Minds of Medicine: Solving Heart Valve Problems without Surgery – TAVR

Minds of Medicine: Solving Heart Valve Problems without Surgery – TAVR


Imagine having a heart attack and a stroke
and being told there was nothing more doctors could do. In my case, 10 years ago, I would
be having to prepare for death. That was — would be the only viable option for me. Now imagine
you’re a young man. You’re faced with the prospect of a second open-heart surgery that
would take away your ability to do the one thing you love. It was kind of scary to hear
that, you know, you’re going to do mechanical valve, you’re not going to be able to play
contact sports. And it’s not just soccer, I mean, I like playing basketball and other
sports as well where there’s some contact. Right now I’m still 32 years old, I should
be active, I should be playing sports. For both men, their best chance is a procedure
doctors call TAVR, or Transcatheter Aortic Valve Replacement. It will give them the new
valves they need without a single chest incision. I think that’s kind of how we’re working it,
for the spirit of innovation. Patients kind of get sent to us with incurable problems
and we have to try to find solutions. It’s the future of heart valve replacement, and
it’s being pioneered right here in Detroit. But will it be enough to save both men’s lives? These are the Minds of Medicine; this is their story. Hello, and welcome to Minds of Medicine. I’m Paul W. Smith. Our hearts are incredibly complex
organs. To keep us healthy, they must beat in perfect rhythm, pumping over 500,000 gallons
of blood throughout our body each year. The valves that keep this blood moving also must
seal and open effectively, to keep us feeling healthy and energetic. Even a small leak around
these valves can put our lives at risk. There are numerous ways that people develop valve
problems: some people are born with them, others have infections of the heart that lead
to valve problems later in life, and in other circumstances it’s just a normal part of aging.
There are just simply patients who would not benefit from the intervention because of their
lack of ability to undergo a surgical approach. Now, Dr. Adam Greenbaum and the team at the
center of some of the country’s most promising heart discoveries is innovating once again.
They’re offering new, life-saving options to the patients who need them most. In the
last year or two, it’s harder to do exercising. I used to in the summertime especially ride
my bicycle and go on hikes with my wife, take some short trips. And that’s been more and
more restrictive, especially in the last year. This past year, I haven’t been able to do
any of that, and it was clear to me that my heart just was not functioning at a level
that I was happy with, and that I was developing more and more health problems as a result
of it. After exhausting every possibility, Lou Mleczko turned to the Center for Structural
Heart Disease at Henry Ford Hospital, and the man who launched this new field of heart
valve repair, Dr. William O’Neill. Well, Lou has been cared for here in Henry Ford Health
System for a number of years, he’s had chronic problems with his heart but last summer he
presented with congestive heart failure. His lungs were filling with fluid and non-invasive
studies and echocardiograms showed that his heart was very weak. It wasn’t contracting
very well, so he was seen by our heart failure service, and they recognized very quickly
that he had a really bad problem, a combination of a very weak heart but also a very damaged
aortic valve. And so, that’s how I first met him, he was in really poor condition, in severe
congestive heart failure, fluids basically filling up his lungs, and in dire straits.
It was not a good long-term prognosis: within a year or two, my heart would continue to
enlarge, would weaken further, and ultimately I would die. That was the future facing me.
I’m only 67 years old, only, and I wasn’t ready to face the prospect of dying within
a year or two and being in poorer health every step of the way until that development of
death. They said that the blockages and the deterioration of the aortic valve are at the
point now where we have to do something to take care of that. And with the valves, that
meant replacing the aortic valve. Traditionally, that’s been open-heart surgery, where they
open your chest and stop your heart and replace the valve on that basis. But they told me
that I was not a candidate for open-heart surgery, that the Henry Ford doctors did not
want to risk that, but they said that “We have a good plan B for you.” The procedure
to repair Lou’s ailing heart involves the use of a small catheter. With it, doctors
will move a new collapsible valve through the artery leading to his heart. Once positioned,
doctors use a balloon to open the new valve. This pushes the old valve away, and if successful,
will allow Lou to return to his active lifestyle. Well, my wife and I like to go up to northern
Michigan, Sleeping Bear Dunes, do some hiking, or perhaps take some longer trips out east
or out west where I can enjoy a vacation trip and the stresses of being on the road without having to worry about your heart and your body telling you, “No, this isn’t good for you, slow it
down.” But just being able to resume normal activities like that, or even just coming
to the gym here in Grosse Pointe Park to exercise, or walk out by the pier and watch the freighters
in the summertime, those are all experiences that I wanted to continue to do without having
to feel constrained or not feeling up to it. When we come back, we’ll learn more about
Lou’s incredible heart valve replacement, and meet one of the youngest patients to ever
receive a new heart valve using this approach. At any time, you can go to henryford.com/structuralheart
and schedule a consultation. Stay with us. Heart problems can strike at any age — some
occur even before birth. And when valve problems threatened the life of 32-year-old Andy Smith,
doctors must look for options that can last a patient for decades, not just years. I was
born with a bicuspid valve, which means I was prone to infection, it was doing twice
the work of a regular tricuspid valve, and at one point I had strep throat, and it got
through my gums into my, down to my heart is what they were saying. I was never diagnosed
with strep throat, I usually didn’t go in to the doctor for sore throats, but at some
point I had strep, it ate my heart valve away, and that’s what caused the first problem.
Andy is amazing, is an amazing person, but also a little bit of an unusual circumstance.
He’s a young guy, early thirties, was born with a congenitally deformed aortic valve
and so at a young age in his twenties he had a surgical valve implanted. And the reason
that that was chosen was because the surgical valves that were used, the tissue valves that
were used, don’t require blood thinners (Coumadin or other medications to keep the blood thin)
and he could go back and have a normal life. He was a young guy, he was a soccer player,
he was a soccer coach, and he wanted to be able to continue with contact sports. So,
that worked fine but the valve aged about 10 years after. These valves tend to last,
these tissue valves, tend to last for 10 to 15 years, and once they start to degenerate
then typically you have to have another operation to change the valve. And, so now you’ve got
a guy that’s 32 facing another problem and he was becoming very symptomatic so he really
couldn’t do anything. You know, he’d become an 80-year-old person and he needed something
to be done and when the tissue valves start to degenerate they really fall apart quickly.
Although Andy could have chosen open-heart surgery and a permanent mechanical valve,
he also would have to take blood-thinning medication for the rest of his life, eliminating
his participation in soccer or any contact sport. Andy’s cardiologist in Traverse City
recommended that he visit one of the most experienced structural heart teams in the
region, so he traveled over 250 miles for his transcatheter aortic valve replacement,
a procedure that would allow him to get back to an active lifestyle almost immediately.
The procedure took about two hours, and he was home literally in 23 hours. He was out
of bed that afternoon, up in the chair the next morning, and home the next afternoon.
So, it was almost like, I mean to me I’ve been doing heart catheterizations since 1979.
The heart catheterization then would require a two day’s length stay in the hospital, we’d
do a heart catheterization, they’d stay overnight, they’d go home the next day. Now we’re changing
heart valves with the same kind of length of stay that we did, you know, with just a
regular heart catheterization. That’s just amazing how much the procedure has changed
and how less invasive it’s become. I think the main takeaway from this is just how amazing
this procedure is. I mean, I was in the hospital having my valve replaced and later that day
was fine, able to walk and do things. It’s just amazing where we’re at, they go in through
your leg, they come down into your heart, they place it there. It’s just, it’s really
cool what they can do and I think that is the biggest change on my life is just being
in awe of what technology, and medicine, and what they’re doing at Henry Ford, and all
over the place. So it’s kind of cool to be a part of that. It was just really nice to
have the ability to walk and feel better right away, whereas open-heart you don’t have that
feeling. Like Andy, Lou Mleczko will need a new aortic valve to reverse his quickly
deteriorating heart. Weeks earlier, he underwent angioplasty and stent placement to open up
clogged blood vessels. Once Lou recovered, the Structural Heart Team at Henry Ford Hospital
was ready for a procedure that would change Lou’s life. So did you feel much different
after we did the valvuloplasty and the… have you felt any better? Yes, yes I did.
I was able to resume the treadmill exercising but at a reduced pace. I could go up to about
3.1 miles an hour at a two and half percent grade for a half hour. If I tried to go faster,
I would start getting the expelling of air and a weakness in my leg so I would ratchet
it back down to 3.1. You know, what happened was just that the heart wasn’t moving at all,
and once we opened up the blood vessel and the valvuloplasty the heart function was actually
improved dramatically. And, but we have to put the new permanent valve in otherwise the
thing will re-narrow and you’ll get back to square one. Back to where I was with the — So
this is kind of like the optimal time to do this. So the procedure, again, to just sort
of go over: you’re going to get put to sleep, then we’re going to put tubes in both of the
blood vessels in your leg — oh both sides — yeah, and then we’re going to put the catheter
in and put the valve in. And when you wake up, you’re going to have a new valve. Looking
forward to that part. This is a new type of valve and it sounds promising. As we’ve seen
here with our Structural Heart Disease program, over the past several years, has now grown
into various other areas, closing defects, and what we do now is really capturing the
imagination of many is replacing heart valves. And that’s a much bigger advance than just
changing the size of the incision; from the standpoint of the patient, the advantage of
having a catheter-based intervention rather than an open-heart procedure is not really
the absence of the incision, although that’s frankly what the patients seem to think most
about, it’s really the avoidance of the heart-lung machine, stopping the heart, opening the heart,
and doing all of the technical aspects of an open-heart procedure. In surgery, Dr. O’Neill
is joined by cardiac surgeon Dr. Gae Paone, along with cardiologists, anesthesiologists,
nurses, and radiation technologists all focused on saving Lou’s life. In the transcatheter
valve procedure, you’re not doing it under vision, you’re doing it looking at shadows
on a screen and the most difficult part is making sure the valve is well deployed because
there is no fixing it, for the most part, after that. Carefully, the valve travels through
his aorta to within millimeters of its intended target, directly inside his old valve. In
a moment, they will deploy the new valve, crushing the old valve against the heart wall.
Okay I’m coming around the arch now, I’m going around the arch. Alright we’re going to go
ahead and deploy the valve now. Okay, respiration’s off, please. Pacer on, please. Respiration’s
off. Inject. Let’s find a good…yeah that’s good. All the way. As the device is deployed,
Lou’s fragile heart becomes unstable, keeping the new valve from operating properly. The
team will have to make a second attempt at opening the valve using the balloon. They
must do all of this while trying to prevent cardiac arrest. What about paravalvular? We’re
going to cross the valve again. We’re going to do another inflation, please. Tell me when
you’re ready. Pacer on, please. Okay, pacer off. Finally, the valve is placed. Although
they will need to watch for leaks in his other valves, Dr. O’Neill can share a moment of
satisfaction. Well, we had a little more drama than we’d hoped for. His blood pressure was
very very unstable and we were working with Dr. Mike Eisley, our anesthesiologist, to kind
of try to support him during the procedure. He should notice the difference within a week
or so, I mean, once he gets out of the hospital I think he’ll notice a big improvement in
his shortness of breath. We’re going to keep him in the hospital for a few days just to
do some fine tuning but when he goes home he should be dramatically better. When we
return, we’ll follow Lou’s recovery, and we’ll see the 3-D technology Dr. O’Neill and his
team are using to plan these difficult procedures. We’ll be right back. This is a 3-D printed
cross-section of Lou’s heart. With models like this one, Dr. O’Neill and his team can
plan some of their most challenging cases, creating a safer procedure and improving outcomes.
This model was created right here at the Henry Ford Innovation Institute, under the direction
of Dr. Dee Dee Wang. My primary role is to do periprocedural imaging planning for these
high-risk, complex cases they do from a non-surgical approach. I use imaging modalities like CT,
MRI, echo, ultrasound, to get an idea of what your heart looks like inside your body before
even going in to do your case. Seeing something that you didn’t anticipate is the beauty of
3-D printing; never before, if you think of medicine, has a physician or anybody in the
medical field, been able to feel a patient’s body without ever making a cut on them or
opening their body up and causing pain. And, the magic of this is I actually have a 3-D
print in front of me, so this is a patient’s anatomy right here, and they have a surgically
placed valve in here. We can see this, but the 3-D is, you can feel it now. I can feel
how big the top part of the heart is. I can feel how big the lower part of the heart is.
But one thing I can do is when I turn this around, I can put my hand in here and look
at what valves will look like at certain heights, high or low, so I know if I will cut off blood
flow to a critical organ. This is when it becomes shocking, and this is how you prevent
deaths on the table. This is where this is really important right now to patient care.
We’ve come initially looking at hearts in two dimensions we have an x-ray, a chest x-ray,
or cath x-ray and hearts are not flat, they’re circular, they’ve got different dimensions,
and trying to figure out the orientation of one structure to another in sizes is really
difficult with the current techniques that we have. And so, what we’re doing now with
the 3-D modeling and with the 3-D imaging is actually creating exact, life-sized replicas
of structures so that we can go in and examine them and take a look at the orientation and
then see exactly how devices would fit, what type of device and how they would fit. Whether
they would interact with other structures in the heart. All of that is really, it makes
the procedure so much more predictable. There have actually been cases where based on the
3-D models we turned patients down, because the risk of what we were going to be doing
was too great, or that we didn’t have the right sized catheter that would fit, so it’s
refining our ability to correctly guess the correct size and the correct structure that
we’re going to be putting in. So it’s been an enormously helpful tool. And the fruit
of this careful planning is Lou Mleckzko Just weeks after his surgery, he returns to visit
his cardiologist, and report back on his recovery. Mr. Mleczko, how are you? Dr. Williams, excellent.
You look fantastic. I feel good. Oh that’s awesome. I’m not having any shortness of breath
or feeling tired, this is the best I’ve felt in a couple years. Well, that’s awesome. That’s
so good. So I know when you were first taking care of me — it wasn’t like that — I was
having problems. You know, Mr. Mleckzo has improved significantly. You know, he’s active,
he’s exercising four times a week, he doesn’t have any symptoms, and he’s happy. You know,
he’s very happy with the quality of his life. It’s amazing, you know, we didn’t have to
— he didn’t have open-heart, so he was very mobile. He went home the next day, he’s exercising,
so we’re very impressed with his recovery. Well since the valve was inserted in early
November, it’s been a little over two and a half months now, and I feel extremely good.
My health in all respects is normal as far as I’m concerned. I know I still have cardiovascular
disease and I have to be aware of that and my diet and exercising, but before and after
I feel so much better. I have more energy, I’m not having the symptoms of shortness of
breath, I just feel stronger overall, and I’m very pleased with the outcome. It’s given
me hope that I still have a number of years and I feel with this procedure I can still
do things that my wife and I were planning to do and were hoping to do. I’m really grateful
for that opportunity. To me, what’s amazing about this field today is that we are coming
up with solutions for patients that have problems that we didn’t think previously reparable.
They gave me the ability to go through a whole change within the heart without having the
pain, without having time away from, you know, life. It’s really cool, the favorite day of
the week for me is in the clinic where we see the people for the one year, for the one
month and then the one year follow-up because they really just notice a miraculous improvement
in their quality of life and just going from completely bedridden into becoming active
and again I think you can see both Lou and Andy are good demonstrations of how well people
do. I think all of my staff, entirely, get totally geeked by seeing how well the patients
do after the procedure. Your heart’s health can impact nearly every aspect of your well-being,
so don’t put off taking care of it. If you, or someone you care about, need a second opinion
or a Heart Smart screening, immediate appointments are available. Go to henryford.com/structuralheart
to learn more. Thanks for watching. If you’d like to watch past episodes of Minds of Medicine at any
time, go to henryford.com.

3 Replies to “Minds of Medicine: Solving Heart Valve Problems without Surgery – TAVR”

  1. Dear doctor please help me in my mitral valve and aortic valve im in Philippines🇵🇭 please help me i cant afford to go there or afford to surgery please 😢 may God bless🙏 you ..and to all doctors im 42 rears old single…i want a new life to live😢

  2. how much does this cost doc?
    I have my little brother he is only 15 and he has TR due to infection please tell me your address!

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