Heart surgery without surgery

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Thirteen-year-old Keaton Pausch can dash back and forth across a soccer field for the entire game without having to stop and rest. Not bad for a young fellow who just underwent a procedure to replace a faulty valve in his heart.

In the past, heart defects like Keaton’s were fixed through open-heart surgeryÑa complicated, costly procedure that requires a chest incision and lengthy recovery period in hospital.

Thanks to a revolutionary procedure, Keaton was on his way home just one day after his pulmonary valve was replaced. He was the first child in Western Canada to undergo transcatheter pulmonary valve replacement, a procedure in which a new valve is implanted in the heart through a blood vessel, rather than a chest incision.

Three adult patients also underwent the procedure the same day Ñ the first adults in Western Canada to do so. In fact, only a few other hospitals in the world have performed these procedures.

“I thought it would be really painful, but it wasn’t,” Keaton says.

Pediatric cardiologist Dr. Yashu Coe and adult cardiologist Dr. Dylan Taylor performed the new procedure together at Capital Health’s University of Alberta Hospital and Stollery Children’s Hospital in Edmonton. “It’s actually very straightforward, very simple,” Dr. Coe says. “Keaton felt good and was ready to go the minute he woke up. But the valve needs time for the body to grow tissue over so it doesn’t dislodge.”

The new pulmonary valve is made from a cow’s jugular vein, which contains valves very similar to natural human heart valves, sewn inside a wire mesh stent. The stent is mounted on a balloon catheter and routed through a large vein in the patient’s leg, using x-ray guidance. The balloon is carefully guided to the right part of the patient’s heart, where the balloon is inflated to deploy the valve.

“It signals a very promising trend for the future,” says Dr. Dylan Taylor, cardiologist and co-site medical director of Capital Health’s University of Alberta Hospital. “As tech-nology blurs the lines between cardiac surgery and interventional cardiology, we’ll be seeing more of these ‘hybrid’ cardiac services.”

The Mazankowski Alberta Heart Institute, scheduled to open in 2007, will include a hybrid operating room to allow the cardiologists and surgeons to work together in the development of these new procedures. This hybrid operating room will be equipped with all the necessary equipment to handle complex cardiac cases involving both traditional surgical and newer, less invasive methods.