Barbara Wilson: Cancer Survivor and Cardiac Patient
An alternative way of treating large blood clots in the chest is making it possible for patients to avoid the ordeal of open heart surgery. At St. Clair, Andy C. Kiser, M.D., FACS, FACC, FCCP, Chief of Cardiac Surgery, uses a sophisticated device called an AngioVac to safely remove not only blood clots, but also tumors and infectious material from the heart and blood vessels without major surgery. The minimally invasive new procedure, called aspiration thrombectomy, is an important advance in the treatment of deep vein thrombosis (DVT), a serious condition in which blood clots form in the deep veins of the legs and pelvis. A clot can become free and travel through the blood vessels to the lungs, where it is known as a pulmonary embolism, a potentially life-threatening situation.
Established approaches to treatment for DVT and pulmonary embolism include thrombolytic medications, which break up clots, but these treatments have some disadvantages. “Thrombolytics such as Streptokinase can break up the clot but there is a high risk of bleeding and the leftover pieces are not removed,” says Dr. Kiser. “These remain in the lung and can lead to pulmonary hypertension, a chronic and disabling condition which causes shortness of breath and loss of energy. When there is an acute event, and the blood clot travels from the leg to the lungs or heart, it can become wedged in a pulmonary artery, obstructing it, and blocking oxygen from reaching the tissues. It’s like a heart attack — the tissue will die.”
Dr. Kiser uses the AngioVac to remove the clot, plus any remaining debris, so that there is minimal risk of the person developing pulmonary hypertension. “It’s a suction device that pulls material out of the heart and blood vessels,” Dr. Kiser explains. “It can remove blood clots, tumors and ‘cardiac vegetation’, which refers to infectious clumps of tissue that can develop in the heart, usually attached to pacemaker leads.
Cardiac vegetation is also associated with heart infections, IV drug use, dialysis, and use of immunosuppressive medication. The AngioVac captures this debris and keeps it from traveling to the lungs.”
The procedure takes place in an operating room under general anesthesia and requires just two small incisions, in the femoral or jugular veins, for access. The technology includes the aspiration device, plus an external bypass circuit with a pump that creates a vacuum. Using ultrasound imaging, surgeons visualize the clot, tumor or vegetation and aspirate it; filter out any debris through the external circuit; and return the clean, filtered blood to the patient. Most patients will be discharged in a day or two, unless there are underlying conditions that require monitoring for a bit longer.
With the AngioVac procedure, the patient avoids a big operation and gets better treatment, too, says Dr. Kiser. That was certainly true for Barbara Wilson, 80, a retired bank teller and private secretary who enjoys fitness walking, golf, and cooking healthful meals for herself and her husband David. She and David have two sons, David, Jr. and Duane, and have lived in their Bethel Park home for more than 50 years. Barbara is a 12-year cancer survivor who has endured melanoma treatment, the removal of a lung, brain surgery and pacemaker implantation. She was experiencing fluctuations in her blood pressure and monitoring it with both her primary care physician and her cardiologist, Mark K. Greathouse, M.D. When she began to feel pain in the left side of her chest, her first thought was not about her heart — she thought that it might mean breast cancer, and she expected to have a mammogram. Instead, her PCP recommended she see Dr. Greathouse, who ordered an echocardiogram.
“Dr. Greathouse told me I had a mass in my heart and that the mass could be a clot, a tumor or both, and he was very concerned. He told me that it could go to my lungs. He referred me to Dr. Kiser at St. Clair, because this would require surgery, and not an everyday kind of surgery.”
When she heard the name Kiser, Barbara says, she immediately relaxed. “I had read about Dr. Kiser in St. Clair’s HouseCall magazine and I thought, ‘If I ever have a major heart problem, I want him.’ All the doctors at St. Clair are very good, but my problem was specialized and it needed a special doctor. I knew that was Dr. Kiser. Being referred to him was an answered prayer.”
Dr. Kiser explained to Barbara and her husband that open heart surgery might be necessary, but he hoped he would be able to remove the mass in a minimally invasive procedure using new technology. “With Barbara, we were able to use the AngioVac and avoid a big operation,” Dr. Kiser explained. “We accessed her heart through two small punctures in her femoral vessels. Barbara had a history of cancer and a previous pacemaker infection; the mass in her heart could have been either a blood clot or vegetation from the infection and pacemaker leads. We were able to aspirate the mass from her heart; it turned out to be a benign tumor. After the procedure, she was cared for in our Cardiovascular Surgery Unit and did very well; she was able to go home in two days.”
Barbara says she healed rapidly. Her blood pressure has stabilized and she feels great. “I’ll be able to resume my walking again soon; I also enjoy golf and hope to get back to that. I will see Dr. Kiser again in his office, but can call him anytime. One of the things I like about him is that if you call him, he calls back right away. He’s very kind and concerned for his patients.”
With her extensive medical history, Barbara has learned a lot about living a healthful lifestyle and coping with illness. “You have to help yourself,” she states. “Find the right doctor and then work with that doctor as a partner. I’m fortunate that Dr. Kiser was able to help me with this new procedure; I was confident that I was in very good hands. The care at St. Clair was fantastic.”
ANDY C. KISER, M.D., FACS, FACC, FCCP
Dr. Kiser earned a B.S. in biology with honors and distinction, and a medical degree with honors from the University of North Carolina at Chapel Hill. He subsequently completed a residency in general surgery there, as well as fellowships in cardiac and thoracic surgery. From 2011 to 2016, he served as the Chief of the Division of Cardiothoracic Surgery at the University of North Carolina at Chapel Hill, where he was also the Byah Thomason- Sanford Doxey Distinguished Professor of Surgery. Dr. Kiser served as the J. Mark Williams Distinguished Professor in Cardiac Surgery, Chief of Cardiac Surgery, and the Director of Cardiovascular Surgical Services at East Carolina Heart Institute, which is affiliated with East Carolina University, in Greenville, North Carolina. In May, 2018, Dr. Kiser earned an MBA degree from the Kenan-Flagler Business School, also part of the University of North Carolina at Chapel Hill. Dr. Kiser practices with St. Clair Medical Services.
To contact Dr. Kiser, please call 412.942.5728.