New heart valve surgery offers frail patients hope
Providence St. Vincent Medical Center marks Oregon's first success with innovative procedure
A pioneering medical procedure using a collapsible heart valve that's given a Vancouver, Wash., man a new lease on life is poised to bring good news to thousands of heart patients in Oregon.
At a news conference held at Providence St. Vincent Medical Center on Tuesday morning, doctors from the Providence Valve Center announced the very first 'transcatheter aortic valve replacement' procedure in Oregon was a success.
The Feb. 1 procedure provided Benjamin Wiener, 91, with a 'collapsible Sapien heart valve,' a one-way valve device the Food and Drug Administration approved in early November.
Providence St. Vincent was selected as the first Oregon location to provide the minimally invasive procedure, which Dr. Todd Caulfield, medical director of cardiovascular research for the Providence Heart and Vascular Institute, called 'groundbreaking.'
'This is a game changer,' Caulfield said. 'This is the beginning of a transformational change in the care of patients with valvular heart disease.'
The procedure is used in the treatment of severe aortic stenosis - a dangerous narrowing of the aortic valve's opening - for patients too ill for conventional open-heart surgery. The valve device is inserted through a 2-inch incision in a patient's groin.
'Trancatheter aortic valve replacement is the new standard of care for the treatment of aortic stenosis in patients who are not candidates for routine aortic valve replacement surgery,' Caulfield said Tuesday morning. 'Now we can replace the valve without surgery, opening up the chance for treatment to thousands of Oregonians who previously had no hope for recovery.'
Wiener's surgery took about two and a half hours and went 'very smoothly,' noted Caulfield, whose surgical team included Dr. Robert Hodson, co-medical director of the Providence Valve Center, Dr. Eric Kirker, co-surgical director, along with Dr. Craig Walsh and Dr. Steve Kelly.
'The aortic stenosis is completely eradicated and Mr. Wiener is in excellent health, walking about the ward upstairs on the sixth floor,' Caulfield said, adding the patient would likely return home 'today or tomorrow.'
Aortic stenosis, which allows too little blood to pump through the valve between the left heart ventricle and the aorta - the body's largest artery - is the most common valve-related heart problem the Providence team treats.
The replacement valve is inserted through a catheter into the patient's femoral artery. The delivery catheter is then maneuvered up through the aorta and carefully positioned across the aortic valve. A balloon is inflated, expanding a stent tube, then deflated. This pushes the old, diseased valve aside and leaves the new, functioning one in its place.
Kirker described the device as a one-way valve from which the 'whole arterial tree in the body accepts that blood,' he said. 'It is a passive, one-way system powered by the muscle of the heart.'
Caulfield said the device and procedure open up the door for as many as 10,000 Oregon patients who previously had few if any options.
'Because this disease often affects very elderly and frail patients, many of them are turned down, or never referred, for surgery. Typically, somewhere between 50 to 70 percent of patients are referred for surgery. Now the remaining patients may also be treatable,' he said.
With Wiener's operation setting a standard for success, Caulfield said the procedure would likely become common for a wide range of patient types.
'In the future, we will see more patients treated at younger ages and with better results by using these transcatheter procedures rather than open-heart techniques,' he said. 'We're hoping this technique will allow us to treat patients in a less invasive, less costly way.'