Valve procedure offers new hope to elderly heart patients
Tom Smart, Deseret News
SALT LAKE CITY — In early April, Merna Nielsen could not walk the 50 feet from her house to the mailbox without running out of breath.
She was diagnosed with aortic valve stenosis. Her valves had calcified — clogged with deposits that had hardened — making it difficult for blood to pass through.
Open heart surgery was not an option. In addition to her age, 83, radiation damage in her chest from earlier cancer treatment made the surgery impossible. The rapid decline of her health signaled to Nielsen that she did not have much longer to live.
On April 24, Nielsen went in for a procedure to clear her arteries. She was out of the hospital within three days and has since made a full recovery.
"It's unreal the difference in her," her husband Ray Nielsen said.
The procedure, called Transcatheter Heart Valve Replacement, involves a valve that is placed on a catheter and inserted into a clogged artery. It is less invasive than open heart surgery and is a growing option for elderly or sick patients who otherwise would not have an option.
Heart disease was the leading cause of death in the United States in 2010, killing almost 600,000 people, according to the Centers for Disease Control and Prevention. Because of this, more people are being referred to surgeons for heart valve replacement.
In order for a patient to qualify for the procedure, the Food and Drug Administration requires a team of cardiac surgeons and cardiologists to assess the case, evaluate the patient and work together during the surgery and after care.
Physicians at St. Mark's Hospital screen each patient who undergoes an echocardiogram to more quickly diagnose whether their arteries are sufficiently clogged to warrant surgery.
In the United States, the valve has only proven to work for three to five years, according to Ed Ganellen. The "million-dollar question" he said, would be to find how to get the transcatheter valve to last as long as valves places through open heart surgery.
This technology has been available in the United States for three to five years, Ganellen said, and came to St. Mark's Hospital this spring. the surgery is also available at the University of Utah's cardiovascular center, the Intermountain Heart Institute and Intermountain Medical Center.
There have been "no major complications" in the 15 St. Mark's patients who have undergone the valve implant, Ganellen said.
This new technology offers treatment to those who otherwise would be waiting to die, said Dr. Gilbert Schorlemmer, cardiac surgeon at St. Mark's Hospital. Even 10 to 15 years ago, the idea of a valve being inserted through a catheter would have been unimaginable, he said.
In a surgical room in St. Mark's hospital, Schorlemmer held up a model of the valve that was kept in a glass case — the valve's cost of between $30,000 and $40,000 prevented him from showing an uncased valve, he said.
The circular valve has about the same circumference as a quarter. It is made up of "a metal stint cage" that surrounds "bovine pericardium leaflets." Once in place, the leaflets will act as the new valve. It is placed over a collapsed balloon on a catheter, and a "crimping device" squeezes the valve onto the balloon.
After cutting an incision into the patient's leg or side, surgeons insert the catheter and work it up to the artery. There they inflate a balloon on the tip to create space in the artery for the new valve.
Surgeons then insert a second catheter with the valve attached. A large TV screen allows the surgeon to track the movement of the valve. Once it is in place, the patient's heart rate is increased to 180 beats per minute. This is so that the valve can be inserted without a lot of obstruction from blood coming through.
The balloon is then inflated, pressing the metal valve against the arterial wall. The more clogged the artery is at this point, the better it is, Schorlemmer said, because the stint cage will have more material to cling to.
Once the valve sticks, the balloon deflates and the catheter is removed.
"It's downright amazing," Schorlemmer said.
As many as half of those with Nielsen's condition do not survive more than two years after symptoms appear without having their valves replaced, according to a study that appeared in British Medical Journal's Heart and Education in Heart Journal in 2000.
With this new technology, however, patients like Merna Nielsen are full of life and energy.
"Now I can't keep up with her when we go to the store," Ray Nielsen said.
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