An alternative for patients who can’t survive open heart surgery replaces the aortic valve without opening the chest or heart. Medical City recently became the first in the country to perform the procedure, just days after it received FDA approval.
The hospital’s Dallas Valve Institute took part in clinical trials for seven years. We caught up by phone with Dr. Bruce Bowers of the institute to explain the procedure.
Dr. Bowers: We make about a three inch incision between two ribs on the left side of the chest and we literally go in through the tip of the heart, the apex of the left ventricle with the catheter and replace the valve.
Sam: This involved a 72-year-old woman who would not have survived open heart surgery. So had the procedure not been approved, what could you have done for her?
Dr. Bowers: That’s the most sobering part of this. In patients that are not good surgical candidates or are deemed inoperable, this is the only option to replace that valve without opening the heart and without opening the chest. So, if this technology did not exist, she basically would have been left to suffer a death secondary to her aortic valve disease.
Sam: This all stemmed from aortic stenosis?
Dr. Bowers: The aortic valve sits between the left ventricle, which is the main pumping chamber of the heart, and the aorta. The aorta, as you may know, carries blood to the rest of the body. In order for the blood to get out of the heart from the left ventricle into the aorta, it must pass through the aortic valve. The aortic valve, you can imagine, is a set of double doors that needs to open and allow blood out of the heart and then it closes. Aortic stenosis is the process by which that valve or those double doors, if you will, become stuck and they can no longer allow blood out of the heart.
Sam: Is this a common problem?
Dr. Bowers: It’s diagnosed in about 250,000 patients every single year. And it’s a disease of more advanced age, over the age of 65 is when it tends to have its onset through the sixth, seventh, eighth decade of life. So, it is a progressive disease. It is a disease of more elderly patients.
Sam: What are the symptoms of the disease?
Dr. Bowers: Shortness of breath, chest discomfort, dizziness, lightheadedness, passing out. All of those symptoms or any combination thereof can be indicative of this valve being an issue.
Sam: Is aortic stenosis something that can be prevented?
Dr. Bowers: There’s not a pill, there’s not a medicine we can give patients to reverse this condition once it starts. It’s a progressive disease and there really is nothing that the patient can do, diet, exercise and so forth.
Sam: You know, we did recent interviews about the use of catheters for treating a stroke and in other cases. What exactly has the use of catheters meant for surgery?
Dr. Bowers: This arguably is the most significant advancement in cardiovascular surgery that we’ve seen in over a decade. This has opened up a realm of therapy to patients who otherwise would have had no option. And so, from that standpoint, catheter-based therapy or minimally-invasive approaches to this type of disease is really going to have a profound impact on the mortality and death rate of patients who suffer with this disease.
Dr. Bruce Bowers is Medical Director for Invasive Cardiology and Co-Director of the Dallas Valve Institute.
For more information:
U.S. National Library of Medicine on aortic stenosis
FDA Approval of transapical replacement of aortic heart valve