STANFORD, California - 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 surgeon Craig 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," Miller said.
"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; Miller; Alan 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 treatment option."
"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 golf again."
By Linda Apeles