Between chasing ducks from his driveway and dancing salsa at Casa Cuba in South Miami, Victoriano Alvarez knew something wasn’t right with his heart.
“I felt a burning sensation in the upper left part of my chest and a lack of oxygen,” said Alvarez, who lives in Kendall.
The Cuban-born, 74-year-old retiree who used to sell stents as a regional manager with Terumo Medical Corp., almost died when he had a triple heart attack in 2009. His coronary artery was nearly completely blocked. He had two drug-eluting metal stents put into his right coronary artery at Baptist Hospital to restore blood flow to his heart.
Earlier this month, after two months of chest pain and shortness of breath, he had a new type of heart stent inserted into his left artery. Only this time, the stent will disappear in about three years.
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The Food & Drug Administration approved the Absorb GT1 Bioresorbable Vascular Scaffold System, or the “Absorb,” last summer. Doctors at Baptist Health South Florida and the University of Miami are now using them, with Mount Sinai Medical Center set to begin next month.
“This is a new revolution in coronary intervention,” says Dr. Ramon Quesada, medical director of interventional cardiology at Baptist Hospital. He’s been using the stents, or scaffolds, for more than four years, since he took part in the FDA clinical trials at Baptist.
Quesada first treated Alvarez with the drug-eluting metal stents when he had the triple heart attack — at home, in the ambulance and in the hospital. He also treated him with the Absorb stent. Alvarez didn’t take the anti-inflammatory medicine or the cholesterol-lowering medicine he was prescribed after the first procedure, he admits, because of the possible side effect of myalgia, or muscle pain. That decision led to his most recent stent procedure.
“Metal inside the artery limits the normal physiology of motion of the vessel,” Quesada says. “Once the artery has repaired itself, you don’t need the scaffold anymore. The function of the artery is completely restored.” He says he’s treated between 40 and 50 patients with the Absorb since December.
The Absorb is made of a biodegradable material. Within two to three years, lactic acid, produced by the body, breaks down the material, similar to dissolvable sutures, into carbon dioxide and water. The body then absorbs it.
The stent is inserted via a catheter into the radial (arm) or femoral (thigh) artery, where doctors guide it to the affected area. The patient is usually kept overnight for evaluation then can resume normal activities. Femoral insertion usually requires more rest, however.
“The stent is expanded with a balloon on which it is mounted once it’s in the appropriate location in the coronary artery,” says Dr. Nirat Beohar, director of the structural heart disease program at Mount Sinai Medical Center in Miami Beach.
He says younger patients, patients with acute coronary syndromes, and those who have had heart attacks are good candidates for the newest stent, as well as those with vessels larger than 2.5 mm.
And after the procedure, patients have to make lifestyle changes, such as not smoking and “controlling the risk factors of high blood pressure, cholesterol and diabetes,” said Dr. Miguel Diaz of Palmetto General Hospital, which offers the Abbott “Absorb’’ heart stent procedure.
“Anti-platelet medication is also recommended for one year in addition to life-long aspirin therapy,” added Diaz, the physician in charge of the program at Palmetto General.
Beohar said the cost of bioresorbable stents is approximately $3,000, while the cost of metallic stents is in the $800 to $1,000 range. Healthcare Bluebook, an online guide that discloses “fair prices” for healthcare services, estimates the procedure should cost around $27,000.
The Absorb is so new that long-term complications aren’t yet known, but it can’t be used in patients with blood vessels smaller than 2.5 mm, since it isn’t sized for such a narrow passage. A slimmer model is being developed.
Like drug-eluting metal stents, the Absorb is coated with a drug that releases over time to block cell proliferation — or prevent clots. By contrast, bare metal stents not coated with any drug can cause the blood vessel to narrow due to scar tissue building up around the stent, which restricts blood flow to the heart.
“The new stents seem to be the holy grail of interventional cardiology,” says Dr. Mauricio Cohen, the catheterization lab director at the University of Miami Hospital. “To put a stent for the time it’s needed to work and then it disappears.”
For the salsa-dancing Alvarez, he says he’s happy to resume his normal life.
“I can go back to what I was doing, like dancing. I feel much better,” he says. “Definitely, this procedure has improved the condition of my body. I have a lot to look forward to — my fourth grandchild was just born.”