Minimally invasive heart valve implants at McLaren Northern Michigan are placed directly through the chest wall, without open heart surgery. The procedure is a step forward in catheter technology and a key advance for especially frail patients. McLaren Northern Michigan Hospital is located in Petoskey. We asked Dr. John Talbott, a surgeon with Michigan Heart and Vascular Specialists, to explain the procedure.
One of the more common forms of heart disease is aortic stenosis, a condition in which the aortic valve becomes stiffened by the accumulation of calcium on and around the valve tissues. A stiff aortic valve does not open and close adequately, and the blood flow through the valve can be greatly reduced. Of course any heart valve with reduced flow is a bad thing, but reduced flow through the aortic valve is noteworthy because it is the valve that blood passes through as it leaves the heart and surges out to the entire body.
Generally, patients who suffer aortic stenosis undergo open heart surgery in which surgeons remove the damaged valve and implant either a tissue valve from a cow or a mechanical valve, Talbott explains. But some patients are too frail to withstand open heart surgery. In the recent past, those patients would have been told nothing could be done and they’d be sent home to wait for the disease to claim their lives.
In response, researchers developed a way to install an aortic valve by using a catheter, thereby avoiding open heart surgery. The FDA originally approved a procedure in which the surgeon, via catheter, guides a balloon tip through arteries in the groin up into the aortic valve and then expands the balloon, widening the opening. The surgeon then retracts the balloon and a catheter delivers a compressed bovine valve mounted on a stainless steel mesh band. The valve is positioned and a balloon expands it into place. Tiny metal prongs anchor the valve into surrounding tissue. “This is done without stopping the heart,” Talbott says.
But even this procedure doesn’t work for all patients. In some patients with vascular disease or naturally narrow blood vessels, the surgeon is not able to fit the valve through the arteries, Talbott explains. “Now we have another option,” he says. “We make a small incision below the left breast, expose the heart in a small area and, using the same aortic valve as with the groin procedure, use a catheter to go in through the apex of the heart.”
The apex is the lowermost chamber of the heart. Surgeons insert the catheter through the heart wall, guide it through the blood-filled chamber of the left ventricle and position the valve. The McLaren team has thus far implanted 30 aortic valves via catheter, with four of them inserted through the chest wall.
Recovery time is one of the most remarkable aspects of the catheter-placed implants. “I recently had a patient who left the hospital in three days and went home and booked a cruise,” Talbott says. Currently the FDA has approved the catheter implants only for patients not eligible for open heart surgery.