Building a Structural Heart Program

Abdelkader Almanfi, MD, joins Owensboro Health to bring leading–edge, minimally invasive treatments to the region

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OWENSBORO Many physicians can point to a mentor or a singular event during their training that influenced their choice of specialty. For Abdelkader Almanfi, MD, his reason for choosing the field of cardiology was a simple, yet global one. “Heart disease is the number one cause of death, not just in the states, but everywhere in the world,” he says.

An interventional cardiologist with an emphasis in structural cardiology, Almanfi’s passion and enthusiasm are evident when he discusses his work and the program he came to Owensboro to build.

Almanfi began his medical career at Al-Arab Medical University in Libya, where he graduated in the top one percent of his class. While there, he also completed an internal medicine residency and post-doctoral cardiology fellowship. His first board certification came from the Royal College of Physicians in the United Kingdom. He then traveled to the United States to advance his education with an internship at George Washington University in Washington, D.C., and a residency at St. Luke’s Hospital in St. Louis. After completing both cardiology and interventional cardiology fellowships at the Texas Heart Institute in Houston, one of the premier cardiology innovations facilities in the world, Almanfi looked for a void in heart care that he could fill. “The reason I moved from Texas to here is that I saw a big need and that there was something new I could bring to the practice, both specialty-wise and organization-wise. That was my main motivation.”

So, nine months ago, Almanfi founded the Structural Heart Program at Owensboro Health, which has been growing rapidly since. He defines structural heart disease as “any disease in the heart, outside of coronary arteries, like valve conditions or holes in the heart.” The program also includes interventional cardiology, which along with the treatment of structural heart disease, includes coronary and vascular intervention. As the medical director, he realized one of the most crucial components in building the program was assembling a structural heart team. Therefore, Almanfi put together a dedicated group of specialists, consisting of himself, fellow cardiologists, cardiac surgeons, valve coordinators, and imaging experts who regularly meet to develop plans of action and coordinate patient care.

A Revolution in Transcatheter Techniques

Currently, Almanfi divides his time between the cath lab and seeing patients, both in-patient and referral. Almanfi does a mix of work, including coronary artery disease management and vascular intervention, but his focus is on the advancements in the treatment of structural heart disease. He states, “There has been a revolution in the industry over the past 10 years allowing us to now fix valves with catheters when the only option was open heart surgery.” Two of the most beneficial are transcatheter aortic valve replacement (TAVR) and MitraClip®.

Since being approved by the FDA five years ago, TAVR has become an option for patients who, either due to their age, risk factors, or degree of illness, were not deemed good candidates for surgery. With minimal invasiveness, TAVR allows physicians to replace the damaged aortic valve with a new valve delivered through a catheter from the femoral artery in the groin. In order to qualify for TAVR, an individual must be diagnosed through echo findings with severe aortic stenosis and be symptomatic, as well as deemed high or intermediate risk by a heart valve team for surgery.

Due to pending approval, Owensboro Health cannot currently conduct TAVR onsite. In order to serve the needs of Owensboro patients, the team endorsed an affiliation with a hospital in Lexington where Almanfi is able to offer TAVR to these patients. It is expected that within the next three months, Owensboro will have the capability to perform the procedure at their facility, which serves Western Kentucky, as well as Southern Indiana.

For those too unstable for TAVR, Almanfi offers balloon aortic valvuloplasty (BAV), another minimally invasive procedure in which a balloon is inserted and opens the valve, allowing for blood flow.

MitraCIip, which has been available at Owensboro Health since October 2016, is also giving patients an alternative to open heart surgery. Again, through a femoral catheter in the groin, a clip is inserted and attached to the valve allowing it to close more efficiently and reduce mitral leak. For many with mitral valve regurgitation, this provides a solution and a much quicker recovery.

Another new structural cardiac technology, which will be available at Owensboro Health in the near future, is the recently approved WATCHMAN device for patients with atrial fibrillation who have had incidents of bleeding with blood thinners. WATCHMAN is another catheter therapy with groin access to deploy this small, coil-like plug to close off the left atrial appendage and prevent clots. Most patients can then stop blood thinners forever.

In addition, because of his endovascular training, Almanfi offers treatment for both aortic abdominal and thoracic vascular aneurysms with the endovascular aneurysm repair (EVAR) and thoracic endovascular aneurysm repair (TEVAR) procedures. During these, Almanfi inserts a stent graft granting an alternative conduit for blood flow, thereby excluding the aneurysmal sac and preventing rupture.

With all of these advancements, it is no wonder the Structural Heart Program is growing so rapidly. Almanfi is grateful for the opportunity and support. “This program requires a lot of work and cooperation from hospital administration, the community, and the doctors around me. That is why we have achieved success. We’re not at full potential, but heading that way. Without teamwork, we could not have achieved that.”

Almanfi is optimistic about the future and the structural heart program’s ability to serve its patients by ensuring the most up-to-date treatments. “The hospital does a great job supporting me in attaining new technologies that were not available here before.”

On the horizon, though not yet approved by the FDA, is transcatheter mitral valve replacement (TMVR). This will be just one more tool that Almanfi and his structural heart team at Owensboro Health can utilize to improve the lives of their patients and increase the accessibility of cutting-edge care.

This program requires a lot of work and cooperation from hospital administration, the community, and the doctors around me. That is why we have achieved success. We’re not at full potential, but heading that way. Without teamwork, we could not have achieved that.– Dr. Abdelkader Almanfi