Heart Valve Replacement without Invasive Surgery

December 20, 2009

Light filters through decorative glass bottles and casts pools of color on stacks of books, past issues of the Smithsonian and New Yorker magazines, and programs from operas, plays, and concerts. The Brookside home of Rosemary Iwersen reflects the many interests of the 86- year-old woman.

But three years ago, her life started to narrow. She stopped her regular walk to Loose Park to admire the roses. Taking more than 20 steps robbed her of breath and tightened her chest with pain. This made it hard to attend the cultural events she so adored, as well.

“My condition was severely limiting what I could do,” said Iwersen, a tall, stately woman whose voice is soft and girlish.

She complained to Aaron Grantham, M.D., an interventional cardiologist at Saint Luke’s Mid America Heart Institute

He listened to her heart and heard the swooshing sound that signaled aortic stenosis. The aortic valve that controls blood flow out of her heart had narrowed to the point where blood was backing up into her lungs. Tests revealed a buildup of calcium deposits, causing her valve to become more like a dam than a passageway.

As Iwersen’s heart had strained to pump blood through the narrowed opening, it had enlarged and diminished in efficiency, causing congestive heart failure. Drugs could help her heart pump more efficiently, but only surgery could fix the problem.

The catch: Iwersen might not survive it.

“Once patients show signs and symptoms of aortic stenosis, their long-term survival is compromised. If they can have a successful valve replacement, their prognosis becomes normal once again,” said Saint Luke’s interventional cardiologist David J. Cohen, M.D.,“But for patients in their 80s with other medical conditions, there may be a 10 percent to 20 percent chance of having a major complication of surgery or even dying.”

There was, however, an experimental procedure.

On trial

Saint Luke’s Mid America Heart Institute was testing an artificial heart valve that doctors could insert through an artery in the leg without invasive surgery. The Heart Institute’s expertise in using catheters to solve heart problems prompted the FDA to include Saint Luke’s in the PARTNER (Placement of AoRTic TraNscathetER) Valve Trial.

Its aim is to assess the safety and effectiveness of the SAPIEN valve for patients with severe aortic stenosis.

“These valves hold the promise to change the practice of cardiology in the next five to 10 years,” said Dr. Cohen, colead investigator with Michael Borkon, M.D., a cardiothoracic surgeon at Saint Luke’s.

Dr. Cohen believes these valves can reverse the narrowing process and eradicate symptoms, like congestive heart failure.

Iwersen fit the criteria. Her valve problem came from aging, not a congenital defect. She hadn’t had a heart attack and her kidneys were healthy. Was she willing?

Iwersen eyed the list of side effects.

“The first one was death,” she said. “That didn’t scare me. I couldn’t have gone on with my heart valve like it was. I had nothing to lose.”

Second try

Iwersen became the second person to get the SAPIEN valve in September. Her medical team included two interventional cardiologists, a cardiac surgeon, a cardiac anesthesiologist, and an echocardiographer to assess images.

As staff pushed her into the operating room, she remembers announcing, “Here comes Rosemary.” That was all she remembers about the procedure.

After her femoral artery was open, Dr. Cohen threaded a small balloon catheter to her aortic valve and inflated the balloon to open her existing valve. Next, he inserted a larger, pencil-sized catheter on which the valve was crimped. He then threaded it into place.

The entire procedure took about two hours. Iwersen’s next memory was hearing someone tell her it all went well.

“I was glad to wake up,” she reported. “I didn’t experience much pain or discomfort afterward either. Everyone I encountered from the admissions clerk to the doctors to the nurses made my stay as pleasant as possible.”

She left the hospital three days later.

Rosier future

Within a month, Iwersen started to feel better. She doesn’t tire as easily and has more energy. She can stand up longer, which means she can cook her signature meat loaf and peanut butter cookies again.

“This has improved my spirit, too,” she said. A daughter who lives in Hawaii is coming to visit. First on the agenda is the Loose Park rose garden.