Hybrid approach to AF, novel brain aneurysm surgery, gastric varices treatments, hospital care at home.
New Hybrid Treatment for Atrial Fibrillation
An innovative treatment called the Convergent procedure combines minimally invasive epicardial and endocardial ablation to achieve rhythm control in persistent and long-standing persistent atrial fibrillation (AF). The procedure is gaining traction as the incidence and prevalence of AF rises nationally. The multidisciplinary approach was added to the 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation?published?last November.
Luis Velazco-Davila, MD, a board-certified thoracic and cardiovascular surgeon with Cleveland Clinic Indian River Hospital in Vero Beach, Florida, and?Brett Faulknier, DO, Director of Electrophysiology at Indian River Hospital, offer this innovative treatment for patients with persistent and long-standing AF who have not had success with medication or previous ablation treatments. The procedure is also available at Cleveland Clinic Weston Hospital.
“Combining a minimally invasive surgical treatment with catheter ablation allows us to provide a durable result, and a lot of patients can benefit from this approach,” adds Dr. Velazco. He recommends referring patients with AF to an electrophysiologist as early as possible for an evaluation.
Innovative, Nearly Scarless Brain Aneurysm Surgery
A novel, minimally invasive approach to microsurgical clipping offers patients nearly scarless brain surgery when endovascular treatment for cerebral aneurysm is not possible or risky. Transorbital trans-eyelid surgery (TOTES) via a superior eyelid incision is an innovative technique for accessing and treating anterior circulating aneurysms, including middle cerebral aneurysms (MCA), without performing a traditional craniotomy.
Mauricio Mandel, MD, PhD, a neurosurgeon with Cleveland Clinic Tradition Hospital, is an early adopter of TOTES and has contributed to the advancement of this field for more than a decade. He is one of the few neurosurgeons in Florida using the approach to treat anterior circulation aneurysms as well as skull base and temporal lobe tumors.
“This approach minimizes soft tissue disruption, injury to nerves and the temporal muscle, and brain retraction,” says Dr. Mandel. “Patients experience less postoperative pain and no difficulty masticating, and the cosmetic outcome is far superior.”
A growing body of research, including a?2017 study?led by Dr. Mandel, shows the newer trans-eyelid approach for microsurgical clipping to be a safe, definitive treatment for MCA aneurysms.
Learn more about TOTES or register for the upcoming Stroke and Cerebrovascular Disease Conference where Dr. Mandel will be presenting.
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More Treatment Options for Gastric Varices
Interventional endoscopists at Cleveland Clinic Weston Hospital have adopted a novel endoscopic ultrasound (EUS)-guided treatment for gastric varices (GV), a common complication in people with liver cirrhosis.
Gastric varices occur in approximately 20% of patients with cirrhosis. They are less common than esophageal varices but are associated with higher mortality (45%).
Today a number of EUS–guided options are used to treat GV, including glue injection, coil embolization, and coil embolization combined with glue injection. These EUS-guided approaches can achieve high obliteration rates with minimum reintervention and fewer adverse events, according to the?literature.
There are also endovascular management options performed by interventional radiologists such as transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO),?which have comparable clinical outcomes, according to practice guidelines?published?in 2021.
“There are many factors that can determine which treatment option or combination of treatments is most appropriate,” says Tolga Erim, DO, Regional Director of Endoscopy and Division Chair of the Department of Gastroenterology, Hepatology and Nutrition for Cleveland Clinic in Florida.
Nurses Deliver Hospital Care in Patients' Homes
Hospital Care at Home? offers qualifying patients the option of receiving virtual, at-home treatment delivered by nurses in Cleveland Clinic’s?Integrated Virtual Care (CIViC) Center?in Vero Beach, Florida; hands-on care will also be provided by clinical specialists.?The at-home care model provides unique benefits, such as deeper connections between nurses and patients, increased patient comfort, and a reduced risk of hospital-acquired infections.
Common conditions that can be treated this way include sepsis, decompensated chronic heart failure and COVID-19 pneumonia. About two-thirds of patients in the program come directly from the emergency department; other eligible patients are initially admitted to a participating hospital and then transition to at-home care.
Hospital Care at Home? is available for patients admitted to any of the Cleveland Clinic in Florida hospitals, including?Cleveland Clinic Weston Hospital,?Cleveland Clinic Tradition Hospital,?Cleveland Clinic Martin South Hospital,?Cleveland Clinic Martin North Hospital?and?Cleveland Clinic Indian River Hospital.?
Learn more about referring your patients to Cleveland Clinic in Florida.