VA’s newest groundbreaking pacemaker surgery

In 1958, VA doctors brought the world’s first implantable pacemaker into service. It was a collection of wires and battery cells and coils that screw directly into the heart. The housing was literally molded from a Kiwi shoe polish tin.

Since that first procedure, the world has enjoyed a golden era of scientific discovery. Every day, another tool grows smaller. More efficient. Less painful. Safer. And more convenient for patients. Technology continuously reshapes our approach to medicine.

On March 5, 2020, Dr. Erdal Gursoy of the Northport VA Medical Center in Northport, N.Y., was slated to push the frontier of modern pacemaker surgery. The Micra A/V leadless pacemaker is a new device that is 10% of a conventional pacemaker’s size. It requires a less-intrusive, 30-minute procedure to place directly into a patient’s heart. The intended results are shorter recovery times and less risk for complications. Just two days prior to his groundbreaking operation, in which he would place a new Micra A/V leadless pacemaker, disaster struck. The impact of the novel coronavirus reached a tipping point and his hospital entered a state of emergency operations.

Within days, New York City hospitals were overrun with COVID-19 cases. The surge in demand stressed the health care system to its limits. As a result, medical staff delayed or cancelled any nonessential appointments and procedures.

Pacemaker patients not able to wait out the storm

Telehealth programs have helped reduce the strain on staff and patients across the country, inside and outside of VA. But, as the health care industry is ravaged by a relentless onslaught of COVID-19 cases, some care – like pacemaker surgery – is too complex for telehealth. Some people, unfortunately, are not in a position to wait out the storm.

To save Veterans’ lives, Gursoy and team had to move forward with the groundbreaking procedure. The surgery Gursoy and his team were slated to perform was hyper-advanced. Through an incision in the groin, surgeons travel through a vein to implant a multivitamin-sized device directly into the heart. The intent of this groundbreaking technique is that doctors usually can discharge patients the next day and to minimize infection rates and conduct the whole procedure in about 30 minutes.

So, in the throes of a global pandemic, Gursoy and his cardiology team scrubbed in. On March 5, they surgically implanted the first Micra AV leadless pacemaker in VA history.

There have been no recorded infections related to the leadless pacemaker. Older iterations of the pacemaker came with a 6% to 12% chance of infection. A large part of the risk coming from wires that screw directly into the heart.

Continuing to provide world-class care

Even under ideal conditions, the Northport VAMC cardiology team would need to employ an incredible level of technical expertise to successfully perform such an advanced procedure. But in the face of a global health pandemic, it would also require flawless coordination with numerous other departments within the hospital.

The housekeeping staff, nurses, logisticians and numerous other specialized services, as well as the cardiology team, ensured personal protective equipment was ready and nurses were available. Every inch of the hospital’s environment – from the operating room to the patient’s recovery room – had to be pristine and free of COVID-19.

“I’ve worked with the same people for years. I know them and they know me. We’re all careful with our procedures. This has given me confidence. My team is great. We always get clean units and clean rooms for our patients,” said Gursoy. “Teamwork is important – big time. I trust my team. They know what I’m looking for and I know what they’re capable of. That’s why I do this with no hesitation.”

In the face of difficult circumstances, with social and economic disruption unmatched in the last century, one small hospital helped blaze a trail into the future of medicine. Less than a month later, Gursoy and his staff successfully repeated the procedure, continuing to provide world-class patient care to Veterans, regardless of the circumstances.

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Eric Guzman is a public affairs specialist at the Northport VA Medical Center.