Patients in Sioux Falls in need of a heart valve replacement may no longer face mandatory open heart surgery. Sanford Health in North and South Dakota has been approved as one of a hundred other sites around the country in performing a new non-invasive heart valve replacement procedure. On today’s Dakota Digest SDPB’s Cara Hetland has the story of how the surgery is different but necessary for the sickest of patients.
Marjorie Walberg was told in February she would need her aortic valve replaced. For her it was bound to happen sometime.
“I’ve had a bad valve a long time,” says Walberg. “I had rheumatic fever when I was six years old and every year when I was in high school.”
But she waited because she didn’t really want open heart surgery. And now a day after a valve replacement, she’s glad she did. Walberg is one of a dozen patients that have undergone a Transfemerol Deployment of a Transcatheter Heart Valve in an Aortic Valve. If you’re not fluent in medical jargon
Dr. Tom Stys is her Interventional Cardiologist and can explain.
“The Procedure consists of ultimately being able to deliver a valve through plastic tubes called catheters without having to open the chest and surgical intervention and it is done by the way of accessing a main artery in the groin area femoral artery it is called,” says Stys. “Through this artery we go up with catheters all the way to the aorta up the circulation all the way to the heart position our catheters right above the valve we want to work on and this is our delivery,” he says.
Once the valve is in place it is deployed like a balloon and replaces the calcified valve by shoving it aside – not removing it. Dr. Stys says he’s done tens of thousands of non–invasive catheter procedures like putting in stents, but he says this one is different.
“Open heart surgical procedures provide a more of a controlled environment. The heart rests as you work on it, the patient is stable, and the circulation doesn’t depend on heart but assisting pump. So here you’re dealing with a situation where patients are depending on their heart function the whole procedure. You’re doing a lot of interference in its function. You have to arrest it for a few moments for the key part of the procedure – even though less invasive – patients recover better. I would say it’s a much more complex protocol,” says Stys.
It takes about 25 to 30 people in the hybrid operating room for the 90 minute procedure. The only view of the heart comes from the shadow of an x-ray. Stys says there is about 15 seconds where everyone in the room has a specific job to do. He says he’s not sure if he holds his breath at the most critical part of the procedure.
“Those 10 to 15 seconds seem like much more than it really is,” says Dr. Stys. “When you really realize you have a patient alive on table and you start pacing the heart so fast that it stops squeezing it starts quivering and you know that the blood pressure drops and you see it on the monitor and you know that the vital organs are not per fusing and you know that every second counts – and you’ve got to really quickly between three or four individuals have to agree on position of the valve double check a half of dozen parameters – make sure they’re all where they need to be deploy the valve and complete the procedure in a short period of time that 10 to 15 seconds feels like a very long period of time,” he says.
While heart surgery is routine for Dr. Tom Stys, he says it is exciting to have a new procedure to perfect. But because this is new - it is highly regulated by the FDA and only the sickest of patients qualify.
“Patients that are basically too frail to undergo open heart surgery are good candidates. Patients that have other conditions such as sever lung disease for instance and would be such a high risk to be placed on a ventilator and would not be able to recover from surgery because of very sick lungs. Patients who have already had a number of open chest surgery and would have scar tissue inside would pose a huge challenge for the physician,” says Stys.
It takes two cardiologists to agree to do the procedure. Tom Stys says it’ll take several years before this non-invasive valve replacement is available for all patients.
For Marjorie Walberg – she could feel a difference immediately.
“Oh I can breathe easier,” says Walberg. “When I’m up walking I’m not short of breath and that’s the biggest difference I’m noticing. Now I can put more effort into losing this excess weight,” she says.
Walberg like other patients see a second chance at life. And because they do not have to deal with the pain of an incision in the chest they can get on with that new life sooner and easier.