Medical Minute 5-16: Healing Hearts Without Heart Surgery

By: Vanessa Welch Email
By: Vanessa Welch Email

Her fountain. Her flowers. Her garden. This is where Gerri Schoolfield loves to be.

"I'm not an indoor person. I'd rather be outdoors anytime," said Gerri Schoolfield.

But last year, being outdoors - even going to the mailbox - was becoming difficult for her.

"I just wasn't feeling well at all, and I was just tired all the time."

She was diagnosed with a deadly form of heart disease: Aortic stenosis. That's a healthy valve on the right, but as people get older, their valves and blood vessels tend to get harder and calcify. 30% of people over age 80 develop it. 90% of those will die within two years if they don't do anything about it.

"It's really far more deadly than any of the malignant cancers."

For the last 50 years, the only option for people like Gerri was open heart surgery. But at 88, the procedure itself could prove deadly.

"It's really a lot, a lot to put people through."

Doctors at Miami's Miller School of Medicine are using a new procedure to treat the disease without surgery. Here's how it works: A catheter is placed in the leg or chest and is delivered to the heart. Then, a balloon pushes aside the diseased valve and implants a new device. The end result?

"As you'll see with Ms. Schoolfield, within months, you're totally back to normal," said William O'Neill, M.D., Professor of Cardiology University of Miami Miller School of Medicine.

"It's just so much better. I can work practically all day without stopping in my yard now, and I'm doing wonderful."

And so are her petunias.

For more information on other series produced by Ivanhoe Broadcast News contact John Cherry at (407) 691-1500, jcherry@ivanhoe.com.

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MEDICAL BREAKTHROUGHS - RESEARCH SUMMARY:

BACKGROUND: Aortic stenosis is a serious heart disease caused by an abnormal narrowing of the aortic valve. When the valves narrow to a significant degree, normal blood flow from the left ventricle to the arteries becomes obstructed, and heart problems arise and can ultimately lead to heart failure. Aortic stenosis is three-times more common in men than in women. (Source: Mayo Clinic)

CAUSES & COMPLICATIONS: There are three conditions known to cause aortic stenosis in adults:
• Progressive wear and tear of a bicuspid valve present since birth (congenital).
• Wear and tear of the aortic valve in the elderly.
• Scarring of the aortic valve due to rheumatic fever as a child or young adult.

Normal aortic valves have three cusps, but two percent of people are born with only two cusps (bicuspid valves). The bicuspid valves don't open as widely as three cusps would, and over time, excessive wear and tear leads to calcification, scarring, and reduced mobility of the valves, possibly resulting in aortic stenosis. This form of the disease is most commonly found in patients younger than 65.

The most common cause of aortic stenosis in patients age 65 and over is called "senile calcific aortic stenosis". As people age, the protein collagen in the valves deteriorate, and calcium is deposited in its place. The valve decreases in mobility, and narrowing increases along with scarring.

Rheumatic fever is an infection caused by the streptococcal bacteria. The infection severely damages the valves and causes narrowing. Aortic stenosis caused by rheumatic fever is relatively uncommon in the United States.

NON-SURGICAL HELP: Instead of open-heart surgery, doctors at Miami's Miller School of Medicine are performing a different kind of procedure. A catheter is placed in the leg or chest and is delivered to the heart. Then, a balloon pushes aside the diseased valve and implants a new device. This procedure is still in clinical trials but should become available later this year.

FOR MORE INFORMATION, PLEASE CONTACT:
Omar Montejo, Media Relations
University of Miami Miller School of Medicine
Miami, FL
(305) 243-5654
Omontejo@med.miami.edu

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William O’Neill, M.D., professor of cardiology at the University of Miami Miller School of Medicine, discusses aortic stenosis, and how treatment for this disease of the elderly has become less invasive.

Can you tell us a little bit about the study that you are currently involved in?

Dr. William O’Neill: We are part of a national study called the Partner Trial, which is a trial of an innovative way of treating deadly diseases of the elderly called aortic stenosis. We are enthralled to be a part of this national study.

Can you discuss aortic stenosis, and the risks that are inherent for these older people?

Dr. William O’Neill: Aortic stenosis is a disease of the elderly. It’s basically calcification and narrowing of the aortic valve. The aortic valve usually opens and closes without difficulty throughout life, but as people get older (70’s and 80’s) the valve starts to calcify.

How many people out of the elderly population have this disease?

Dr. William O’Neill: 1 out of every 3 people over the age of 80 has some component of aortic stenosis. As we treat a lot of other deadly diseases – heart disease, cancer and infections – people are living longer. The average age for a woman to live to right now is 78, so more and more people are getting into their 80’s and 90’s and this disease is really starting to affect all of them.

How deadly is this disease?

What is really important to know about the disease is that when people begin to become symptomatic . . . they have less than 2 years to live. This disease is in due course exceptionally deadly. It is really far more deadly than any of the malignant cancers. The fortunate thing is that there is really a very good treatment for it.

How did these patients respond to the old method of treatment in comparison to the novel less invasive methods?

Dr. William O’Neill: The traditional method of treatment for these patients is valve surgery. The surgeon goes in and cuts the breastbone open, opens up the chest, and then puts the patient on bypass and puts a new one in. People in their 40’s, 50’s and 60’s can usually tolerate that very well, but patients in their 70’s, 80’s and 90’s . . . well, it’s really a lot to put them through.

How do patients respond to having an invasive treatment that late in life?

Dr. William O’Neill: In my experience over the past 20 years, I have experienced countless patients say that they don’t want to go through with the surgery. They say, "Look doc . . . I don’t need to live that much longer . . . I’ve had a full life and I don’t want to have to go through the pain of having open-heart surgery." Before, there wasn’t much of an option for them; however, with these less invasive treatments they are very interested in having something that can increase their function as well as their quality of life.

Can you discuss the new-fangled method of putting the stent in that offers patients a less invasive form of treatment?

Dr. William O’Neill: The new treatment for aortic stenosis is putting a stent that is crimped on a balloon, and then the valves inside open and sit along the aorta valve. Usually we put the valve through a blood vessel in the leg and run the valve all the way to the heart and ultimately implant it there.

Are there ever any difficulties that come with running the valve through the blood vessels in the leg?

Dr. William O’Neill: Sometimes, the blood vessels in the leg of the patient may be too small, so the surgeon in point of fact has to make a small incision on the side of the chest – they will actually puncture the heart and once the valve is put in that hole is sown shut. This is a little more invasive, but it is no more risky than doing a regular open-heart operation.


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