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Serious Medicine. Extraordinary Care.

New Alternative to Open-Heart Surgery

The Nebraska Medical Center is the first in the region to offer LARIAT

Marc Leger lived under the constant threat of having a stroke. His heart has atrial fibrillation, an irregular heartbeat. Because of another medical condition, the 62-year-old Plattsmouth, Neb man cannot take blood thinners, which is how doctors typically deal with the stroke risk that is present with atrial fibrillation patients.

Dr. John Scherschel guides the Lariat into place during Marc Leger’s procedure

"It’s always in the back of your mind but you put your trust in your doctors and your prayers," Leger said. Previously, the only way to deal with the risk was with open-heart surgery to close off the left atrial appendage; a small part of the heart where blood can pool and clots can form.

"With atrial fibrillation, blood doesn't go in and out very well," explained John Scherschel, MD, cardiologist at The Nebraska Medical Center. "The clots form in those nooks and crannies and can be carried out."

Dr. Scherschel is the first physician in the region to bring a new alternative to surgery for patients like Leger. It's called Lariat. “When I saw this technique described in scientific literature back in 2009, I said, 'We need to be doing that,'“ Dr. Scherschel said. "That’s the right way to do this."

The Lariat procedure involves two small incisions. It is done in a cardiac catheterization lab with the patient under general anesthetic.

Dr. Scherschel began Leger's procedure by placing a needle and then a small tube into the pericardium, the space around the heart. Then, a catheter was placed in a vein in his leg. Guided by x-ray and ultrasound, Dr. Scherschel ran the catheter into Leger’s heart and into his left atrial appendage. That catheter is tipped with a small magnet which attached to another magnet on the probe on the outside of the heart.

"That creates a rail over which the Lariat loop can pass," Dr. Scherschel explained. "We place that loop over the neck of the appendage and close the loop."

The cath lab team then uses ultrasound to make sure no more blood is flowing into the appendage. The stitch closing the appendage is then cut and the tiny instruments removed. The process typically takes less than an hour.

"I woke up afterwards and felt really good," Leger said with a smile. "I've seen people have dental work that was more uncomfortable than this procedure."

Dr. Scherschel said the biggest benefit of the Lariat procedure is the ability to provide the same outcome as open surgery without the lengthy hospital stay and risks of complication.


Dr. John Scherschel watches x-ray and ultrasound images of Marc Leger’s heart during his Lariat procedure

"It really is an elegant solution," Dr. Scherschel said

The Nebraska Medical Center is one of a small number of hospitals in the U.S. and the only hospital in the region performing Lariat procedures.

"This is proof that the medical center is committed to bringing new cutting edge procedures here for the benefit of our patients," said Jorge Parodi, executive director of cardiovascular services at The Nebraska Medical Center. “It also has the potential to reduce costs to the healthcare system because of the shorter hospital stay and recovery time.”

About a week after his Lariat procedure, Marc Leger was all smiles.

"I feel great; not quite ready to go out for the Olympics but I really feel good," he said. "When you put down on your prayer request at church that you're going to have a heart procedure done, everybody assumes they're going to crack open your chest and you're going to be weeks in recovery. Then they see you four days later and you're running around a fish fry. They say, 'Did you have your procedure?' Oh, yeah it's all done."

He was one of the first Lariat patients in Nebraska, and Dr. Scherschel believes this will become the dominant way doctors deal with the condition in the future.

In his pocket, Leger carries a regular looking band aid taped to a business card as his souvenir of his Lariat procedure. It's what covered the access point in his chest. Leger says it beats a big scar on his chest that would have resulted from open-heart surgery.

"I've cut my finger before and had to put bigger band aids on it than that," he said. "They did a heart procedure and that's it - one little band aid."