SAN FRANCISCO — Have a heart problem? If it's fixable, there's a good chance it can be done without surgery, using tiny tools and devices that are pushed through tubes into blood vessels.
Heart care is in the midst of a transformation. Many problems that once required sawing through the breastbone and opening up the chest for open heart surgery now can be treated with a nip, twist or patch through a tube.
These minimal procedures used to be done just to unclog arteries and correct less common heart rhythm problems. Now some patients are getting such repairs for valves, irregular heartbeats, holes in the heart and other defects — without major surgery. Doctors even are testing ways to treat high blood pressure with some of these new approaches.
All rely on catheters — hollow tubes that let doctors burn away and reshape heart tissue or correct defects through small holes into blood vessels.
"This is the replacement for the surgeon's knife. Instead of opening the chest, we're able to put catheters in through the leg, sometimes through the arm," said Dr. Spencer King of St. Joseph's Heart and Vascular Institute in Atlanta. He is former president of the American College of Cardiology. Its conference earlier this month featured research on these novel devices.
"Many patients after having this kind of procedure in a day or two can go home" rather than staying in the hospital while a big wound heals, he said. It may lead to cheaper treatment, although the initial cost of the novel devices often offsets the savings from shorter hospital stays.
Not everyone can have catheter treatment, and some promising devices have hit snags in testing. Others on the market now are so new that it will take several years to see if their results last as long as the benefits from surgery do.
But already, these procedures have allowed many people too old or frail for an operation to get help for problems that otherwise would likely kill them.
"You can do these on 90-year-old patients," King said.
These methods also offer an option for people who cannot tolerate long-term use of blood thinners or other drugs to manage their conditions, or who don't get enough help from these medicines and are getting worse.
"It's opened up a whole new field," said Dr. Hadley Wilson, cardiology chief at Carolinas HealthCare System in Charlotte. "We can hopefully treat more patients more definitively, with better results."
Here are some common problems and newer treatments for them:
Millions of people have leaky heart valves. Each year, more than 100,000 people in the United States alone have surgery for them. A common one is the aortic valve, the heart's main gate. It can stiffen and narrow, making the heart strain to push blood through it. Without a valve replacement operation, half of these patients die within two years, yet many are too weak to have one.
"Essentially, this was a death sentence," said Dr. John Harold, a Los Angeles heart specialist who is president of the College of Cardiology.
That changed just over a year ago, when Edwards Lifesciences Corp. won approval to sell an artificial aortic valve flexible and small enough to fit into a catheter and wedged inside the bad one. At first it was just for inoperable patients. Last fall, use was expanded to include people able to have surgery but at high risk of complications.
Gary Verwer, 76, of Napa, Calif., had a bypass operation in 1988 that made surgery too risky when he later developed trouble with his aortic valve.
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