BizWest: Pulse check - The caregivers and treatments revolutionizing cardiac care in Colorado

BizWest published a feature article this week on innovative cardiology services in Colorado. Boulder Heart interventional cardiologist Srinivas Iyengar, MD and cardiothoracic surgeon Daniel O'Hair, MD were interviewed and are quoted in the story related to their specialties - the Structural Heart & Valve Program and robotic-assisted mitral valve repair, along with open heart surgery. 

Continue reading the full article below:

Health Care & Insurance March 4, 2025 1:01:00 am

Pulse check: The caregivers and treatments revolutionizing cardiac care in Colorado

By Paula Aven Gladych

The Boulder Valley and Northern Colorado are known for attracting health-conscious people who love the outdoors, exercising and eating right, but sometimes genetics plays just as much of a role in healthy outcomes as a healthy lifestyle.

“I live here in Boulder. This is the healthiest population in the country. There is no doubt that the individuals I see every day are motivated to stay healthy,” said Dr. Srinivas Iyengar, an interventional cardiologist and director of structural heart at Boulder Community Health.

The downside to that health-conscious mentality is that people feel they are doing everything right and don’t need to see a doctor, take medications or do procedures. Iyengar tells patients that they may be able to outrun, outhike or outbike anyone but even if “you outrun your competitors, you can’t outrun your genetics.”

The good news is that technology is evolving rapidly, especially in cardiovascular disease, he said.

Health care in general is trending toward noninvasive procedures and early intervention, according to Dr. Lief Sorensen, anesthesiology specialist at AdventHealth Avista in Louisville. That holds true for cardiac care as well, with programs throughout Northern Colorado and the Boulder Valley focused on minimally invasive surgeries, robotic technologies, cutting-edge procedures, and educational programs that target both children and families.

“The trend in medicine and specifically in procedures is to be less invasive,” said Dr. Brad Oldemeyer, a cardiologist for UCHealth Medical Center of the Rockies in Loveland. “That means not having open heart surgery in an operating room but transcatheter procedures in a transcatheterization lab.”

Transcatheter aortic valve replacement, or TAVR, was invented in 2002 with trials held throughout the early 2000s. Much like putting in a stent, the procedure allows surgeons to replace heart valves that have narrowed or don’t open fully by inserting a catheter through an artery in the groin or chest instead of by cutting into a person’s sternum. Those trials proved that using catheters to replace heart valves is safe and results in fewer major complications, such as strokes or death, and shorter hospital stays.

BCH’s Iyengar said he was one of the first five fellows trained in the procedure at Columbia University.

“It was amazing to be experiencing that in 2007. This was science fiction. Putting a new valve in through the groin. In that span, from 2007 to today, nearly 900 sites are doing this procedure, including BCH,” he said. “That was why I was brought to Boulder.”

Aortic valve stenosis “reduces or blocks blood flow from the heart to the aorta and to the rest of the body,” according to the Mayo Clinic. If this problem isn’t treated, it can lead to life-threatening consequences.

Medical Center of the Rockies has participated in several TAVR research trials. Initially, the technology was only studied in high-risk surgical patients, such as the elderly, who might not survive more invasive open-heart surgery. It was thought that this procedure would not have good results in low-risk patients.

Oldemeyer helped conduct TAVR research, documented in the New England Journal of Medicine, that disproved that theory. The study found that among patients with asymptomatic severe aortic stenosis “a strategy of early TAVR was superior to clinical surveillance in reducing the incidence of death, stroke, or unplanned hospitalization for cardiovascular disease.”

The next trial, which recently completed enrollment, will study people with moderate aortic stenosis to determine if there is a benefit to treating that condition earlier as well.

An emerging trend, which was accelerated by COVID-19, has been the transition from inpatient to outpatient care, Oldemeyer said. In 2012, patients who used TAVR would stay in the hospital five to seven days after the procedure but during COVID that wasn’t possible, and it was found that patients would do fine recuperating at home after one day of observation.

“Equipment got better and there was less damage to the blood vessels. It is a lower risk procedure,” he said.

Oldemeyer added that now patients can have a heart valve replacement and leave the hospital six hours later.

Atrial fibrillation

Atrial fibrillation, or AFib, occurs when an abnormal heartbeat causes blood to flow poorly through a person’s heart. It can lead to heart failure or blood clots that can cause strokes.

“From an epidemiological perspective, it is becoming more prevalent,” said Dr. Amar Trivedi, a cardiac electrophysiologist at UCHealth. “By 2030, there is going to be about 9 to 12 million people that have AFib. By 2050, that will be as high as 16 million. This disease is becoming an epidemic. Our region of Colorado is no different. There’s going to be a growing need for diagnostic and treatment options that are safe, effective and efficient.”

In the past, AFib was treated with blood thinners, or surgeons would try to disconnect areas of the heart that were triggering atrial fibrillation. A new procedure, pulsed field ablation, or PFA, uses short bursts of electricity to eliminate tissue that causes dysrhythmias. Either radiofrequency (high frequency electrical energy) or cryo (freezing) can be used for this purpose. This is achieved by catheters with electrodes that are inserted via the femoral veins in the groin and threaded to the heart.

Four pulmonary veins bring oxygenated blood from the lungs to the heart.

“Our goal is to destroy tissue where the veins and the heart come together. If you destroy that tissue, it can’t conduct electricity,” Trivedi said. It is like disconnecting the ignition from a motor.

With heat or cold there is a small risk of damaging surrounding structure, such as the esophagus, which is right next to the areas being burned or frozen, or the nerve that controls the diaphragm, he said.

“PFA is a new way of destroying cardiac tissue. Eighteen volts of high energy creates an electric field. That field is able to then destroy cardiac tissue without letting energy get into the nerves around the heart or the esophagus,” he said. “It allows us to destroy the triggers of AFib in a safer way.”

Because the procedure is so efficient, the time to do procedures has dropped, allowing the hospital to treat more patients per day. UCHealth did more than 400 PFA procedures in 2024, the first year it was offered.

Another procedure to treat AFib, the Watchman Implant, was developed about 10 years ago. It can be inserted through a catheter to plug up the left atrial appendage. Since more than 95% of blood clots are formed in the left atrial appendage, the device has had great success in treating AFib in patients that is not caused by a heart valve problem, BCH’s Iyengar said.

Tricuspid and mitral valves

Treatments for the aortic and mitral valves have benefited the most from advances noninvasive procedures over the past 20 years, but in the past year, two brand new technologies, one for full tricuspid valve replacement and one for percutaneous tricuspid valve repair, called the TriClip, have been approved by the FDA.

Intermountain Health St. Joseph Hospital in Denver is at the forefront of tricuspid valve disease treatment. The hospital system was the only one in the area to participate in the Edwards PASCAL Transcatheter Valve Repair System Pivotal Clinical Trial and was the first hospital in the state to perform an Evoque Tricuspid Valve Replacement System procedure commercially.

“It does seem like we are on the precipice of having multiple technologies, where for patients a year ago there was nothing FDA-approved for this,” said Dr. Jake Chanin, medical director of Intermountain Health’s Structural Heart Program.

Tricuspid valves, which prevent the backflow of blood into the upper right chamber of the heart from the lower right chamber of the heart, degenerate and stretch over time creating a redundancy of tissue, Chanin said. The Abbott Tricuspid TriClip pulls that tissue together and locks it down, significantly improving how the valve works and helping patients to breathe better and experience a much better quality of life.

The Edwards Evoque Valve is the first FDA-approved tricuspid valve replacement system. Both technologies are inserted into the largest vein in the groin area using a catheter that can deliver the valve or clip into place. Both procedures are minimally invasive, and most patients don’t spend more than one or two nights in the hospital.

Dr. Daniel O’Hair, medical director of cardiovascular surgery at Boulder Community Health, is a specialist in robotic-assisted mitral valve repair using DaVinci robots. The mitral valve keeps a person’s blood moving in the right direction. Leaky valves don’t close the way they should, allowing blood to flow backward in the left atrium. Mitral valve surgery uses robots to go in and stop the leak.

The robot sits next to the operating table and consists of three arms that are controlled by a surgeon. Each arm is about the diameter of a pencil. The robot is controlled from a console that allows the surgeon to perform super precise movements inside the heart, like cutting and sewing, without having to put their hands in the chest. The minimally invasive approach uses small incisions, resulting in shorter hospital stays and quicker recovery times with less pain. O’Hair has been involved in over 500 robotic surgeries.

He has used DaVinci robots for this procedure since 2001. Other robotic systems are being developed that will make things even easier, he said, and may be able to combine some of the transcatheter valve work that his colleague Dr. Iyengar is involved with.

“Seeing some of those fields merge will only be good for patient care,” O’Hair said.

Early intervention

“Things are changing every day,” O’Hair said. “There also have been good advancements in medical therapy and disease prevention, cholesterol management and heart scans helping prevent disease or identify patients earlier.”

UCHealth’s Healthy Hearts and Minds program takes a different approach to heart health. The program, which started in 1992 as a way to teach children about healthy lifestyles and cardiac risk, now offers programs in fifth, seventh and 10th grades in several Northern Colorado school districts. The program is expanding into Longmont this year and has partnered with several schools in Colorado Springs.

As part of the program, students are given a free screening to determine their current heart health and then are educated about how to prevent heart disease and build lifelong healthy habits to promote physical and emotional wellness.

“We have the results as soon as we get them with a finger stick and we explain how this information relates to them and their numbers, what it means to them as an individual and they take that home to their family,” said Dr. Gary Luckasen, a cardiologist and medical director at UCHealth who developed the program more than 30 years ago.

The program is important because “obesity in children has become a pandemic across the U.S.,” Luckasen said. As obesity rises, so does the amount and severity of cardiovascular disease, diabetes, high blood pressure and cholesterol.

Children who already show signs of cardiac risk will be invited with their families to participate in the Healthy Hearts and Minds family program, which works with entire family units for a full year to help them improve their health and reduce their cardiovascular risk factors.

The school program is now seeing almost 10,000 kids each year. In the past 30 years, the program has screened more than 70,000 students and educated more than 100,000 in Northern Colorado schools.

“Knowledge is health, but in the next five years we will have more kids who have done all three points. The program by itself helps but, long-term, the reality is unless they internalize it by doing different things, physical activity, better diet, stuff like that, this one point in time is not going to be the thing that makes all of them live longer,” Luckasen said. “It is a starting point.”