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Arlee rancher Vern Morgan, left, smiles in July 2017 during a meeting with Dr. Dan Spoon, an interventional cardiologist at the International Heart Institute of Montana at Providence St. Patrick Hospital. The IHI's $500,000 expansion in May allows it to see 1,200 more patients a year.

Just months after a $500,000 expansion of the International Heart Institute at Providence St. Patrick Hospital in Missoula, doctors there have successfully performed a rare, high-risk procedure that has never been completed in the region.

Dr. Daniel Spoon and Dr. Tod Maddux, both specialists in interventional cardiology, recently collaborated on a retrograde epicardial reverse CART technique. It's a fancy name for a complicated, risky procedure.

“We were basically flossing the guy's heart,” Spoon explained, trying his best to put it in layman's terms. “We go in through one leg, through a tube, and get a wire down the left [blood circulation] system, then go back to the right system and come out the right coronary artery and come out through the opposite leg. The result was beautiful.”

The procedure was performed on a patient in his 70s who had a completely blocked artery — a chronic total occlusion — and was miserably unable to exert himself as a result. Spoon said the patient and his wife were elated at the result, as he was already able to do more exercise a few days after the procedure than he had been able to do in years.

“He could finally take a deep breath,” Spoon said. “It’s a really useful tool that Dr. Maddux and I have now, to really push the boundaries of what’s possible. This is crazy for us to have the ability to do this here, and it’s really because we have an unbelievable staff. It’s a great group.”

Spoon said he and Maddux formalized a CTO program recently. Because there are fewer than 1,000 trained individuals in the country who can do that type of procedure, the IHI sees patients from Wyoming, Idaho, Washington and all over the region who have been told it’s their only option.

“It takes a planned strategic approach,” Spoon said. "We’ve probably done 75 of them. They’re high-risk procedures. Normally, only big academic centers would do this. You have to be doing this a long time. The first goal is staying out of trouble, but you also have to have the ability to get out of trouble if things go wrong.”

The team at the IHI also recently replaced its 500th aortic valve with the cutting-edge transcatheter aortic valve replacement (TAVR). Unlike a surgery where the breastbone has to be opened to get to the chest cavity, TAVR involves threading a catheter tipped with a replacement valve through a blood vessel from the groin or arm to the heart. Because it’s less invasive, people can get out of the hospital within one or two days and get back to their normal routine.

“TAVR has totally revolutionized the way we treat patients,” said Dr. Mike Reed, a cardiac interventionist. “We were the first hospital in Montana to perform the procedures, and we’re celebrating our 500th TAVR milestone. This procedure is quite comfortable for us, and that translates to excellent outcomes for our patients.”

George Fryett of Dillon, Montana, was one of the IHI’s recent TAVR patients. He had no idea the technology was available so close to home.

“I was not only amazed with the exceptional care, but that I was in at St. Pat’s in the morning and able to recover at home,” he said. “It is amazing to me how far technology has come and that I didn’t have to fly to a metropolitan area to receive this.”

All three doctors said that a recent five-bay expansion of the IHI, completed in May, allows more patients to be seen and is boosting the facility's reputation as a regional leading program for complicated cardiac procedures. The expansion allows the facility to see an average of seven more patients every weekday, which equates to almost 1,200 more patients a year.

Dr. Maddux said the innovative design allows for more efficient and patient-friendly care that reduces wait times and increases access to services.

“The cardiology practice in Missoula is unique and draws cardiology specialists who want to practice in this patient-centered team environment,” Maddux said. “An expanded observation unit and the additional rooms allow us to care for more patients in need and helps our team maintain that tradition of excellence and access.”

Fran Albrecht, executive director of the Providence Montana Health Foundation, said the $500,000 expansion was made possible by a handful of gifts from donors.

“There was a point where IHI could accept more patients, but they were limited by space in recovery,” she explained. “The solution was an expanded observation unit for pre- and post- procedural care. Several friends of the Foundation who intimately understand and appreciate how fortunate we are to have this level of care in Montana, responded with generous support to make the expansion a reality.”

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