Story on Experimental Heart Valve Procedure

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Jeff S

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Washington University Doctors Successfully Complete Experimental Heart Valve Procedure
Sunday, January 20, 2008, 5:10 PM
By Steve Walsh

Washington University heart specialists are celebrating the successful completion of an experimental procedure giving an elderly woman a new heart valve. 78-year-old Mary Ann Cahalin of Florissant is the first patient in this part of the country to receive the device, which replaced her defective aortic valve without opening the chest wall or using a heart-lung machine.

Leading the team was Doctor John Lasala, Professor of Medicine at Washington University in St. Louis and Medical Director of the Cardiac Catheterization Laboratory at Barnes-Jewish Hospital in St. Louis. "This entire procedure," says Doctor Lasala, "Is now done via a tube in the leg, not too dissimilar from the way people would have a stent placed in the arteries around the heart. This is a much larger tube, and it's not going to the arteries, it's going across the valve into the ventricle or the pumping chamber of the heart."

Doctor Lasala says once the procedure is completed, the patient can be up and talking an hour or so later. This is quite a contrast to open-heart surgery in which recovery periods can be very lengthy.

Mrs. Cahalin, who had undergone by-pass surgery nine years ago, was chosen from among a group of individuals who required treatment but who were not good candidates for the standard open-heart surgery. This experimental procedure was the right remedy at the right time for her. "I would not have been here too long a time for the way my whole general condition was deteriorating," says Mrs. Cahalin. "I would have been on medication," she continues, "And probably in a wheelchair and just sitting there huffing and puffing."

Now, Mrs. Cahalin will be monitored by doctors keeping track of her progress. "They'll follow me for five years or longer."

Experimentation involving this procedure began in France in 2002, and has since spread to Canada and a number of other areas of the United States. Doctor Lasala expects another year of experimental procedures, followed by a year to review the data, and believes the U.S. Food and Drug Administration could approve this treatment in about three years.
 
FANTASTIC!! We can certainly all relate to this story!! I didn't really realize that this procedure was so close at hand. Excellent news for many!!

Thanks. Marguerite
 
I asked my cardio about it last spring (he was referring me to a surgeon) and said it was almost limited to Vancouver and Ottawa for the time being, and that it was mostly being used for people who, for one reason or another, would not tolerate OHS.

Good to see it coming sooner rather than later, though !
 
Jeff,
It's interesting that you would post this. Down here (Cape Girardeau) one of our hospital's has a one minute health related segment that runs several times a day. This week, one of the cardiothoracic surgeons has claimed that aortic valve replacement, by means of a catheter, is only a year away from being practiced here. Of course, I'm highly dubious, but I have wondered what makes him so confident.
Perhaps the time is getting closer than what we think. However, I must say there is no way on God's green Earth, that I will be one of the experimental guinea pigs!
 
Actually the first one was done right here at my hospital in Royal Oak Mi.
This was well over a year ago and we had a lot of discussion on this forum regarding this subject.
Just by chance I met the man who had this procedure and he was doing great.
He was out of the hospital in no time and back to the car dealership he owns.
Pretty amazing and hopefully a promising procedure for those unable to tolerate open heart surgery.
Rich
 
This would probably not be for a younger, more energetic person. Although there are a number of percutaneously delivered valves available, my understanding is that they are more restrictive of blood flow and there is little understanding of what their average useful lifespan will turn out to be.

However, they can be an absolute lifesaver in those who truly cannot withstand cardiac surgery. They are, as far as the ones I have read about, all tissue valves, which I find rather astonishing.

Best wishes,
 
The percutaneous graft of the aortic valve is also being done at the Cleveland Clinic on a test basis. They are reporting good results so far. Candidates presently are elderly patiens with comobirbidities that make OHS not the best approach.

susan
 
rachel_howell said:
I wonder if they will be able to do it in people who have scar tissue from previous surgeries, or if it will be only for "virgin" patients.

Boston Children's has been doing pulm valves one and i know they are doing them on people that have had multiple heart surgeries,(including valves) because when we talked to them about Justin in the spring, we weren't sure if his problem was in his valve or conduit, but IF he needed his valve replaced the doctor thought he might be a canidate for the trials since his risks were higher since that was his 5th OHS. His valve ended up being fine so we didn't get alot of details about it.
 
It is amazing but I think they still have a ways to go.
As I mentioned earlier I met the first patient to have this done.
It didn't go quite as planned. The first valve they inserted apparently did not expand correctly. They had to collapse it, push it aside and insert another valve. How they did all that I don't know, but the guy looked really great.
He was in his late seventies at that time..
My nephew and his wife have been medical professionals at the Cleveland Clinic for many years. He had AVR there himself not too long ago and mentioned they are working also to perfect this procedure.
Susan,
Welcome aboard to this great forum. It's nice to hear from someone in our hometown. No we don't live there these days but were born and raised there.
Sure do miss it down there.
Rich
 
Hmmm....

I was going to ask if this could be done with the Mitral Valve also but as I think about it, the only access would be THROUGH the Aortic Valve... unless there is a way they could enter the vein from the lungs going to the Left Atrium... and the Mitral Valve is Bigger than the Aortic Valve...

Probably not a viable option, especially for those who already have an artificial Aortic Valve (i.e. Mechanical)...

Can any of you enlighten us on this subject (MVR via catheter)?

'AL Capshaw'
 
Lynlw said:
Boston Children's has been doing pulm valves one and i know they are doing them on people that have had multiple heart surgeries,(including valves) because when we talked to them about Justin in the spring, we weren't sure if his problem was in his valve or conduit, but IF he needed his valve replaced the doctor thought he might be a canidate for the trials since his risks were higher since that was his 5th OHS. His valve ended up being fine so we didn't get alot of details about it.

Wow, this is really promising news for those of us who have massive amount of scar tissue due to multiple surgeries & are not good candidates for OHS. Amazing what can be done! There's always hope.......:)
 
One of the reason that I choose a tissue valve was because my surgeon (Cleveland Clinic, Weston Florida) was certain that this would be the way of the future.

He explained that trials are currently underway, and that right now the only candidates are those who stand a 50% chance of not surviving the current surgery.

He stated that better data would be available within the next 8-10 years, and that so far things looked very promising.
 
As a mitral valver, I'm feeling very left out.:(

In all seriousness though, we are seeing a lot of doctors making recommendations based on their educated guesses about when this surgical procedure will be readily available and seem to be operating under the assumption that it will be available for just about all. We see them saying it will be available anywhere from "a few years" to "10 years". While it is a promising procedure, I believe we all need to be very cautious making too many assumptions about for whom it will be available. I, like Bob, have read that the major focus seems to be on those who would face very difficult valve replacement otherwise. This tells me that at this point, they are still believing that, given the lack of long-term data, the "old-fashioned" valve replacement is still going to be the standard for quite a while. If I was going in for a 2nd valve replacement and was in pretty good shape, I don't think I'd go for an option that appeared to be physically easier, but may not give me the full-functioning or longevity, that a standard tissue, or mechanical replacement would give me. I'd want to know that someone 15 years ago had a percutaneous placement, and has had no physical restrictions since. But I'm very cautious - and I agree - God bless those who step forward to try the new things. I wouldn't.:eek:

I'm one that believes that our decisions should be made on what technology tells us can be done now, not on what may be able to be done in X years. Many times a new medical procedure is developed and then has many transformations before it lands on it's best use.

tobagotwo said:
This would probably not be for a younger, more energetic person. Although there are a number of percutaneously delivered valves available, my understanding is that they are more restrictive of blood flow and there is little understanding of what their average useful lifespan will turn out to be.

However, they can be an absolute lifesaver in those who truly cannot withstand cardiac surgery. They are, as far as the ones I have read about, all tissue valves, which I find rather astonishing.

Best wishes,
 
I do think that this is the wave of the future, but Bob brings up a very good point (he usually does!) about whether you could be very active with this valve.

As for people who currently have mechanical valves, I was told by my son's surgeon that you would not be able to use this method for the next surgery.

I think that this is the same situation faced by all people with medical decisions to make. Innovation is constant and we all have to use our best judgment on what is appropriate for now and in the future. It would be so much easier if we were omniscient:D
 
This procedure (percutaneous aortic valve replacement) was done about a year or so ago at the Montreal Heart Institute by my cardiologist along with one of the surgeons (not my surgeon) for a woman who had a other health problems that would have made it very dangerous to have OHS.

Although it?s true that a mitral valve has never been replaced in this manner, there is a percutaneous (still experimental, I think) procedure to repair the mitral valve. I think it?s called E-valve or something. I?m not sure of the exact access to the mitral valve, but I know it has been done.

By the way, I used to live in a suburb of St. Louis, and my father had a bypass at Barnes-Jewish Hospital. Also, another claim to fame for Washington University is that the doctor who first innovated the Maze Procedure, Dr. Cox, was from Washington University.
 
All very good news indeed. I was also told by my surgeon that percutaneous valve replacement for aortic tissue valves and native valves was 5+ years away. My surgeon is one of the pioneers at Cleveland Clinic working on research for percutaneous valve replacement. But I still do agree that choices for types of valves should be made as if you were frozen in the moment, with the technology available in the present, as you really never know what the future will hold.

Betsy
 

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