Tuesday, March 15, 2005

Valve Job...
From the New York Times: A Promising Recovery After a New Aortic Valve Procedure
A team of cardiologists in Michigan has implanted an artificial heart valve in a 76-year-old man by feeding the device through a vein in his left leg instead of opening his chest and stopping his heart.

The patient, Fernando Giangrande, had the three-hour procedure on Thursday, left the hospital on Sunday and was back at work yesterday customizing vintage cars at his Ford dealership. Replacement of the valve through open-heart surgery normally requires a week in the hospital and a longer total recovery time, assuming the patient was deemed strong enough to have the surgery in the first place.

The experimental implant was the first of at least 150 that federal regulators will require before considering approval of the technique for widespread use. But medical experts say the procedure could eventually extend the lives of many people who are too frail or ill to endure open-heart surgery. Failing valves are diagnosed in tens of thousands of Americans each year, and that number is expected to grow as baby boomers pass the age of 70.
Alas, endovascular valve replacement is not for everyone:
Medical experts warn that even if the technique is mastered, the heart repairs may not last as long as those achieved through conventional surgery.

Mr. Giangrande's doctor, Dr. William W. O'Neill, the chief of cardiology at Beaumont, said that in its current form, the technique is a last resort. "People who are good candidates for open-heart surgery should not even look into this," he said in a brief interview immediately after the procedure.
I remember when stent-grafting for abdominal aneurysms was limited to the same set of patients. The procedure was not without difficulty:
The first effort to deploy the valve failed when it became jammed in a passageway the team made through a wall in Mr. Giangrande's heart. When Dr. O'Neill tried to pull it back, the balloon inside the valve inflated. Unable to go forward, the team spent 30 minutes scrambling to move the valve back down the large vein that runs up the spine. They pinned it into the wall of the vessel just above his kidneys, where it is expected to have no impact on blood flow. A second artificial valve was attached to the catheter and, ultimately, successfully installed
I guess they had to install the valve antegrade because they may have not been able to seat the valve against the flow. I wonder if they used adenosine to temporarily stop the heart during deployment? An exiting development to say the least.
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