Boca Raton Regional Hospital’s Richard G. Cartledge, MD, FACS, has
begun performing ultra-minimally invasive left atrial appendage ligation
for atrial fibrillation patients who are on anticoagulants such as Coumadin,
Xarelto or Effient. Dr. Cartledge, who is Chief of Cardiothoracic Surgery
at the Hospital, is one of a select group of surgeons nationally using
this method, which involves making two microscopic incisions in order
to seal off the left atrial appendage (LAA) in patients where anticoagulants
are contraindicated or who refuse to be on such medications.
Patients with atrial fibrillation, or irregular heartbeat, have a five
times greater risk of suffering a stroke than people who don’t have
the condition, according to the Framingham Heart Study, which followed
over 5,000 patients for more than 30 years. The risk is associated with
the failure of the left atrium to fully evacuate blood from itself as
a result of this type of arrhythmia. The blood then pools in the LAA,
which is a small outpouching within the left atrium containing irregular
interior surfaces called trabeculations. In patients with atrial fibrillation,
clots can form in these areas and can “flick off,” resulting
in stroke or other serious problems.
“Your left atrial appendage is analogous to your appendix; it’s
something you don’t need but it can kill you,” said Dr. Cartledge,
who completed a fellowship in thoracic surgery at Memorial Sloan-Kettering
Cancer Center and a cardiac surgery fellowship at The New York Hospital/Weill
Cornell Medical Center. “Whoever is on anticoagulants because of
atrial fibrillation is a potential candidate for this ultra-minimally
invasive procedure, which, in essence, removes the LAA from the picture
much the same way as your appendix is removed.”
What separates Dr. Cartledge’s method from other minimally invasive
procedures is the size of the incisions he makes underneath the arm in
the left side of the chest. Both incisions are less than 1/5 of an inch
in diameter, compared to the standard minimally invasive method that involves
an incision of about 2.5 inches. The procedure also eliminates the need
for a post-operative chest tube.
During the procedure, an ultra-thin, fiber optic, high-definition camera
is inserted through one of the two incisions, while the other is used
for an instrument port. This allows for a clear 360-degree view of inside
the chest and the portion of the heart from where the LAA emanates. Dr.
Cartledge then accesses the LAA and a device is inserted that seals off
the LAA at its base. This totally excludes the appendage from circulation
so clots can no longer be formed in that structure.
The LAA is reabsorbed by the body over a short period of time and the
potential for clots is eliminated. With anticoagulants no longer being
required, the procedure also greatly reduces the chance for bleeds elsewhere
in the body.
“This ultra-minimally invasive procedure is efficient, safe, quick
and is done with minimum discomfort,” Dr. Cartledge said. “The
patients essentially need only Tylenol post-operatively for pain and they
can go home the next day. It really changes the paradigm of how to deal
with afib in a patient that should not be on anticoagulants or doesn’t
want to be on anticoagulants.”
In addition to his accomplishments as a heart surgeon, Dr. Cartledge has
been awarded more than 100 domestic and international patents for medical
devices he developed that are being used in hospitals throughout the United
States, the Middle East and Europe.
About Boca Raton Regional Hospital – Advancing the boundaries of medicine.
Boca Raton Regional Hospital is an advanced, tertiary medical center
with 400 beds and more than 800 primary and specialty physicians on staff.
The Hospital is a recognized leader in oncology, cardiovascular disease
and surgery, minimally invasive surgery, orthopedics, women’s health,
emergency medicine and the neurosciences, all of which offer state-of-the-art
diagnostic and imaging capabilities. The Hospital is a designated Comprehensive
Stroke Center by the Florida Agency for Health Care Administration (AHCA).
Boca Raton Regional Hospital is the recipient of the 2014 Distinguished
Hospital Award for Clinical Excellence™ for 10 years running and
was named one of America’s 50 Best Hospitals in 2011, 2012, 2013
and 2014, both by Healthgrades®. Boca Raton Regional Hospital was
also recognized in
U.S. News & World Report’s
2015–2016 Best Hospitals listing as a top-ranked hospital in the
South Florida metropolitan area for the fourth time in the last five years.
Andy Kent, 561.955.3586 (o)
Boca Raton Regional Hospital