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Minimally invasive procedures make aortic valve repair easier on patient

TAMPA — Some patients with aortic valve disease may not require open heart surgery to have their faulty valve replaced. A growing number of cardiac surgeons offer a minimally invasive procedure performed through a small incision in the upper chest that results in a quicker, less painful recovery than the standard open chest procedure.

Plus, a new-generation replacement aortic valve is now in clinical trials; it is placed in the heart through the leg, completely avoiding the need for a chest incision and making life-saving surgery possible for people whose other medical conditions make them ineligible for other procedures.

Standard surgery for valve replacement usually means making a long, vertical incision down the center of the chest, through the sternum or breastbone and spreading the rib cage apart to get to the heart and aortic valve. It's a big surgery, said Dr. Ernesto Jimenez, a cardiothoracic surgeon at Tampa's Pepin Heart Hospital who has done it thousands of times in his career. "We have to use a saw to open the chest and patients have to go on the heart-lung machine," he said.

Now Jimenez is among those who offer the smaller incision procedure — just 2 to 3 inches compared with 7 to 10 inches for standard surgery. The incision is made between the rib bones. "It's less painful for patients, recovery is easier and you have the same results," Jimenez said.

If the aortic valve doesn't work properly, the heart has to work harder to compensate, causing it to become enlarged and weak. It's possible to never feel symptoms, or to be able to control them through healthy lifestyle and medications.

Most people find out they have a faulty valve in their 60s or later in life; an estimated one in eight older Americans has valve disease. Others are born with a valve defect that may cause no symptoms or can become life threatening.

That's what happened to 30-year-old Jessica Luke of Tampa. She knew she was born with a valve abnormality, which occurs in about 1 to 2 percent of the population, according to the National Institutes of Health. But last month it became serious.

"I was really tired, sleepy," said Luke. "My heart would beat so hard in my chest I was dizzy, weak, had no energy and was out of breath." She was having difficulty keeping up with her children, ages 2 and 4.

Luke was the first person to have the minimally invasive aortic valve replacement procedure done at Pepin, on March 25. "I can feel a difference already," she said.

Jimenez, who performed Luke's procedure, said it can take up to four weeks for patients to fully recover; recovery from standard open chest surgery takes six to eight weeks.

The minimally invasive procedure isn't right for everyone. Among others, patients who are obese may still require open chest surgery.

Some patients who need valve replacement surgery but are considered high risk because of other health issues may soon have another option — a device that is inserted through a catheter. One such valve currently in clinical trials is the Edwards SAPIEN valve, manufactured by Edwards Lifesciences Corp. It is collapsible and is placed in the chest via a catheter threaded to the heart through the femoral artery in the upper leg.

"There's a huge interest in the medical world for this procedure," said Dr. Crayton Pruitt, a cardiothoracic surgeon at St. Joseph's Hospital in Tampa.

Pruitt said the femoral approach reduced the death rate in certain patients who were previously not considered candidates for surgery by 25 percent.

"That's significant," said Pruitt, who added that St. Joseph's is gearing up now to offer the new procedure soon after it receives FDA approval, expected later this year.

Irene Maher can be reached at imaher@sptimes.com.

Minimally invasive procedures make aortic valve repair easier on patient 04/20/11 [Last modified: Wednesday, April 20, 2011 5:15pm]
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