Transforming heart care: The structural heart program at Sentara RMH Medical Center

The structural heart program at Sentara RMH Medical Center in Harrisonburg, Va., is revolutionizing cardiac care for patients in the Shenandoah Valley and beyond. This innovative program, led by Dr. Matthew Cauchi, D.O. with Sentara Cardiology Specialists and medical director of both the interventional cardiology and structural heart programs at Sentara RMH, provides advanced, minimally invasive solutions for complex heart conditions.

These advanced treatments offer hope to patients who may not qualify for traditional open-heart surgery.

What is structural heart medicine?

Structural heart medicine focuses on the anatomy and physiology of the heart beyond coronary arteries. The specialty addresses abnormalities such as:

• Valvular heart disease (including leaking or narrowed valves)
• Hypertrophic cardiomyopathy (HCM), a condition that affects the heart’s pumping chamber
• Advanced heart failure
• Congenital heart defects

"We focus on the moving parts of the heart, which, as they age, are prone to breaking down," Dr. Cauchi explains.

Thanks to new interventional techniques and imaging, structural heart medicine has advanced to offer treatment options for patients who, just 10 to 15 years ago, had few alternatives due to their age or anatomy. These techniques, often performed using catheters (flexible, hollow tubes), allow cardiologists to access the heart to diagnose and treat a wide range of cardiac conditions.

Specialized cardiac care close to home

A structural heart program of this size and capability is rare at community hospitals, making this program a valuable option for our patients. Previously, patients in the region would have to travel to larger cities like Richmond, Norfolk or Charlottesville for specialized structural heart care.

A collaborative approach that benefits patients

The Sentara structural heart program’s multidisciplinary team ensures patients receive comprehensive evaluations and personalized treatment plans closer to home. The team includes general and interventional cardiologists, cardiothoracic surgeons, cardiac anesthesiologists and advanced cardiac imaging specialists. Having surgeons and interventional cardiologists on the team means patients can be confident knowing all options are explored for the best outcome.

“Our decision making is a collaboration of expertise, insight and experience from a diverse range of providers who always place the patient, not the disease, at the center of our discussions,” says Dr. Cauchi. “In this way, we know we are treating patients with dignity, respect and providing them the best care possible.”

Benefits of non-surgical (percutaneous) heart procedures

A percutaneous, minimally invasive approach to structural heart issues is often the best option for older patients and patients with complex heart anatomy.

The minimally invasive technique offers multiple benefits to patients, including:

• Faster recovery
• Less pain
• Lower risk of complications
• Shorter hospital stays

"Most of our procedures are minimally invasive and don’t require putting patients completely to sleep, which reduces risks and recovery time," Dr. Cauchi notes.

Thanks to the interventional approach to common structural conditions, the structural heart program at Sentara RMH Medical Center successfully treats patients of all ages.

“It’s amazing what you can do when you can treat the patient without as much worry about their age,” says Dr. Cauchi. “Our team has successfully treated patients in their nineties, including two who are now thriving at age 103.”

The structural heart program at Sentara RMH Medical Center offers a variety of cutting-edge procedures:

• Transcatheter aortic valve replacement (TAVR): A procedure to replace a narrowed aortic valve.
• Transcatheter edge-to-edge repair (TEER): A procedure using MitraClip™ technology to repair mitral valve leakage.
• Alcohol septal ablation: This procedure treats thickened heart muscle by injecting alcohol into a coronary artery, causing a controlled thinning of the tissue to improve blood flow.
• Atrial septal defect (ASD) closures: This procedure repairs congenital heart defects by closing holes between the heart’s upper chambers.
• Patent foramen ovale (PFO) closures: This procedure closes small holes in the heart for stroke patients under 65 with no other stroke causes.
• CardioMEMS device implantation: This device is implanted within the lungs' arteries to monitor pulmonary artery pressures and allow for proactive management of heart failure.
• Left atrial appendage occlusion device implantation: A procedure using the Watchman™ device for patients with atrial fibrillation who cannot take blood thinner medications.

"It’s rare for a hospital of our size to offer the range of advanced procedures we do, and it’s incredibly fulfilling to provide this level of care close to home," explains Dr. Cauchi.

Dr. Cauchi’s vision for the program stems from his background in larger academic medical centers and his desire to bring high-level care to a community hospital setting. "In a community hospital, you’re treating your neighbors, friends and family," he says.

Dr. Cauchi also values time with patients to ensure they understand what is happening in their bodies and navigate treatment options and expectations.

What’s next for structural heart medicine?

The future of structural heart medicine at Sentara RMH Medical Center is promising, with advancements like transcatheter tricuspid valve therapies on the horizon. Dr. Cauchi and his team are preparing to expand their program to address this under-treated condition.

“It takes time and investment from the entire team to launch new programs, but the potential to help more patients is worth it,” he says.

How to get care from the Sentara Structural Heart program at Sentara RMH Medical Center

Your primary healthcare provider or cardiologist may refer you to the Sentara Structural Heart program if they detect a heart murmur, stroke or other symptoms that warrant further evaluation.

The structural heart program at Sentara RMH Health Center is a testament to the power of innovation and collaboration in medicine. By bringing cutting-edge cardiac care to the community, the program transforms lives and sets a new standard for what’s possible in a regional hospital setting.