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Ace of Hearts: For elderly with diseased hearts, new technology offers hope for longer life

Categories: Heart & Vascular

?As seen in Orange County Register?

For decades, cardiovascular surgery has been done one way: a surgeon like me opens a patient's chest and operates, turning over a patient's heart and lung functions to a machine for one to two hours or more. These grueling operations work well, but they are too risky for frail, elderly patients.
Robotic imaging and space-age technology are reinventing the field, allowing us to conduct major, delicate operations through tiny incisions. Thanks to millions in donations, Hoag Hospital is now able to use these new technologies to save the lives of patients who are too old or sick to qualify for open-heart surgery.
The newBob and Marjie Bennett Hybrid Surgical Suite (named after a Newport Beach couple who gave $2 million to the project) is unique for an operating room, in that it has highly sophisticated imaging equipment and technological capability that a team of doctors can use to both diagnose a problem and help fix it – all in one visit.
In the last few weeks, we have successfully completed our first half dozentrans-catheter aortic valve replacement surgeries, TAVR. For years, surgeons have been able to diagnose and treat some problems using catheterization. Now, we can use the minimally invasive procedure for valve replacement, thanks to new technology from Edwards LifeSciences called theSAPIEN? Transcatheter Aortic Heart Valve.
Using 3D imaging technology capable of depicting every heartbeat in real time, doctors insert a catheter into an artery via the groin and move it to the heart by guide wire. The SAPIEN valve folds up in order to fit through blood vessels just a few millimeters wide. Once the catheter is put through the old, diseased aortic valve, a balloon inflates and deflates, expanding the SAPIEN valve and locking it into position. 
Hoag is the only hospital in Orange County approved to use this procedure to treataortic stenosis, a fatal disease found in millions of seniors which causes narrowing of the aortic valve. Without an operation, most aortic stenosis sufferers die within two years. From a personal perspective, we like to believe we can successfully operate on anybody, but the truth is some patients are just too old or too sick to go under the knife. The folks you're afraid to look at twice for fear of hurting them, simply wouldn't be candidates for open heart surgery. They're usually given therapy such as diuretics. But aortic stenosis is a mechanical problem. It needs a mechanical correction. 
That's what we can give them now. 
As theTAVR procedure is refined, it has potential for wider use. There is now some risk of stroke, and we don't yet know how durable the valves will be over 10 or 20 years. We may not know about long-term outcomes. But now, we have something to offer somebody who had previously been facing a death sentence: another year or two or five, or even 10 more years of life. 
Open heart surgery will not disappear entirely, but we surgeons will likely find ourselves working more and more with the kind of high-tech innovations we are seeing at Hoag, making it possible for my colleagues and me to help more and sicker people than ever before.
Dr. Aidan A. Raney is Hoag Hospital's Medical Director of Cardiovascular Surgery and Surgical Director of Hoag Heart Valve Center.