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Making the “Impossible” Possible, a Team Approach to Heart Care

Every week at Hoag, physicians and staff hear patients recount their medical journeys, and how they have been told by non-Hoag providers “it can’t be done,” when referencing the complexity of their health condition.

On the referral of his Hoag treatment team, patient Wayland Wong had such a discussion with Hoag interventional cardiologist Jorge Castellanos, M.D. At the age of 80, Wayland experienced a series of “mini heart attacks.” The nature and complexity of Wayland’s coronary artery disease was exacerbated by a chronic total occlusion (CTO), or the complete blockage of one of his arteries, as well as 80 percent blockages of two other coronary arteries all of which are responsible for supplying blood to the heart muscle.

The situation for Wayland was dire as his team, pulmonologist Russell Klein, M.D., and referring non-interventional cardiologist Michael Radin, M.D., felt he was not a good candidate for open heart surgery, with which cardiac surgeon Colin Joyo, M.D., agreed. In Wayland’s situation, many cardiologists would not have a recommendation for non-surgical treatment for blockages this severe.

Hoag, however, has a different approach when it comes to CTO. Percutaneous coronary intervention (PCI) by a highly skilled cardiologist is an option. PCI involves inserting catheters through the wrist or groin and up to the heart. Once inside, cardiologists can insert stents into the artery to open them up. The procedure can be lengthy and take more than one visit, but it causes less trauma to the body with shorter recovery periods.

Dr. Castellanos was able to insert stents into all three of Wayland’s affected arteries to open them and restore complete flow to the heart muscle. He started with the two that were 80 percent blocked, opening those up in one procedure. In a second procedure, a month later, a final stent inserted in the artery that was completely blocked.

As one of many board-certified interventional cardiologists at the Jeffrey M. Carlton Heart & Vascular Institute at Hoag, Dr. Castellanos along with his colleagues, focus on innovative ways to safely and effectively treat patients whose health conditions complicate their treatment possibilities. Hoag is one of the highest volume providers of complex PCI in Southern California.

“It was hard to know what to do. I never had this kind of experience before,” said Wayland, whose only other hospital experience was an appendectomy in 1960. “I knew that with open heart surgery, I’d be out for quite a while. My wife and I, we thought it over. We talked with other doctors, and we just decided to go for it.” Along his journey, Wayland was told that his disease would probably not be able to treat with stents.

After each procedure, Wayland was able to go home the next day. He’s no longer out of breath and, thanks to Hoag Cardiac Rehabilitation Services, he’s taken up exercise. He says he feels “grateful to God, the doctors and staff at Hoag for the excellent care.” In fact, they were so pleased with the outcome that when Wayland’s wife, Clara, was diagnosed with coronary artery disease earlier this year, she turned to Hoag.

“My wife had two stents put in by him. Now we’re a family of nine,” Wayland joked.

Dr. Castellanos credits Hoag with valuing patients’ quality of life and empowering patients to make informed decisions.

“Hoag has a team-based approach that allows us to address procedures intelligently, with the time and the staff to help,” Dr. Castellanos said. “That support is what makes it possible. You normally only see that kind of approach in academic centers.”

Wayland’s first procedure took an hour and a half, and his second took three hours. The complexity of a CTO is what makes PCI in such complicated patients so challenging, but by providing patients the choice, Hoag allows people like Wayland to make a more informed decision about their care.

“It’s an amazing feeling when you’re able to help people so dramatically using techniques that, while they might be difficult, are the right thing to do,” Dr. Castellanos said.

For more information, call 888-290-5621.