New Valve-in-Valve Replacement Technique Extends Life of Stockton Heart Patient

Posted on Oct 29, 2018 in Cardiac, Quality, Sutter Medical Center, Sacramento, Sutter Medical Foundation

Sutter Medical Center, Sacramento Is First in Central Valley to Use New Life-Saving Procedure

 

The Sutter Medical Center, Sacramento TAVR Valve Team was the first in the greater Sacramento area to perform a BASILICA procedure, which saved a Stockton woman’s life. Pictured are the medical directors of the TAVR program: from left, Michael Ingram, M.D., David Roberts, M.D., and Pei-Hsiu Huang, M.D. Dr. Ingram’s partner, James Longoria, M.D., was the heart surgeon on the first procedure.

SACRAMENTO – Sutter Medical Center, Sacramento became the first hospital in the Central Valley region and the third in the entire state to perform an innovative catheter procedure called BASILICA, which was successfully used Oct. 24 on an 82-year-old Stockton patient whose bioprosthetic aortic valve was failing, effectively saving and extending her life.

By using this new BASILICA procedure followed by a minimally invasive valve replacement called transcatheter aortic valve replacement (TAVR), the interventional cardiologists, heart surgeon and specialty heart valve team were able to prevent an often-fatal complication of a valve-in-valve replacement — coronary artery obstruction caused by displacement of the old valve’s leaflets.

“Because of this patient’s anatomy, if we just performed a standard valve-in-valve TAVR for the failed valve without first doing the BASILICA procedure, there would have been a very high risk of blocking a coronary artery, which would result in a large and probably fatal heart attack,” said Sutter Health interventional cardiologist Pei-Hsiu Huang, M.D., who performed the procedure together with cardiovascular surgeon James Longoria, M.D., and interventional cardiologist David Roberts, M.D. “By performing this new BASILICA procedure first, it prevents the valve leaflets from obstructing the coronary arteries when the new valve is implanted.”

Illustration of the BASILICA procedure: (A) a catheter directs an electrified guidewire through the base of the left aortic cusp into a snare in the left ventricular outflow tract; (B) after snare retrieval, the mid-shaft of the guidewire is electrified to lacerate the leaflet (C); (D) the leaflet splays after TAVR permitting coronary flow. Khan, J.M. et al. J Am Coll Cardiol. Int. 2018.

BASILICA (Bioprosthetic Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction) uses an electrified guide-wire directed by a catheter to slice the leaflet of the patient’s failing bioprosthetic valve. The split leaflet prevents obstruction and allows blood to flow through into the coronary artery after implanting the new valve.

“More and more patients are outliving their bioprosthetic heart valves, which are expected to last 10 to 15 years,” Dr. Huang explained. “Because of their age and sometimes frail health, a second open-heart surgery to replace a failing valve is usually higher risk than the first surgery. With TAVR, the new valve is placed using a less invasive catheter procedure, making it a lower-risk alternative. Now we have a way to prevent a major complication when it comes to valve-to-valve TAVR. This is great news for our patients.”

The area’s first BASILICA patient, Carol Jolly, is seen by the Stockton father-son team of Drs. Fram and Cyrus Buhari. Dr. Huang and the Sutter valve team previously collaborated with Dr. Cyrus Buhari and the heart team in Stockton on more complex TAVR procedures.

“Because of the high risk of the valve leaflet obstructing the coronary, Mrs. Jolly’s valve replacement was not a routine, run-of-the-mill case,” Dr. Buhari said. “I knew that Sutter was getting ready to use the BASILICA technique, and they agreed that a standard TAVR could cause a catastrophe for this patient. We trust Sutter and we trust Dr. Huang, so we referred her to them. And everything went very well.

“Mrs. Jolly is one of the most pleasant patients you’ll ever meet. If she was nervous about going through with this new technique, she didn’t show it at all.”

After the TAVR, Jolly was up and walking within a day of the procedure at Sutter Medical Center, Sacramento, and was discharged from the hospital two days later. In 2007, her valve was originally replaced through an open-heart surgery that required many days in the hospital and weeks of recovery, she said.

“My replacement valve was failing, so it was time for a new one,” said Jolly. “But I couldn’t have it done with an open-heart surgery, and my cardiologists were afraid a TAVR may block my arteries. After performing this new technique, the Sutter doctors were able to drop in the new valve without any issues, and the recovery is so much better.”

Jolly has been a Stockton resident for nearly 60 years, is a retired Realtor and the mother of four children and grandmother of 10. “Now I could last another 10 years,” she said. “I have a lot to live for.”

Sutter Heart & Vascular Institute, whose flagship hospital is Sutter Medical Center, Sacramento, was a pioneer of the TAVR procedure in 2012 and is the leading TAVR site in the greater Sacramento region, having performed about 750 of them in six years. For more on Sutter Heart & Vascular Institute, go to www.sutterhealth.org/services/heart-vascular/sutter-heart-vascular-institute. For more on the TAVR program, go to www.sutterhealth.org/lp/cardiovascular-tavr/.

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Posted by on Oct 29, 2018 in Cardiac, Quality, Sutter Medical Center, Sacramento, Sutter Medical Foundation | Comments Off on New Valve-in-Valve Replacement Technique Extends Life of Stockton Heart Patient