Northwest Arkansas Democrat-Gazette
New heart procedure arrives
Transcatheter aortic valve replacement less invasive
A medical procedure newly available in Northwest Arkansas could help heal hearts worn out by life and disease.
The procedure replaces one of the valves that controls the flow of blood through the heart by using a small incision into an artery instead of open heart surgery.
Mercy Northwest Arkansas’ Rogers hospital in February did the procedure for the first time in the area. Washington Regional Medical Center in Fayetteville and Northwest Health in Springdale plan to eventually offer the service, a spokeswomen said.
The valve replacement helps mostly older patients who are too ill for major surgery, but could be near death because of a malfunctioning heart, said Dr. Amr El-Shafei, one of four Mercy physicians who do the replacement as a team. He and the others expect up to about 100 patients a year will benefit from it.
“The minute you start having symptoms, you have a high risk of dying within months,” El-Shafei said. “You have to do something.”
The procedure aims at the aortic valve, essentially a one-way swinging door that lets blood move from the heart to the body’s largest artery and into every other blood vessel. For some, particularly people in their 70s or older, the door stops opening fully in a condition called aortic stenosis. Dr. Anton Cherney, a cardiothoracic surgeon on the Mercy team, said millions of heartbeats over a lifetime can have that effect.
The condition makes the heart work harder and harder to pump blood out and gradually damages it, said Dr. Matthew Parmley, also a cardiothoracic surgeon at Mercy.
For Mary Anne Erlinger, 85, it meant years of trouble breathing, which she didn’t give much mind. But it got so bad in recent months that she’d be out of breath just
walking a few feet in her house, she said. She agreed to be Mercy’s first patient undergoing the procedure and said she “had no fear whatsoever” after the doctors explained their plan.
The physicians made an incision in her thigh to reach an artery, then pushed in the artificial replacement valve, folded up like origami to take up less space. An X-ray scanner provided the view of the folded valve’s progress as a long, thin catheter pushed it up the body to the heart. The valve expanded to full size and pushed the faulty valve out of the way, which helps hold the new one in place.
“When I woke up, I could breathe. It was unbelievable,” Erlinger said in her home a few weeks later. Now she’s going through weeks of physical therapy to strengthen her heart and body and healing from some bruising after the surgery, but she said it was all worth it. “To me, it’s a miracle procedure.”
Roughly one-third of people with aortic stenosis are like Erlinger, with age or other health issues that make open heart surgery at least as dangerous as leaving the condition alone, said Dr. Lance Weathers, a cardiologist and final member of the Mercy team. Before now, those patients had to travel to Tulsa, Okla.; Springfield, Mo.; or Little Rock. Cherney said some chose the regular surgery closer to home despite the risk.
The new procedure is just one among many Northwest Arkansas’ health care providers are adding in a yearslong effort to keep patients from going elsewhere. The Arkansas Children’s Northwest hospital, which opened in Springdale earlier this year, is meant to prevent some patients from needing to go to the main hospital in Little Rock, for example.
The U.S. Food and Drug Administration approved transcatheter aortic valve replacement for widespread use in 2011 after clinical trials.
Replacing aortic valves this way rather than surgically opening up the ribcage to reach the heart had less risk for some complications, such as heart attacks, according to an analysis of multiple studies tracking thousands of cases that appeared last year in the journal Catheterization and Cardiovascular Interventions. Some patients died or suffered strokes within a year, but did so about the same rate as those who had the regular surgery, researchers found.
Mercy built a special hybrid catheterization lab and operating room for the procedure’s equipment, but it also took years of training on the doctors’ parts, Parmley said. That training will continue, as the new facility allows more advanced heart procedures and treatment programs once the doctors have the needed experience.
“So that’s just the beginning,” El-Shafei said. “You open the door.”
Washington Regional is in the middle of a $43 million expansion and renovation, which will make room for better stroke treatments and provide space and equipment for the valve replacement and similar procedures, CEO Larry Shackelford wrote in an email.
Amy LeSieur, the health system’s vice president of ancillary services, said it also is focused on building an interdisciplinary team of surgeons, nurses and others.
Christina Bull, spokeswoman for Northwest, said that system is working on offering the service.
“We look forward to making an announcement as this work is complete,” she wrote in an email.
Mercy spokeswoman Jennifer Cook didn’t say what the valve replacement costs, but noted Medicare pays for the procedure and covers most of the patients who have it done.