Ecru Man State’s First for Heart Procedure

Dr. Karthik Prasad (left) and Dr. Richard Arriola (right) recently performed the state’s first transhepatic Watchman procedure on Gary Cameron of Ecru. 

TUPELO, Mississippi—Gary Cameron recently made history as the first person in Mississippi–and only fourth in the nation—to undergo a transhepatic Watchman procedure for atrial fibrillation.

Watchman is a minimally invasive procedure for people like the 72-year-old Ecru resident who have A-fib but don’t do well on blood-thinning medication because of frequent bleeding problems. In A-fib, the upper chambers of the heart quiver instead of beating effectively. When this happens, blood can stagnate and form clots in the heart’s left atrial appendage. If a clot forms there, it can break loose and cause a stroke.

Approved by the U.S. Food and Drug Administration in 2015, the Watchman serves as a plug, sealing the left atrial appendage to keep larger blood clots from entering the bloodstream. During the procedure, a cardiac electrophysiologist guides the device into the heart through a catheter, or flexible tube, inserted through a vein in the groin. After placing the device, he releases it from the catheter to leave it permanently implanted in the heart.

The NMMC team that performed Mississippi’s first transhepatic Watchman procedure

Cameron’s cardiac electrophysiologist, Dr. Karthik Prasad, attempted a Watchman procedure in October 2022. Dr. Prasad took the traditional approach of going through the femoral vein in the right groin. Unfortunately, Cameron’s blood vessels were too twisted to allow access to the heart. During the same procedure, Dr. Prasad tried to gain access through the left femoral vein but was unsuccessful there too.

“I did some homework and learned about a technique to access the hepatic vein via the liver and then implanting the Watchman that route,” Dr. Prasad says. “There had been only three other such cases in the U.S. reported.”

Dr. Prasad reached out to interventional radiologist Dr. Richard Arriola, who is accustomed to accessing the hepatic vein via the liver for other procedures in his field. “We collaborated, planned and reviewed imaging studies,” Dr. Prasad says, “then I proposed this approach to Mr. Cameron.”

A few weeks later, Cameron returned to NMMC. Dr. Arriola performed the initial part of the procedure—accessing the hepatic vein through the liver—then Dr. Prasad implanted the Watchman device. “The procedure was successful with no complications,” he says, “and we were very pleased with the outcome.”

The only person more satisfied with the results might be Cameron. “The doctors got together and they made it work,” he says.

Six weeks later, Cameron had a follow-up transesophageal echo (TEE) to check the Watchman device. “The device looked great,” Dr. Prasad says. “We have taken him off his blood thinner, Xarelto, and now he’s on what we call dual anti-platelets—aspirin and Plavix—for five months. At that point, we’ll stop the Plavix and he’ll just remain on aspirin.”

Cameron is grateful for Dr. Prasad, Dr. Arriola and the entire team who made this innovative procedure possible. “I’m very thankful because without them, I couldn’t have had the procedure,” he says. “I’m doing great.”

NMMC recently celebrated a milestone with more than 750 Watchman procedures implanted by Drs. Karl Crossen and Jim Stone, along with Dr. Prasad. For more information about NMMC’s Heart and Vascular Institute, visit www.nmhs.net/heart-vascular.