Healthy people don’t generally think too much about how well their heart is beating, that 24 hours a day when it’s continually pumping blood to the far reaches of the body. But when the heart isn’t working the way it should, particularly the aortic valve, the symptoms are obvious.
For people whose heart valve has aged and can’t open and close fully—a degenerative condition called aortic stenosis—their hearts are forced to push really hard to pump blood. This may result in chest pain, trouble breathing and passing out, or more subtle symptoms like constant fatigue and difficulty in simply walking around, according to Dr. Aidan Raney III of St. Joseph Medical Heritage Group in Orange. “People will decrease activity to avoid the symptoms,” he says.
Now, a new minimally invasive surgical technique that replaces a bad valve with a new one is being performed by doctors around the country—Dr. Raney, an interventional cardiologist, is one of them. The procedure offers a major improvement in life quality and prognosis for older and generally very ill patients.
This new technique is faster and simpler than older valve replacement procedures, Raney says.
“What we did in the past was open heart surgery to replace the valve,” he says. “This meant cutting the breastbone, cutting out the old valve and stitching on a new one made of pig or cow pericardium.”
Patients with symptoms and severe aortic stenosis usually need immediate treatment. If they do nothing, says Dr. Raney, they have 50 percent chance of dying in two years.
“Instead of opening the chest wall and cutting into the aorta, we place a catheter—a hollow tube—into the femoral artery in the leg, advance it upward into the aorta, then put a wire into the heart,” explains Dr. Raney. “Over the wire we put a new heart valve that is mounted on a tiny balloon—we blow up that balloon, expanding the new valve on a metal frame, and pushing the old one out.“ The balloon is deflated and removed via the catheter, with the new valve staying in place.
Just before the procedure, the patient gets a temporary pacemaker, so that for the short 10 seconds that the new valve is deployed, the heart is still.
Dr. Raney performs this procedure at Hoag, currently the only hospital in Orange County with the cardiologists, surgeons and the technology to do it.
The first trial for the technique was done mainly in high-risk patients, a group who could not safely get through major surgery. “The results have been great,” says Dr. Raney, who has performed the new technique alongside his father, who is a surgeon at Hoag.
“Most of the patients for this are elderly—people with valve disease tend to be in their 60s, 70s and 80s. One gentleman was 102,” says Dr. Raney, adding that the patient did well during and since the procedure.
A heart valve is not just a single flap, but rather three connected flaps or “leaflets,” that create a Y-shape opening. Through the catheter, a tiny metal frame expands in the valve and a balloon opens up to place a new valve over the damaged one.
In order for Dr. Raney to perform the replacement successfully, a 3-dimensional CT scan is done ahead of time, so he can see exactly what the patient’s aorta and damaged valve look like. Then during the procedure, which takes about 45 minutes, a live X-ray shows him the heart and its surroundings.
Afterward, patients stay in ICU for a night, and usually go home two days later.
As with any procedure, there are some risks, such as stroke, but Raney believes that compared to doing nothing, “it’s a win.”