Valve procedure giving heart patients a new outlook on life

ST. LOUIS -- A new surgical procedure is saving lives by patching damaged hearts for older people who couldn't survive conventional heart surgery.

The procedure is called "transcatheter aortic valve replacement." It fixes aortic stenosis, a potentially deadly condition developed primarily by people over 70, said Dr. Anthony Sonn, cardiologist with Mercy Heart Hospital on South New Ballas Road.

"It's for people who may be too frail for heart surgery," Sonn said. "It's a faster healing time, a shorter hospital stay and a lot less stressful."

The procedure has been undergoing trials for years, with a major part of the research at Barnes-Jewish Hospital. The hospital offers the procedure now that trials are finished.

The U.S. Food and Drug Administration approved the procedure late last year. Earlier this year, Mercy Heart Hospital became the only other hospital in the metro area to offer the procedure.

HOW IT WORKS

Aortic stenosis develops over years, but ill effects show up late in life. As the heart pumps blood into the aorta, a valve opens to allow blood to leave, then closes to prevent blood from backing up. When the valve stiffens or becomes clogged, blood flows both ways or fails to flow much at all.

The effects can be life threatening. Those who have the condition and can't handle heart surgery are in their 80s, even 90s, Sonn said. In the decades since the condition was identified, doctors considered the condition terminal.

But with transcatheter aortic valve replacement, a surgical team enters the femoral artery in the thigh or a nearby artery and snakes a catheter equipped with tiny instruments through the blood vessels to the aortic valve. There, the doctor inserts an artificial valve made from metal and tissue from a bovine heart sack. The stent and valve expand until they're firmly in place over the top of the old valve.

"The change was almost instant," said Loretta Klump, 88, of the Meadowlands Assisted Living facility in O'Fallon, Mo.

She takes exercise classes, plays games, walks and visits her daughter, grandchildren and great-grandchildren.

Her active life is far from where she was in January, when doctors recommended hospice.

"They'd make her comfortable," said Barbara Duncan, Klump's daughter of Lake Saint Louis.

Klump had accepted her infirmities of shortness of breath, chest pains, lack of energy, collapsing and slow deterioration as part of getting old. While living alone in her home, she fell a lot and called emergency responders for help.

One day, she called police four times. That's when she moved to the extended care facility.

"The doctor said she had six months, maybe two years," Duncan recalled.

A friend of a relative with connections to Barnes-Jewish Hospital told Duncan about the new procedure for older people who had aortic stenosis. They found the procedure at Mercy Hospital, closer to home.

In May, Klump became the first person to undergo the procedure at Mercy Hospital.

"It returned her to the energetic person she used to be," Duncan said.

"I have so much more energy; it's like I never had a heart problem," Klump said. "They've taken me off the list of having a heart problem. I'm a new person; I owe my life to Dr. Sonn."

Sonn said that during the trials, survival rates ranged from 50 percent for people who didn't have the procedure to nearly 70 percent for people who did. He has performed nine procedures, "and all my patients are still alive."

Articles in medical journals, including the New England Journal of Medicine, note that mortality rates are tricky to quantify because people in their 80s and 90s could die from conditions unrelated to the heart problem or the procedure.

SURGERY IS STILL FIRST OPTION

Still, Sonn said the procedure doesn't replace heart surgery. For people well enough to endure heart surgery, that's still considered the first line of defense. Transcatheter aortic valve replacement is "a last resort procedure," Sonn said.

Medical science still wants to see the lasting power of the artificial valves, he said.

Sonn said he's getting the word out because so many older people believe they're at the end of their road, "but they're not."

Meanwhile, he said, researchers continue to work on the artificial valve.

As for Klump, she's deciding whether to return to her home or remain in the extended care home, which has become a lot of fun since the procedure.

She's surrounded by friends rather than living alone. Her husband is in extended care in New Mexico.

"I take a walk in the morning and afternoon and we walk to the dining room three times a day, and I take exercise classes here," she said.

She also believes her sister, three years younger, may be a candidate for the procedure.

Meanwhile, she celebrated her 88th birthday on Friday. ___

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