A minimally invasive procedure produces positive results at Hoag.
Healthy people don’t generally think too much about how well their
heart is beating, that 24 hours a day when it’s continually pumping
blood to the far reaches of the body. But when the heart isn’t working
the way it should, particularly the aortic valve, the symptoms are obvious.
For people whose heart valve has aged and can’t open and close fully—a
degenerative condition called aortic stenosis—their hearts are forced
to push really hard to pump blood. This may result in chest pain, trouble
breathing and passing out, or more subtle symptoms like constant fatigue
and difficulty in simply walking around, according to
Aidan R. Raney, MD, a board-certified cardiologist at
St. Joseph Heritage Medical Group in Orange. “People will decrease activity to avoid the symptoms,” he says.
Now, a new minimally invasive surgical technique that replaces a bad valve
with a new one is being performed by doctors around the country—Dr.
Raney, an interventional cardiologist, is one of them. The procedure offers
a major improvement in life quality and prognosis for older and generally
very ill patients.
This new technique is faster and simpler than older valve replacement procedures,
Dr. Raney says.
“What we did in the past was open heart surgery to replace the valve,”
he says. “This meant cutting the breastbone, cutting out the old
valve and stitching on a new one made of pig or cow pericardium.”
Patients with symptoms and severe aortic stenosis usually need immediate
treatment. If they do nothing, says Dr. Raney, they have 50 percent chance
of dying in two years.
“Instead of opening the chest wall and cutting into the aorta, we
place a catheter—a hollow tube—into the femoral artery in
the leg, advance it upward into the aorta, then put a wire into the heart,”
explains Dr. Raney. “Over the wire we put a new heart valve that
is mounted on a tiny balloon—we blow up that balloon, expanding
the new valve on a metal frame, and pushing the old one out.“ The
balloon is deflated and removed via the catheter, with the new valve staying in place.
Just before the procedure, the patient gets a temporary pacemaker, so that
for the short 10 seconds that the new valve is deployed, the heart is still.
Dr. Raney performs this procedure at Hoag, currently the only hospital
in Orange County with the cardiologists, surgeons and the technology to do it.
The first trial for the technique was done mainly in high-risk patients,
a group who could not safely get through major surgery. “The results
have been great,” says Dr. Raney, who has performed the new technique
alongside his father, who is a surgeon at Hoag.
“Most of the patients for this are elderly—people with valve
disease tend to be in their 60s, 70s and 80s. One gentleman was 102,”
says Dr. Raney, adding that the patient did well during and since the
A heart valve is not just a single flap, but rather three connected flaps
or “leaflets,” that create a Y-shape opening. Through the
catheter, a tiny metal frame expands in the valve and a balloon opens
up to place a new valve over the damaged one.
In order for Dr. Raney to perform the replacement successfully, a 3-dimensional
CT scan is done ahead of time, so he can see exactly what the patient’s
aorta and damaged valve look like. Then during the procedure, which takes
about 45 minutes, a live X-ray shows him the heart and its surroundings.
Afterward, patients stay in ICU for a night, and usually go home two days later.
As with any procedure, there are some risks, such as stroke, but Dr. Raney
believes that compared to doing nothing, “it’s a win.”
Learn more about
Dr. Raney. Learn more about
St. Joseph Heritage Medical Group.
(This article originally appeared in OC Catholic, December 2015)