New procedure takes 'open' out of heart surgery

NORFOLK

A faint scar down the center of Donald E. Chapman's chest serves as a reminder of the two times doctors operated on his heart 16 years ago.

But the only outward sign of his third heart procedure - performed less than three weeks ago - is a two-inch incision where his right leg meets his torso.

The 83-year-old Virginia Beach resident was the first of two South Hampton Roads patients to undergo a new type of heart-valve replacement that Sentara Heart Hospital started offering last month. More procedures are scheduled in the new year.

The new option is for patients with calcific aortic valve stenosis, a condition in older patients in which calcium deposits narrow the valve connecting the heart and the body's main artery.

That narrowing decreases blood flow to the body, making the heart work harder and eventually weaken. People with severe cases can feel breathless when they exert themselves and experience chest pain. The condition can lead to heart failure or cardiac arrest. Left untreated, it usually is fatal.

Traditionally, replacing the valve involved cutting through a patient's breast bone, stopping the heart, and temporarily hooking the patient up to a cardiopulmonary pump outside the body.

That's not feasible for more fragile patients like Chapman, who are elderly or have other conditions that make the trauma of open-heart surgery too risky.

With the new procedure, doctors thread a catheter through an artery in the patient's leg up to the heart and implant a replacement valve.

The Sapien transcatheter aortic heart valve is made of cow tissue and polyester, supported by a stainless steel mesh frame. The device is manufactured by Irvine, Calif.-based Edwards Lifesciences.

At Sentara, cardiologist Dr. Paul Mahoney and heart surgeon Dr. Jeff Rich performed the procedure in the hospital's "Hybrid Cardiac Operating Suite," which contains equipment for both a full-service operating room and cardiac catheterization laboratory. They were assisted by cardiologist Dr. Deepak Talreja and cardiothoracic surgeon Dr. Joseph Newton.

"Many cardiologists have watched patients die of this over the years and wished we had some way to treat these patients," Mahoney said. "It offers a potential cure for what is otherwise considered a progressive and fatal disease."

In November, the U.S. Food and Drug Administration approved the Sapien valve and its delivery method for patients who aren't eligible for open-heart surgery. It is not approved for patients who can be treated with the surgery.

There are risks.

In a study, patients "receiving the Sapien valve experienced two and a half times more strokes and eight times as many vascular and bleeding complications than patients who did not receive the implant," according to the FDA. However, patients with the valve also were more likely to survive one year after surgery.

As part of the approval, the FDA is requiring studies to track patients who receive the valves.

So far, Chapman and his family are reporting promising results.

Before the new valve, his heart condition was taking its toll. Merely reaching for a glass on a top shelf left Chapman so tired he needed to sit down.

Now, he's thinking more clearly, and he's no longer short of breath.

"It definitely improved my lifestyle," the retired Navy officer said. He and his wife, Anne, often kid each other about living to 90, he said.

"It's definitely possible now."

Amy Jeter, (757) 446-2730, amy.jeter@pilotonline.com