July 22, 2010

New technology eases heart valve replacement surgery

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Drew Amons, M.D., holds up a stent VUMC surgeons are using in transcatheter pulmonary valve replacement procedures in children. (Photo by Joe Howell)

New technology eases heart valve replacement surgery

Doctors with the Vanderbilt Pediatric Heart Institute have performed Tennessee's first procedures to replace heart valves without open-heart surgery.

The technique, called transcatheter pulmonary valve replacement, uses new technology to position the heart valve into place using a catheter placed in the vein of the leg and then up into the heart where it is deployed.

The first patient to receive this new technique at the Monroe Carell Jr. Children's Hospital at Vanderbilt was able to go home after an overnight stay.

Thirteen-year-old Nick Feck had quit playing sports and his grades were slipping because he tired so easily. Feck was born with a heart defect that was repaired at birth, but a valve in the Bedford County middle-schooler's heart was failing. He and his family were bracing for open-heart surgery, but Nick's doctors told him Vanderbilt was prepared to try the less invasive technique.

“Each time we would come to see Dr. (Thomas) Graham, we wondered if this would be the time he would need the surgery,” said Nick's mother, Natalie Feck. “But each time, Dr. Graham told us to hold on. I know God had a place in that.”

Tom Doyle, M.D., Ann and Monroe Carell Jr. Family Associate Professor of Pediatric Cardiology, Dana Janssen, M.D., director of the Pediatric Catheterization Laboratory, and Robert Piana, M.D., director of the Adult Congenital Interventional Program, performed the first cases, including Feck's.

Doyle said the technique is FDA- approved for a specific type of pediatric case: those in whom a connective tube, either made of artificial or natural materials, is placed between the right heart and the artery to the lungs. In this type of repair, the valve that keeps blood from back flowing from the lungs into the heart, often wears out.

“The replacement valve is created from a valve found in the neck vein of a cow,” Doyle said. “The section of vein with the valve is hand sewn onto a large metal stent that can be expanded on a balloon. The stent/valve combination is folded into a catheter about as wide as a pen.

“Under X-ray guidance we can move the catheter into the conduit, expand the stent in the vessel, and in so doing, deploy the valve in the heart. Nick's procedure was very smooth; just perfect,” Doyle said.

During the procedure on June 23, just one incision was made in Feck's leg where the catheter entered.

He went home the next day. A week later he was given the go-ahead to attend a long-awaited summer camp program.

“We spent the summer raising money through garage sales to go to church camp on July 5. If I had open heart surgery, I wouldn't have been able to go,” Feck said.

“And Dr. Doyle said not only could he go, but he'd be the fastest one there,” Natalie Feck said, smiling.

Due to the size of the delivery system, Vanderbilt is currently reserving the procedure for patients at least age 7.

Since the device is so new, it is not known how long the valves will last, although data from Europe show it does well up to five years out.