Canada leads in new heart valve replacement surgery

Canada is the world leader in a new surgical technique that is transforming the lives of patients too sick to undergo conventional treatment to replace diseased aortic valves.

One hundred patients have been treated and the results are excellent, says Dr. John Webb, whose team is pioneering the new surgery at St. Paul's Hospital in Vancouver. "This is a new procedure. When we started, people didn't think it was going to work," says Dr. Webb. "So we took patients who were thought to be too high a risk for conventional surgery." Over 13,000 Canadians undergo surgery every year to replace aortic valves that have become partially blocked or weakened, Dr. Webb's team member Dr. Robert Boone told the Canadian Cardiovascular Congress 2007, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.

"Dr. Webb's work is giving new hope to Canadians living with heart disease, and clearly demonstrates Canadian leadership in revolutionary treatments for valvular heart disease," said Dr. Beth Abramson, Heart and Stroke Foundation spokesperson and cardiologist.

The aortic valve allows blood to flow from the heart's lower left chamber into the aorta and to the rest of the body. The aortic valve can become leaky or blocked, and when that happens angina and heart failure can result. Seventy five to 80 per cent of people who have symptoms will die in three to five years if they do not have the valve replaced.

The conventional approach to valve replacement involves sawing the breast bone in half, stopping the heart, putting the patient on a heart/lung machine, removing the old valve and sewing in a new one. "Any way you look at it, that's major surgery," Dr. Josep Rodés Cabau told the Congress. Dr. Rodés Cabau has performed the surgery in Quebec.

The new procedure uses percutaneous aortic surgery to replace the defective valve. In percutaneous surgery a needle puncture in a blood vessel is used to insert a balloon catheter, mounted with the new valve. The balloon is used to expand the new valve inside the old valve, which it pushes out of the way.

The technique is performed under local anaesthesia and light sedation. "These patients had been rejected for surgery because they had a one in three chance of dying. So we took them on and our mortality was one in 10 after 30 days - much less than had been anticipated," says Dr. Webb. "Today our results using percutaneous surgery are better than expected for people who are too high risk for conventional surgery." The concept of aortic valve replacement was first proposed in the 1990s in Denmark.

The first surgery in Canada, performed by Dr. Webb, was in 2004. Dr. Abramson of the Heart and Stroke Foundation says, "This minimally invasive technique is promising and will hopefully affect clinical practice not only in Canada but around the world. What is particularly encouraging is the short amount of time that it takes these patients to get back to normal life."

Video footage and illustrations of the procedure are available to the media. Statements and conclusions of study authors are solely those of the study authors and do not necessarily reflect Foundation policy or position.

The Heart and Stroke Foundation of Canada makes no representation or warranty as to their accuracy or reliability. The Heart and Stroke Foundation (www.heartandstroke.ca), a volunteer-based health charity, leads in eliminating heart disease and stroke and reducing their impact through the advancement of research and its application, the promotion of healthy living, and advocacy.

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