UBC Reports | Vol. 50 | No. 2 | Feb. 5, 2004

Old Skill Provides Modern Solution to Heart Valve Replacement

New technique may mean no more broken breastbones

By Hilary Thomson

A traditional sailors' craft was the inspiration for a new technique to replace heart valves without major surgery.

Much like a ship in a bottle, the procedure involves inserting a foldable valve through a small incision and
running the valve along a blood vessel into the heart where it is 'unfurled' and attached remotely -- a virtually non-surgical intervention.

Valve replacement surgery currently requires breaking ribs and breastbone to access the heart, a minimum of a week's hospitalization and considerable recuperation time.

Called Percutaneous Valve Replacement, the new procedure is being developed by Dr. John Webb, director of the cardiac catheterization laboratory at St. Paul's Hospital in Vancouver. Still in the experimental stages, the technique offers promise for patients who are too ill to survive traditional valve replacement surgery.

The new method involves a small incision made in the thigh to allow a tube the size of a pencil to be inserted. The tube is threaded along the veins up to the heart. Once the folded valve has been opened and attached in the heart, the tube is withdrawn. After a couple of stitches for the incision and a day's rest, the patient would be able to go home.

Sound simple? Not quite, says Webb, who is also a UBC associate clinical professor of cardiology.

"The new remote procedure is still highly experimental. We haven't yet tried it on a patient. The tube is about three feet long and the placement of the valve within the complex structure of the heart is critical. A few hair widths out of place and the whole thing is wrong. We have to get it exactly right every time."

If the technique can be perfected, it would mean huge health-care savings compared to current methods requiring an operating room and long hospital stays. Most importantly, it would mean that individuals who are too weak for surgery and unlikely to survive might be saved.

Also, patients would be able to avoid the significant pain and discomfort of heart valve replacement surgery.

"When they broke my breast bone and ribs to get at my heart it really hurt," says 86-year-old Eleanor Wetherly.

"I was in the hospital for a long time. It was two or three months before I felt better."

Four valves direct blood to and from the body through the heart: the aortic valve, the pulmonic valve, the tricuspid valve, and the mitral valve. Any of these valves may malfunction because of a birth defect, infection, disease, or trauma. When the malfunction is so severe that it interferes with blood flow, an individual will have heart palpitations, fainting spells, and / or difficulty breathing. These symptoms will progressively worsen and cause death unless the damaged valve is replaced surgically.

Webb expects it will be at least two years before patients can benefit from the procedure.

About 80 per cent of Canadians have at least one risk factor for cardiovascular disease and 11 per cent have three risk factors or more, according to the Heart and Stroke Foundation of Canada. Risk factors for cardiovascular disease include smoking, lack of exercise, being overweight, and high blood pressure.

For more information on heart disease and treatment, visit ww2.heartandstroke.ca.