Two years ago, when she started feeling out of breath and slight chest pains, Minna Blander went to see a cardiologist, who explained that the aortic valve in her heart, the gatekeeper for the blood her body needed, was not doing its job.
Blander, then 95 and remarried just five years earlier, would probably be dead in a year, a doctor told her family.
What Blander didn’t know is that doctors in clinical trials around the country, including at the University of Miami, had been testing a new kind of non-surgical valve replacement procedure that could save the lives of people considered too frail or elderly to survive the grueling hours of conventional open-heart surgery.
The procedure, part of a growing trend to repair the heart in non-surgical ways, uses a catheter to slide a new valve into place. It can take just two hours to perform, and if all goes well, patients go home in about two days.
“The thing that’s interesting about her, other than being a spry 96-year-old lady full of life, was that she was slowly dying from aortic stenosis,” said Dr. Harold Roberts, the Holy Cross Hospital thoracic surgeon who performed the procedure. “In the past, these patients have been left to die basically.”
Advances in non-surgical procedures using catheters has meant not only easier procedures for patients with less complicated medical conditions, but help for those whose only option was medicine that could sustain, but not cure them.
Over the years, improved imaging and better catheters have staked out new territory. By making them in different sizes and varying stiffness, catheters can now be manipulated to perform not just cardiovascular procedures, but neurovascular, gastrointestinal, urological and ophthalmic.
“At 2:20 this afternoon, I had a perfectly healthy 56-year-old guy who decided to have a heart attack. And 28 minutes later, 100 percent of the blockage was fixed,” said Dr. Howard Bush, assistant chief of staff at Cleveland Clinic Florida, where doctors use an incision in the wrist to insert catheters and deploy stents, reducing the risk of bleeding and making recovery easier.
“I started my training 30 years ago and that patient would have been in the hospital for two weeks recovering. Now he’s in the hospital for two days.”
Catheters got their big break working inside the body in 1953 when Swedish radiologist Dr. Sven-Ivar Seldinger used one to inject dye into the heart to get a better angiogram. Now, Bush explained, they can be used to clean blocked carotid arteries that can cause strokes; holes in the heart, through which deadly pieces of plaque or blood clots might escape to the brain; and aneurysms in the aorta, the main vein highway that ships oxygenated blood throughout the body.
The technique used on Blander — in medical jargon called the transcatheter aortic valve replacement — was approved in 2011 and is reserved for the frailest patients because traditional aortic replacement is still less risky, Roberts said. It is now performed at a number of hospitals in South Florida, including UM, the Cleveland Clinic and Baptist Cardiac & Vascular Institute, which has teamed up with the University of Heidelberg to get a jump on the latest medical treatments in Europe, where methods are more progressive.
Like Blander, Janice Carlson was last summer feeling out of breath, but also tired and dizzy.