Open-heart surgery – the conventional procedure for treating heart valve disease – typically isn’t an option for many older and more fragile patients, leaving them to live with symptoms that diminish their quality of life.
But an innovative procedure called percutaneous aortic valve replacement, approved by the U.S. Food & Drug Administration in November, is giving hope to patients who previously would have been considered too high risk to undergo open-heart surgery.
Disease of the heart valve affects millions of people, most of them elderly.
“This disease is such a debilitating disease,” said Dr. Basil Paulus of the Stern Cardiovascular Center in Memphis. “The life expectancy, once you develop symptomatic aortic stenosis, is worse than it is for almost any cancer. People develop chest pains, dizziness, shortness of breath, they start passing out sometimes. Usually people say they can’t do anything anymore because they get really short of breath. I’ve had people who were out there playing golf and now they can’t walk from the front porch to the mailbox.”
But, he said, percutaneous aortic valve replacement is giving patients a new lease on life, allowing them to return to their normal activities with more energy and without chest pains or shortness of breath.
“It’s completely transforming the way we treat people who have valve disease,” said Paulus, who in February performed the Memphis area’s first successful percutaneous aortic valve repair. “Traditionally, when you have a problem with the valves in your heart, you have to have open-heart surgery. … This is basically the equivalent of what stenting is for the heart arteries. It’s using that same kind of technology and doing valve replacement, with that minimally-invasive cut or a hole in the artery just like you do with a heart catheterization.”
“It’s completely transforming the way we treat people who have valve disease.”
–Dr. Basil Paulus
Stern Cardiovascular Center in Memphis
The minimally invasive approach is performed without cracking open the chest or stopping or exposing the heart. Instead, an incision is made in the femoral – or groin – artery, where a small, hollow, plastic tube is placed and wire is threaded up to the heart.
“We use it to get across the really tight valve, and we basically go across the valve with a balloon, open up the balloon, and crack the valve open a little to make room for the new valve that we’re getting ready to put in there.”
Recovery time associated with the procedure is much shorter than that of open-heart surgery.
Thousands of patients in Europe have undergone the valve replacement procedure, and the number of clinical sites offering the procedure in the U.S. – including the Memphis area – is growing.
Paulus said surgeons and cardiologists working in concert with the Baptist Heart Institute at Baptist Memorial Hospital-Memphis have so far performed 18 percutaneous aortic valve replacements.
“We think it’s a huge, huge step,” he said. “There was an article in one of the cardiology journals that called it the biggest technology breakthrough in cardiology in at least the last decade.”
Many patients who undergo the procedure are in their 80s and 90s. Paulus said a 102-year-old patient in New York successfully underwent this type of valve replacement.
However, as of now, he says, there’s no long-term data on the survival rates of patients who’ve undergone percutaneous aortic valve replacements.
“We think it will last for five to 10 years, but we don’t know that for sure,” Paulus said. “We’re trying to save this more for people who are higher risk, but eventually we’re thinking that this is really going to change the way we treat valve disease.”
But, he said, there will always be a need for open-heart surgery for some patients.
“It’s like bypass surgery; we’re doing a lot less than we used to do because we’ve got stents now,” Paulus said. “This is similar to that. We’ll probably do a lot less of the old-fashioned valve surgery as this gets better, but there are certain cases where bypass surgery is still better than stents.”