Less invasive repairs let more patients bypass open-chest surgery
Brad Gale had already endured open-heart surgery in 2003 along with the many weeks of recovery.
So when doctors told him he’d need more surgery – this time a heart valve replaced – he dreaded the thought of going through the ordeal again.
“I knew I wanted something different,” the retired Lockheed Martin executive said.
Fortunately, his cardiologist had heard about a surgeon at UT Southwestern Medical Center who is one of the few in the country specializing in repairing and replacing heart valves using less invasive techniques.
Dr. Neelan Doolabh, Director of Minimally Invasive Heart Valve Surgery at UT Southwestern, replaced Mr. Gale’s aortic valve by entering through a 2-inch opening between the ribs rather than sawing down the sternum and cracking open the rib cage.
“I didn’t have any rib pain or chest pain,” Mr. Gale said.
Dr. Doolabh, Associate Professor of Cardiovascular and Thoracic Surgery, is among a select group of specialists who wield special, extra-long surgical tools through small incisions in the patient’s side to replace valves, remove tumors, and repair holes and arrhythmias (irregular heartbeats) in ailing hearts.
If the patient is not a candidate for surgery, other surgeons and cardiologists are turning to collapsible heart valves, stents, and other devices that can be loaded onto a catheter tube and delivered to the heart by snaking the catheter up from the groin, through the arteries, and to the heart.
The result?
“You’re seeing fewer and fewer open-chest procedures performed,” said Dr. Mark Link, Professor of Internal Medicine and a nationally renowned heart arrhythmia specialist who uses minimally invasive catheter techniques to treat arrhythmias.
Trending toward less invasive
Earlier this spring, UT Southwestern became only the second center in the nation to implant a new, customized stent device using minimally invasive techniques. The device acts as a protective sleeve in the aortic arch, with branches for the three related arteries that come off it as it curves just above the heart. The four catheter-delivered stents can carry blood past a bulge (aneurysm) or a tear in a damaged aorta.
Dr. Carlos Timaran, a vascular surgeon and Professor of Surgery at UT Southwestern, performs the procedure under special permission from the Food and Drug Administration. He is one of only two surgeons in the country who have implanted such a device under an FDA physician-sponsored investigational device exemption to make this procedure a possibility for patients.
Another leading-edge procedure brought UT Southwestern success last year. Surgeons began using the Watchman, a small catheter-delivered device that blocks off a bulge in the left atrium where blood clots can form and lead to strokes. The collapsible device, once implanted into the heart, looks like a tiny jellyfish with wire tentacles.
Other devices are allowing UT Southwestern specialists to replace damaged heart valves – the flap-like openings that allow blood to flow from one chamber to the next – in the catheterization lab rather than in operating rooms.
“More and more of these procedures are being performed in the cath lab rather than in the operating room,” said Dr. Joseph A. Hill, Chief of UT Southwestern Medical Center’s Division of Cardiology and Professor of Internal Medicine and Molecular Biology. “As a result, patient satisfaction is substantially improved and recovery times are vastly shortened.”
Pioneering technologies benefit older patients
Dr. Sarah Gualano, Medical Director of the Cardiac Catheterization Laboratory at William P. Clements Jr. University Hospital, said the academic medical center has been instrumental in pioneering many of the less invasive approaches that can provide new options for children as well as older patients, who may not be able to survive open-heart procedures.
“About 40 percent of people needing an aortic valve replacement were not getting an operation because they were thought to be too high risk for it,” noted Dr. Gualano, also Associate Professor of Internal Medicine. “There were a lot of people not being treated, which can be fatal.”
UT Southwestern doctors performed the Medical Center’s first aortic valve repair using TAVR (transcatheter aortic valve replacement) in 2013 and since then have placed more than 275 valves with the procedure. UT Southwestern doctors also are able to offer another catheter-delivered device, the MitraClip, to coax a leaky mitral valve to close more tightly.
Children now benefiting too
At the other end of the age spectrum, children born with congenital heart disease also are benefiting from less invasive procedures, said Dr. Michael Luna, an interventional cardiologist and adult congenital heart disease specialist.
“Some of these children went through three, four open-chest surgeries to repair heart defects,” he said. “Previously we would have to operate on them over and over and over.”
The repeated surgeries caused tissue to break down, said Dr. Luna, also Assistant Professor of Internal Medicine. And exposure to antibodies in blood from various donors put the children at greater risk of organ rejection if they needed a heart transplant later in life – which many did, he said.
Before these latest advances, most children with congenital heart disease died before reaching adulthood. “Now, more than 90 percent live into adulthood, and a significant number will need further repairs throughout their lifetimes as the early fixes wear out or the children outgrow them,” said Dr. Beth Brickner, Co-Director of the Adult Congenital Heart Disease Program and Professor of Internal Medicine. “So the less invasive nature, easier recovery, and lower cost for catheter procedures make a difference.”
Levester Hughes Jr., a 28-year-old detention officer from Cedar Hill, said he cried for days last year after learning he would need another valve repair.
Officer Hughes was born with a malfunctioning pulmonary valve and underwent open-heart surgery as a baby. Though he was too young to remember the operation, as a child he often felt embarrassed by the large scar left behind. By his senior year of high school, he needed another open-heart procedure.
“When I laughed, it hurt. I was scared to touch myself because of all the metal stitches in my chest,” he recalled.
For Officer Hughes’ new valve replacement in 2017, Dr. Luna was able to use a TAVR valve placed via catheter.
“I was able to go about everyday activities in three days and back at work in 13,” Officer Hughes said. “I would prefer the catheter any day. It was a whole lot easier and better.”