without an alternative like this, he's a goner."
Like Dunlap, roughly one in 500 Americans suffers from blood clots in
the leg veins, a condition called deep vein thrombosis. Estimates double
in people older than 80. Nearly 100,000 Americans die each year when a
clot breaks away from the blood-vessel wall and lodges in the lungs or
heart. In one of every four cases, sudden death is the only clue an
individual is suffering from the condition.
"When you hear about
new cutting-edge options, it gives you hope," said Cheryl Dunlap, who
has been married to Todd for 32 years. "Without it, you run into a brick
wall. If we'd consulted only with our community hospital and not a
teaching facility like UCLA, we wouldn't have learned about all the
treatment choices available to us."
"It takes a large team of
experts to perform a potentially high-risk procedure like this for the
first time," Moriarty said. "We couldn't have been successful without
the collaboration of our colleagues in cardiac surgery, radiology,
cardiology and anesthesia."
Source: University of California, Los Angeles (UCLA), Health Science via Newswise