Loyola University Medical Center physicians deploy aortic valve through patient's abdomen

In a first-of-its-kind procedure in the United States, Loyola University Medical Center physicians have deployed an aortic valve by going through a patient's abdomen.

The patient is participating in a clinical trial of a device called CoreValve, which offers an alternative to traditional open-heart surgery for patients who need new aortic heart valves.

Patients in the clinical trial have severe aortic stenosis: The heart's aortic valve is narrowed, restricting blood flow from the heart to the body. The valve doesn't open properly, forcing the heart to work harder to pump blood. Aortic stenosis can lead to heart failure, stroke and death.

The most common treatment for this condition is to replace the aortic valve in a traditional open-heart surgery. The clinical trial is evaluating an alternative procedure, in which an artificial valve is delivered and deployed with a catheter (thin tube). The catheter typically is inserted into an artery in the groin and guided up to the heart. Once in place, the artificial valve takes over the function of the diseased valve, ensuring that oxygen-rich blood flows into the aorta, the body's main artery.

In some patients, the groin artery is too small to accommodate the catheter. In such cases, physicians can gain access by inserting the catheter in an artery in the arm. But in a recent patient, the arm arteries also were too small for this approach.

Another alternative approach is to insert the catheter directly to the ascending aorta through an incision between the second and third ribs. But this approach couldn't work in the patient, either, because her ascending aorta was too clogged with calcium deposits. (The ascending aorta is the part of the aorta that emerges from the left ventricle at the top of the heart.)

So Dr. J. Michael Tuchek and Dr. Fred Leya used a novel approach. They made a small incision above the navel, cut through the abdominal wall, poked a tiny hole in the aorta, inserted the catheter, guided it up to the heart and then deployed the artificial aortic valve. The procedure was a success, and the new valve is working well.

Leya said the abdominal approach "gives us one more way to reach the aorta, when other approaches are not possible."