Mission offers new heart surgery option

When Claire Orenzow‘s replacement heart valve failed eight years after it was surgically implanted, the symptoms were excruciating.

“I had terrible pained breathing,” says the 87-year-old Asheville woman. “My lungs filled up completely with water. I had to be taken to the hospital [last November] in an ambulance.”

Doctors at Mission Hospital repaired Orenzow’s ailing heart with a new procedure called valve-in-valve replacement that offers significant benefits over traditional open-heart surgery.

Orenzow says she left the hospital a few days after the operation feeling like a new woman.

“It’s just amazing to me,” she says. “It’s a miracle I’m still walking around. I’m still enjoying my children and my grandchildren.

“Because of my age, they didn’t want to break my chest open again, and they said we’re going to try something new. It’s just marvelous.”

Dr. William Abernethy, a cardiologist and director of Mission’s Cardiac Catheterization Laboratory, says open-heart surgery is usually an effective way to replace heart valves that have become blocked.

“These valves are delicate structures and can become obstructed and hardened as we get older,” he says. “There is no medicine that makes that better. The only way to relieve that is to replace the valve. This is a standard procedure, and it’s done over 100,000 times a year in the U.S. The operation works very well, and it’s done very commonly here at Mission.

“People feel fantastic after the valve’s been replaced. It’s like their heart has been turbocharged.”

But there are drawbacks that make the open-heart surgery riskier for some patients.

“It is a big operation,” Abernethy says. “It involves opening the breast bone, use of a heart-lung machine, stopping the heart, taking the old valve out and putting in a new valve.”

Several years ago, French cardiologist Alain Cribier developed trans-catheter aortic valve replacement. It’s a better option for some patients, says Abernethy, and involves inserting a new valve via a catheter. There’s no need to cut through bone, stop the heart or cut the old valve out, he explains.

“The advantage is it’s much easier to recover from that type of approach,” Abernethy says. “It’s the preferred treatment for replacing a valve when people are too frail to be operated on. We’ve been doing this for a few years now, and it’s been a big advance for our patients.”

More recently, with approval from the U.S. Food and Drug Administration, trans-catheter valve replacement has been extended to patients, such as Orenzow, who previously had valves replaced. Abernethy says doctors at Mission started using valve-in-valve replacement on those type of patients a few months ago. The need is growing, he says.

“This is an increasing problem because, No. 1, people are living longer,” he says. “Life expectancy has improved. The problem with those biologic valves is they have a life span. Up to 30 percent have problems within 15 years. Then we are talking about a person needing another operation, and that is more difficult, because when we reoperate on a valve, even in low-risk individuals, the chance of mortality is doubled.”

The valve-in-valve replacement procedure involves the doctor compressing the new valve, placing it on the end of a delivery catheter, and inserting it into an artery in the leg or neck or through a small incision between the ribs. Doctors push the catheter through the blood vessels until it reaches the old valve. They release the new valve, which stretches open inside the old one.

Abernethy says the procedure has been performed successfully on several patients at Mission.

“It has really helped individuals who really had no alternatives otherwise, and they have done extremely well,” he says. “It just restored their quality of life in a tremendous way. We’re excited about this. It’s a fairly rapidly evolving field.”

Orenzow says she recovered from the procedure much more quickly than with her previous open-heart surgery.

“I just have a tiny scar there on my left side,” she says. “It’s unbelievable what they performed. In three months I was doing everything. The last time it took me a year. I feel wonderful.”