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Vital Signs


Vital Signs

Spring 2011

Heart-Valve Replacement Without Surgery

Many children born with congenital heart disease require open-heart surgeries to replace their pulmonary valves with prosthetic valves and conduits. As these children grow, and the valves become dysfunctional, they require as many as five or more open-heart surgeries over the course of their lifetimes to replace poorly functioning valves. A promising new catheter-based approach to replacing these valves may help patients reduce the number of required surgeries, and minimize side effects, by moving the procedure from the operating room to the cardiac-catheterization lab.

“After the first open-heart surgery, it’s daunting for our patients to think they may need four or more additional open-heart surgeries during their lives,” explains Daniel Levi, M.D., pediatric cardiologist at Mattel Children’s Hospital UCLA, who has been part of the team responsible for using the new transcatheter system to replace pulmonary heart valves in 12 pediatric and adult patients at UCLA. “When we tell them we can replace their pulmonary valves through a small incision in the leg instead, rather than opening their chest with a large, painful incision, they are very excited.” The new procedure takes only a few hours, avoids the need for the heart-lung machine and minimizes pain and lengthy hospital stays, Dr. Levi notes.

The pulmonary valve opens and closes to let blood flow from the right lower chamber of the heart (right ventricle) to the lungs and prevents blood from flowing back from the artery into the heart. These valves may not function properly in patients with congenital heart defects and need to be replaced with a conduit to prop open a section of the right ventricle and an artificial valve — fitted inside the conduit — to regulate the blood flow. These conduits, however, wear out over time and need to be replaced. The new procedure is the first minimally invasive alternative to open-heart surgery for pediatric and adult patients who require a replacement conduit and valve to restore pulmonary function.

“It’s much less invasive,” says UCLA adult congenital cardiologist Jamil Aboulhosn, M.D., who explains that the procedure is performed through a catheter (a thin, hollow tube) holding an VS-Spring2011-Heart Valveartificial heart valve that is inserted into a leg or neck vein and guided to the heart. The artificial valve is attached to a wire frame that expands with the help of balloons to deliver the valve.

“Patients walk out of the hospital the next day with minimal side effects and no major scarring,” Dr. Aboulhosn says. By comparison, patients undergoing openheart surgery to replace their pulmonary valves spend, on average, seven days in the hospital, including a few days in the Intensive Care Unit, followed by eight to 12 weeks of recovery at home.

Small patients (those under 60 pounds), those with large conduits and patients with coronary arteries positioned too near the conduit are not candidates for the procedure, according to Dr. Aboulhosn.

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