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Mark Robbins, M.D., left, John Byrne, M.D., and David Zhao, M.D., perform the new trans-catheter valve-replacement procedure in Vanderbiltís hybrid OR. (photo by Daniel Dubois)

VHVI debuts novel treatment for aortic stenosis

BY: JESSICA PASLEY

7/14/2011 - Doctors at the Vanderbilt Heart & Vascular Institute have successfully performed the state’s first trans-catheter valve-replacement procedure.

Nearly 200,000 people each year are diagnosed with aortic stenosis, a narrowing of the main valve allowing blood to leave the heart.

Seventy-five percent of those diagnosed are deemed high risk or ineligible for open-heart surgery – the standard therapy.

Now, doctors at Vanderbilt are able to use a minimally invasive catheter procedure to help this group of patients.

Fifteen patients are currently enrolled in the Medtronic CoreValve System U.S. Clinical Trial at Vanderbilt.

Crossville’s George Ellenberg, 85, was the Medical Center’s first recipient of the novel valve replacement technique. Acceptance into the trial saved his life.

“There are no other options for this group of patients,” said David Zhao, M.D., director of the Cardiovascular Catherization Lab and Interventional Cardiology. “With this new procedure, there will be a 20 percent reduction in mortality.

“This is transformational technology and can potentially save thousands of lives.”

Ellenberg, who was discharged home on Monday, feels “very fortunate” to be given another chance at life.

The surgical team for the new minimally invasive catheter procedures included (front row, from left) Marshall Crenshaw, M.D., Waylon Cotter, Ida Oudomsouk, R.N.2, Eberhard Grube, M.D., (middle row, from left) Chi Curtis, R.N.2-CC, David Zhao, M.D., Joseph Fredi, M.D., Lynn Blair-Anton, RNS-IV, Jerry Talbert, (back row, from left) Kevin Daigle and Bill McGee.  (photo by Lauren Owen)

The surgical team for the new minimally invasive catheter procedures included (front row, from left) Marshall Crenshaw, M.D., Waylon Cotter, Ida Oudomsouk, R.N.2, Eberhard Grube, M.D., (middle row, from left) Chi Curtis, R.N.2-CC, David Zhao, M.D., Joseph Fredi, M.D., Lynn Blair-Anton, RNS-IV, Jerry Talbert, (back row, from left) Kevin Daigle and Bill McGee. (photo by Lauren Owen)

“He is doing wonderfully,” said Carol Ellenberg, his wife. “I really don’t know what we would have done had he not had this procedure. Over the last two months, his breathing was getting really, really bad. This was his only chance.”

Last week, the VHVI team, comprised of Zhao, John Byrne, M.D., Joseph Fredi, M.D., Mark Robbins, M.D., and Marshall Crenshaw, M.D., successfully replaced valves in three patients and all are doing well.

The multi-disciplinary team also includes Lisa Mendez, M.D., Mike Baker, M.D., Robert Deegan, M.D., Susan Eagle, M.D., and teams from the cath lab and operating rooms. The procedures are performed in Vanderbilt’s hybrid OR.

An additional three cases are scheduled for this week. Zhao anticipates performing at least four valve replacement procedures a week using the newest technology.

This image shows the artificial aortic heart valve as its being guided by catheter to the patients heart. (photo by Lauren Owen)

This image shows the artificial aortic heart valve as its being guided by catheter to the patients heart. (photo by Lauren Owen)

The valve is a Nitinol-frame with hand sewn bits of bovine heart tissue.
Using trans-catheter aortic valve implantation, an artificial aortic heart valve is attached to a wire frame and guided by catheter through the groin to the heart.

Once in place, the wire frame expands, allowing the new aortic valve to open and begin to pump blood.

Compared to the four to six hours typical in open-heart surgeries, this procedure calls for a smaller incision and takes about 90 minutes to complete.

Doctors are encouraged by the potential cost savings for both the patients and the Medical Center.

It is too soon to determine quantitative cost savings, but they will be substantial, according to Byrne, the William S. Stoney Professor and chair of the Department of Cardiac Surgery.

Major factors contributing to savings include reduced hospitalizations, lower infection rates and shortened procedural times.

“Although we don’t have the data yet, there will probably be a significant cost savings,” said Byrne. “The length of stay for patients who received the newest technology is three to four days compared to a seven to 10 day hospital stay for open heart procedures.

“This is the single most important and transformational advancement in cardiovascular care in more than 30 years,” he said.

Zhao and Byrne, principal investigators for the Vanderbilt trial, agree the non-surgical valve replacement technique will become a standard therapy in the next three to five years.

Zhao is also the Harry and Shelly Page Professor of Interventional Cardiology.
 

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