STANFORD, Calif. — Patients previously deemed too sick to have
open heart surgery for aortic
valve replacement are now being offered a new, innovative and
minimally invasive treatment at Stanford Hospital & Clinics.
One of the first patients to have the procedure since it was
approved by the Food and Drug Administration is praising its dramatic
effects and thanking Stanford physicians for their life-saving
ingenuity. Gary Verwer, 76, was in despair earlier this year when he
developed a serious case of aortic stenosis, the most common type of
valvular disease, which was diminishing his ability to breathe, move
and even think. The traditional approach for valve replacement, a
surgery that requires sawing open the sternum and stopping the heart,
was too risky for an older patient like Verwer. A previous triple
cardiac bypass also presented physical barriers to further surgery.
Fortunately, Verwer's cardiologist referred him to cardiovascular
Miller, MD, and the heart
valve team at Stanford. After four years of successful clinical
trials with nearly 200 patients, Stanford had been approved by the FDA
as the first facility in the Bay Area to be able to use a new device,
the new transcatheter heart valve in patients like Verwer, who were
not good candidates for the traditional surgical approach. The
procedure is known as transcatheter aortic valve replacement, or TAVR.
Using a catheter, physicians guide the artificial valve to the heart
through a small incision in the groin or between the ribs. No internal
incisions are necessary.
"The treatment represents a major medical paradigm
shift—something to address an otherwise fatal disease in patients whom
we once could offer nothing but supportive care and counseling,"
"People estimate that perhaps 30 percent or more of patients
who have severe aortic stenosis who should get surgery aren't getting
it because of the risk," said Bill Fearon,
MD, a Stanford cardiologist who specializes in non-surgical
heart repair. "Aortic stenosis is a very common problem,
and many patients are at high risk with traditional open heart
surgery, especially those who've had prior open heart surgery. It's
become more and more of an issue because our population is getting
older and older."
Verwer's procedure involved a full team of Stanford physicians. With
support personnel, the Stanford team tallied 20, including Fearon;
Yeung, MD, director of interventional
cardiology; cardiac surgeon Michael
Fischbein, MD; three cardiac anesthesiologists; and physician
specialists in echocardiography and cardiovascular radiology.
"We feel it's very important to have the cardiac surgeon's
expertise on how to deal with the valve and the cardiologist's
expertise on how to deal with the insertion," Yeung said.
"It's a hybrid, a convergence."
"The device has really advanced the treatment of aortic
stenosis with a team approach," Fischbein said, "with
cardiologists and cardiac surgeons working together, bringing their
experience to the table."
Seeing the difference the device has made in the lives of his
patients "has been most gratifying," he added. "After
the valve replacement, it's like night and day. It's an incredible
technique that offers so much for patients who really had no other
"I feel alive again," Verwer said. "I feel I can do
anything I want, and I've got my positive outlook on life again. I'll
be dancing with my granddaughter at her wedding, and I'll be playing