CANADA: New Heart Surgery Helps Frail Patients

QUEBEC CITY, Canada (Globe and Mail), October 22, 2007: On a warm July night, Marguerite Noel found herself so horribly out of breath she thought she was going to die. Rushed to hospital, doctors quickly figured out that Ms. Noel was suffering from aortic stenosis, and she needed valve replacement surgery. The problem was that, at age 85 and having already undergone a quadruple bypass, Ms. Noel was a poor candidate for open-heart surgery. "They told me it was too risky, that I probably wouldn't make it out of surgery alive," she said yesterday. Ms. Noel, active and healthy until that point, resigned herself to living with ever-worsening angina and breathlessness, and the knowledge that her days were numbered because her heart was slowly failing. But in September, surgeons at the Institut de Cardiologie in Quebec City called and asked if she would be willing to undergo an experimental procedure. Conventional valve replacement involves sawing the breast bone in half, stopping the heart, putting the patient on a heart/lung machine, removing the old valve and sewing in a new one. The new approach requires only a small incision below the left breast, between the ribs. Then, a new valve is mounted on a balloon and threaded into the heart on a small wire, or catheter. The balloon is used to expand the new valve inside the old valve, which it pushes out of the way. "This is minimally invasive surgery, so there is a lot less risk," said Robert Boone, an interventional cardiology fellow at the Heart Centre of St. Paul's Hospital in Vancouver. He presented research findings yesterday at the Canadian Cardiovascular Congress in Quebec City that suggest the new approach is safer and opens the door to a lot more patients being treated. "Right now, between 30 and 60 per cent of patients with aortic valve stenosis can't undergo open-heart surgery," Dr. Boone said, "so there's the potential for a lot more surgery." The procedure is still experimental. Only 450 patients worldwide have had the operation, but more than one-third of those have been performed in Canada. Yesterday's lecture, however, attracted a lot of attention, particularly from surgeons who are forced to turn many patients away. About 13,000 aortic valve replacements are done annually in Canada, but thousands of patients are too frail for traditional surgery. Their prospects are bleak, as about 80 per cent of those with aortic valve stenosis die within five years. The aortic valve allows blood to flow from the heart's lower left chamber into the aorta and to the rest of the body. Cholesterol can build up in the aortic valve, causing it to become calcified. When this happens, the aortic valve can become leaky or blocked, which can lead to angina and heart failure. The cause of stenosis is unclear, but the process tends to happen slowly over time, putting the elderly at greatest risk. Paradoxically though, they are often the least able to survive surgery. Ms. Noel said that her minimally invasive surgery was "a marvel." In the month since the operation, her angina has disappeared and her breathing has improved tremendously. "I'm a young woman of 85 again," she said with a laugh. By Andre Picard © Copyright 2007 CTVglobemedia Publishing Inc.