Health Care

June 8, 2014

New heart procedure in Fresno hospitals avoids major surgery (video)

For some cardiac patients, open-heart surgery is just too risky. Fresno hospitals are beginning to use a new, minimally invasive procedure that can repair damage.

Alice Glenn's dizzy spells and shortness of breath were getting worse.

When Glenn, 89, passed out in her room in a Reedley assisted living center and was rushed to a hospital in February, tests showed her aortic valve was worn out.

Her heart was having to work too hard to pump blood through the valve to her body and needed to be replaced.

But having open-heart surgery to implant a new valve would be risky, and recovery would be difficult and long for Glenn, doctors at Saint Agnes Medical Center's valve clinic told her daughter, Linda Boyd of Selma.

Instead, Glenn was a good candidate for a new, minimally invasive procedure that would replace the valve without cracking open her chest, the doctors said.

Under transcatheter aortic valve replacement (TAVR), doctors could make a small opening in her groin and insert a catheter -- a small flexible tube -- through her femoral artery. A small replacement valve feeds through the catheter and expands inside the old, aortic valve. Once it's in place, the catheter is removed. The procedure is similar to balloon angioplasty, where a catheter with a device on the end opens up narrowed arteries in the heart.

Glenn had the surgery at Saint Agnes on April 23 and was discharged two days later. "I feel great," she said with enough gusto at an interview last month to make her doctors laugh. She is the hospital's first transcatheter aortic valve replacement patient -- and the first person to have the procedure in the central San Joaquin Valley.

Community Regional Medical Center also is performing the procedure and had its first patient on May 28, a hospital spokeswoman said. Community doctors insert the valve through a small opening in the chest or the femoral artery, she said. Both are accepted options.

Before the Valley hospitals offered the procedure, patients with aortic stenosis -- narrowing of the valve -- had to go elsewhere to have the procedure, or else they had to be able to survive open-heart surgery, which cuts through the chest bone.

But the new procedure is not cheap. The cost of the artificial valve is about $30,000, compared to $6,000 for older valves. And performing the procedure requires a team of doctors: Interventional cardiologists, cardiac surgeons and others. The federal Centers for Medicare & Medicaid Services pays for the procedure, which was approved by the agency in 2012.

Over time, the cost to the health care system decreases as patients who undergo the TAVR procedure have fewer admissions to hospitals for other symptoms, said Dr. Rohit Sundrani, an interventional cardiologist and member of the Saint Agnes valve clinic team.

The procedure also carries risks, including an increased risk of stroke.

It's not meant to replace open-heart surgery and is not right for everyone, doctors at Saint Agnes said. For every five patients evaluated with aortic valve disease, only one may be chosen for the procedure, they said.

But people who are too fragile or too sick for open-heart surgery can still benefit from valve replacement. "It's really revolutionary," said Alfred Valles, a Fresno interventional cardiologist.

Aortic valve disease affects 7% of the population over age 65, and 25,000 deaths occur yearly. Half of patients with symptoms from aortic valve stenosis do not live more than two years, said Dr. Richard Gregory, a Fresno cardiothoracic surgeon. Gregory and Valles are part of the Saint Agnes valve clinic team.

The TAVR procedure is gaining in popularity.

Doctors in Europe have performed the procedure for several years. Regulations for approving new cardiac devices in the U.S. are more strict than in other countries.

In the U.S., the procedure will become "less fantastic and more commonplace over the next decade," said Dr. Melissa Walton-Shirley, a Kentucky cardiologist in private practice. Walton-Shirley recommended her father have the procedure done about two years ago. And she has written about the procedure for a "Medscape" blog.

Hospitals that offer the procedure soon become busy doing them, she said. "Actually, people are dying waiting for this procedure because nobody else will touch them."

Boyd said her mother's health was declining rapidly before the valve replacement. The daughter of Armenian immigrants, Glenn had lived on the family's grape farm in Selma until about a year ago. A few months before the heart procedure, she had to be taken to the hospital about every five weeks. "It was a downward spiral for her," Boyd said.

Now, her mother plays bingo and participates in crafts at the assisted living center and can walk without being out of breath, she said. "She's doing really good and everything is checking out well so far."

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