Feature

Top Docs 2012: Matters of the Heart

Meet the Top Doctors who keep an eye on the rhythms of the city.

August 2012

Replacement Parts

University of Colorado Hospital’s valve clinic is at the leading edge of heart surgery’s newest frontier.

 

Modern medicine’s ability to prolong human life has raised the average life expectancy in America to 78.2 years. Better medicines and more refined surgeries are allowing many of us to not only live longer, but also to experience a high quality of life during those “extra” years. The problem is that, just like anything else, the human body has parts that simply wear out after too many years of use.

Ninety-two-year-old Albert Verderaime knows that scenario all too well. Until early April 2012, Verderaime was still working two days a week at the bread bakery his parents opened in 1927 in Aguilar, Colorado. He was baking cakes, Italian bread, loaves of white, and apricot Danishes until he began having chest pains. The aching continued for a couple of weeks before Verderaime decided to visit the Veterans Affairs Medical Center in Raton, New Mexico. “They immediately sent me on a plane to Denver,” Verderaime says.

Without treatment, the aortic stenosis Verderaime was experiencing would likely kill him within the year. The aorta is the main artery that carries blood out of the heart. When blood leaves the organ, it flows through the aortic valve, into the aorta, and then to the rest of the body. With aortic stenosis, the aortic valve does not open fully, causing symptoms like weakness, fatigue, breathlessness, and chest pains. It is fatal within one year in 50 percent of patients with symptoms. What the doctors in New Mexico likely knew before they sent Verderaime north was that he was not a good candidate for open-heart surgery to fix his malfunctioning valve. At the University of Colorado Hospital, however, interventional cardiologists Drs. John Carroll and John Messenger had a better option for Verderaime: transcatheter aortic valve replacement (TAVR).

Approved by the FDA in November 2011, TAVR is a less invasive method of replacing a worn-out valve with a new biologic valve, usually harvested from a cow. Using a catheter system inserted through a three-inch incision in the groin, Carroll and Messenger slowly navigate the valve—which is mounted inside a stent—through the body’s vascular system toward the heart. While the heart is still beating, the doctors can position the stent-mounted valve into place right over the original valve.

“This procedure probably has the largest set of benefits of any new technology in the last decade,” says Carroll. It offers an alternative to people who likely would not survive open heart surgery. It provides an incredible bump in the quality of life for older Americans who might otherwise suffer a miserable final year of their lives. And the possible future applications for this procedure are almost limitless.

Because the procedure is so promising, the University of Colorado Hospital just completed the construction of a $3 million “hybrid” operating room outfitted with a state-of-the-art X-ray system specifically for these surgeries. The OR, which can accommodate the more than 20 health-care professionals it takes to complete this three-hour-long surgery, combines the typical sterile setting of an operating room with the cutting-edge imaging of a cath lab.

For Verderaime, who was Carroll and Messenger’s 10th TAVR patient ever, the procedure was a success. “Mr. Verderaime’s procedure went better than expected,” Messenger says. “He was only in the ICU for 24 hours, and he was discharged just five days after his procedure.” Not only is Verderaime’s chest pain gone, but just weeks after the surgery he is also walking and getting better all the time. And, he says, he hopes to be back at his bakery sooner rather than later.

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