A minimally-invasive aortic valve
replacement (AVR) approach being pioneered by BC surgeon
Dr John Webb means frail patients could now be candidates
for heart surgery. The groundbreaking procedure was
presented at the Canadian Cardiovascular Congress in
Quebec City on October 21.
Dr Webb and his team at Vancouver's
St Paul's Hospital have been working on two versions
of the fluoroscopy-guided percutaneous technique for
AVR, transarterial (through the femoral artery) and
transapical (through the apex of the heart).
The new valve is mounted on a balloon
which is guided to the damaged valve via a catheter.
When the diseased valve is reached, the balloon is inflated,
expanding the new valve inside the old one, which is
then pushed out of the way.
The procedures are still experimental
and have been limited to high-risk, elderly patients.
But Dr Webb is very optimistic. "These patients had
been rejected for surgery because they had a one in
three chance of dying," he said in a press release.
"So we took them on and our mortality was one in 10
after 30 days." What's more, patients' recovery time
is drastically reduced.
Only 100 have been performed so
far in Canada, but studies are ongoing across the country,
and in the USA and Europe, to determine the long-term
effects. Once that's established, Dr Webb expects it
will appeal to those with less morbidity as well.
AVR is performed on over 13,000
Canadians with leaky or blocked valves, which can lead
to heart failure or angina. Conventional valve replacement
involves sawing the breast bone in half, stopping the
heart and putting the patient on a heart/lung machine,
while the old valve is substituted for a new one. But
the operation has high mortality and is considered too
risky for many patients, including the elderly with
co-morbid conditions.
|
