September 23, 2021 by John Fernandez and Bethany Rundell
Cardiac Patient After Minimally Invasive Procedures: ‘How Do You Thank Someone for Saving Your life?’
Even with regular care, heart disease can get very complicated and worsen suddenly. That was the case with David Horovitz, who sought help at Miami Cardiac & Vascular Institute and discovered he had a near total blockage in the artery that causes so-called widow-maker heart attacks.
After multiple interventions that included a balloon angioplasty and coronary stenting, followed later by a minimally invasive transcatheter procedure to replace his aortic valve, Mr. Horovitz, 77, is now feeling strong and is looking forward to the future.
“How do you thank someone for saving your life?” Mr. Horovitz asks. “Words cannot describe the care I received. It was absolutely amazing.”
Mr. Horovitz, who is diabetic, says he was already under a cardiologist’s care for conditions that included an arrhythmia and problems with his mitral valve, which was allowing blood to flow in the wrong direction in his heart. He thought he had those conditions under control, but he noticed he was feeling weaker and weaker.
“It was so bad that I couldn’t walk more than 20 feet without getting out of breath or having to sit down,” he recalls. “I couldn’t even take out the garbage. I couldn’t do anything.”
While he was concerned, he didn’t realize yet how serious it was.
Diagnosing the problems
Tests revealed a problem with the aortic valve and a severe blockage in Mr. Horovitz’s left anterior descending (LAD) artery, which supplies blood to the larger, front part of the heart. Because it serves such a big portion of the heart, the LAD artery is a particularly dangerous place to experience a blockage — which is why heart attacks that originate there have been nicknamed “widow-makers.” Although not always fatal, such heart attacks can cause lot of damage to the heart muscle if blood flow isn’t restored quickly.
“When they told me it was 98 or 99 percent occluded, I understood immediately why I couldn’t walk and I couldn’t breathe,” said Mr. Horovitz, a former respiratory therapist who manages a large pulmonary medical practice. He is familiar with the heart’s anatomy — and the danger he faced. “It’s the main aorta of the heart. If it’s occluded, or blocked, you would be in imminent danger of having a heart attack and could pass away.”
A multi-pronged approach
Helping Mr. Horowitz required a two-staged, minimally invasive approach that used his blood vessels as a super highway to reach his problem area without having to undergo the trauma of open-heart surgery. “He was not a surgical candidate because his heart was so weak,” explains Dr. Erwin, the director of complex coronary and structural interventions at South Miami Hospital.
In the first procedure, Dr. Erwin used a catheter to temporarily insert the world’s tiniest heart pump, called an Impella, into Mr. Horovitz’s left ventricle to keep blood moving while he worked. “It’s sort of like a backup generator for the heart,” he explains. “It does some of the work for the heart, so that while you are fixing blocked vessels and reducing the heart’s blood flow, the body still has some support.”
Dr. Erwin then threaded a miniature diamond-tipped drill called a Rotoblader toward Mr. Horovitz’s heart, starting at a vessel in his groin. The drill was used to break up the hardened blockage in a procedure called a rotational atherectomy. “The plaque blocking his artery was so highly calcified, it was like cement in there,” Dr. Erwin explains. Once the drill broke up the blockage, Dr. Erwin did an angioplasty, expanding a balloon in the artery to restore blood flow and then placing a stent to support the wider opening. Mr. Horowitz went home the next day.
About a month later, after his heart grew a bit stronger, Mr. Horowitz returned to South Miami Hospital for a transcatheter aortic valve replacement (TAVR) with Dr. Erwin.
During this minimally invasive procedure, a new folded-up valve is inserted through a catheter and deployed in place of the old, diseased valve without having to cut open the chest. Miami Cardiac & Vascular Institute specialists participated in clinical trials for this technique and were instrumental in developing this technology. Originally designed as an intervention of last resort for the sickest and most fragile patients, the procedure was approved by the FDA last year for wider use among even low-risk patients because of the potential advantage of avoiding open-heart surgery. TAVR is offered is Baptist Hospital, Bethesda Hospital East, and Boca Raton Regional Hospital, as well as South Miami Hospital.
A grateful family
Mr. Horovitz, who went home the next day, says he was feeling better before he even left the hospital. “I couldn’t believe it. I got out of bed and with the help of my wife and the nurse, and I was able to walk again,” he says. And he has continued his journey toward better health. “I’m not going to say I run around the block, but I can walk around the block five times now without getting out of breath.”
Mr. Horowitz is grateful to the Institute and South Miami Hospital for the care he received, but he is especially appreciative of Dr. Erwin, who he described as very compassionate as well as skilled. Upon noticing Mr. Horovitz’s worried wife, Maria Luz, was crying as her husband was prepped for the TAVR procedure, Dr. Erwin pulled her aside for a reassuring hug. He promised to care for Mr. Horowitz as if he were his own father. “You have no idea how much that meant to my wife,” Mr. Horowitz says. “That’s the kind of person Dr. Erwin is.”
The right place for treatment
It is for complicated cases such as Mr. Horovitz’s that the Complex Percutaneous Coronary Intervention program was established at Miami Cardiac & Vascular Institute. “The physicians have a long history of implementing cutting edge technology and innovative procedures,” says interventional cardiologist Ramon Quesada, M.D., medical director of Structural Heart and Complex Percutaneous Coronary Intervention at the Institute. A pioneer of hybrid procedures for complex cardiac cases, Dr. Quesada has been at the forefront of the design, development and implementation of new techniques.
Thanks to the Institute’s involvement in clinical research, patients have access to new technology years before they would at other regional hospitals, he says. “Our involvement in clinical research over the years in both interventional and structural cardiology, as well as minimally invasive heart surgery, has laid the groundwork for better care.”