A multidisciplinary team at the Montreal Heart Institute (MHI) performed a percutaneous aortic valve implantation, using a new type of valve (ReValvingª System, CoreValve, Paris, France). The procedure was carried out on December 6, 2005, by a non-surgical method known as percutaneous cardiac catheterization. The team included Dr. Raoul Bonan, cardiac hemodynamics specialist, Dr. Raymond Cartier, cardiac surgeon, Dr. André Denault, anesthesiologist, and Dr. Arsne Basmadjian, cardiac specialist in sonography from MHI, as well as Dr. Jean-Claude Laborde, hemodynamics specialist at the Clinique Pasteur of Toulouse, France. It was the first implantation of its kind performed in North America. The patient responded favourably to the procedure.
In addition to severe aortic stenosis, the 64-year-old female patient suffered from severe idiopathic pulmonary fibrosis, confining her to a wheel chair and to wearing an oxygen mask at all times. Her lung condition made valve replacement surgery extremely risky. By using percutaneous implantation of an aortic bioprosthesis as an alternative solution, the medical-surgical team at the MHI succeeded in correcting the patient’s aortic stenosis problem, thereby restoring adequate physiological cardiac function.
Before the delicate procedure began, the patient was placed under general anesthetic, and extra corporeal circulation was used to ensure optimal delivery of the prosthesis. A catheter was inserted into the radial artery and a radiopaque liquid injected into it, allowing objectivation of the prosthesis implantation procedure under fluoroscopy. An incision was made in the femoral artery for insertion of the new type of valve crimped up inside a fine membrane. The hemodynamics specialist then delicately pulled back the membrane, allowing the valve to be deployed and to adapt to the anatomy of the patient.
A medical-surgical team composed of Dr. Arsène Basmadjian, Dr. Luc Bilodeau, Dr. Raoul Bonan, Dr. Denis Bouchard, Dr. Raymond Cartier, Dr.Réda Ibrahim and Dr. Michel Pellerin is now in the process of setting up a program for percutaneous replacement and correction of valve pathologies. Devices for mitral and pulmonary valves, as well as aortic valves, are now being studied and, as early as this year, they will be used for implantation procedures in the catheterization rooms of the MHI. This constitutes a major breakthrough in the treatment of valve pathology.
“We are obviously thrilled by the results of this first procedure using a bioprosthesis, especially since it was the only conceivable option, given the patient’s medical history”, said Dr. Raoul Bonan, hemodynamics specialist at the MHI. “This procedure provided a radical solution to her heart problem and improved her condition, which is limited by her lung incapacity.”
Dr. Raymond Cartier, cardiac surgeon at the MHI, added, “The entire procedure was carried out in a relaxed and precise manner, with the patient’s hemodynamic condition remaining stable throughout. This new approach is promising and is sure to provide relief to patients for whom we could do nothing up until now. Medicine is a giant, and it keeps on growing…”
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