Aortic valve procedure gives new life to high-risk patients
By Doug Boyd
ECU News Services
Joe Hofmann of Washington talks about his newfound energy following an aortic valve replacement procedure as his wife, Doris, listens. Photo by Doug Boyd, ECU News Services
(Feb. 13, 2012)
At nearly 86 years old, Joe Hofmann is looking forward to getting out and doing more.
That's because he recently received a new aortic valve in an advanced procedure led by a team of East Carolina University physicians and performed at the East Carolina Heart Institute at Vidant Medical Center.
"I couldn't walk five steps without having to stop to catch my breath," he said at his Washington home after wiping some dust off his Toyota pickup. With the new valve, he said, "I'm going to live another 15 years."
The new valve and the catheter-based procedure doctors use to implant it helps patients with stiff or narrowed aortic valves get back to more normal activities. It could soon be a standard of care.
The procedure, known as transcatheter aortic valve replacement, or TAVR, allows doctors to replace a worn valve without opening the chest. TAVR is considered to be less invasive than a traditional valve-replacement operation, which involves open-heart surgery. Candidates for a TAVR are either not good candidates for the traditional surgery or might be considered too weak or too old to undergo the surgery.
In the TAVR procedure, the valve is inserted with a catheter through either an artery in the leg (transfemoral) or by making a small chest incision and inserting the valve through the tip of the left ventricle of the heart (transapical). The TAVR can be performed by implanting the new valve and pushing back the old one.
"Many years ago, doctors could never fathom a valve replacement without opening the chest," said Dr. Walter A. Tan, an interventional cardiologist and associate professor of cardiovascular sciences at ECU. "It is a game-changing technology."
Patients will benefit from less invasive aortic valve replacements with faster recovery, less pain and fewer complications than are associated with traditional aortic valve replacement. Patients say they have more energy, and studies show better one-year survival rates compared to no therapy.
A team of ECU physicians performed the first TAVR procedure at the heart institute on Jan. 23 on an 85-year-old man from Elizabeth City. The team was led by Drs. W. Randolph Chitwood Jr., director of the institute and professor of cardiovascular surgery at ECU; Tan, who is also associate director of the ECHI cardiac catheterization labs; Curtis Anderson, a cardiothoracic surgeon and associate professor of cardiovascular sciences at ECU; Alan Kypson, a cardiothoracic surgeon and associate professor of cardiovascular sciences at ECU; and Ramesh Daggubati, a cardiologist and clinical associate professor at ECU.
While Hofmann received an FDA-approved valve that's been available since November, ECU physicians are also using a newer, more flexible model called the Edwards SAPIEN XT Transcatheter Heart Valve as part of a clinical trial. Tan implanted the first of these valves in the Carolinas last month.
"The ECHI has the unique distinction of being the only center in the world with a population less than a half a million people involved in this selective clinical trial because of our superb track record for innovation in cardiac care," Tan said.
While doctors have taken their time on these initial procedures, the process will typically take about 90 minutes to perform.
Hofmann had his valve implanted Jan. 30 and went home Feb. 3. He said he is breathing more easily and has more energy.
"I don't know that I would have made 86," said Hofmann, who also has diabetes and pulmonary fibrosis, which can cause shortness of breath and fatigue. "As I tell everyone, they gave me a new life."
Within the next five years, Tan estimated, a TAVR procedure will be the option for about 30 percent of patients with aortic stenosis.
The team has performed a total of three successful TAVR procedures.Update: The first patient to undergo this procedure died Feb. 27 in Elizabeth City of an unrelated illness.