Featuring Dr. Guy Fradet, MD, FACS, FRCSC, Cardiothoracic Surgeon

Duration: 3 minutes, 7 seconds

When we replace an aortic valve, we actually have to stop the heart and open and get access within the heart.

That’s usually done by cutting this blood pipe here and getting access to it. To do it with a catheter there’s two to options. We don’t open the heart, we don’t stop the heart, and a catheter is inserted, most commonly into your leg, in the artery of the leg and brought backward to the heart.

And to that blood pipe, and at the end of that catheter there’s a balloon, and then there’s a valve that has been crimped on a stent or a mesh of metal if you want. So the catheter’s coming up this blood pipe, turning around, and going back toward the heart. And then the valve is deployed this way.

Now let’s say that the arteries are too diseased you cannot access that, so we have the heart in your chest like that here. So what can be done is surgeons can go in between your ribs there and then open that, so without breaking the ribs.

So it’s a small incision, and then they make little sutures there to control. And then the catheter is brought into the heart this way, from the apex of the heart and now the valve is going to be deployed this way as opposed to backward.

And when all that is done and the ribs are closed and - similar, it’s the same - it’s usually a short stay procedure, one or two days. The advantages to doing that procedure as opposed to an open heart surgery, surgical replacement of the valve, one is you avoid the cutting of the chest. 

Two is the recovery is usually much faster, maybe one day before you’re discharged home, the risk of bleeding is less. The risk of infection is less because the chest is not open. But there’s other risks like stroke, and also not knowing how long those valves last, that’s what’s being studied.

So it’s a compromise, right now within the study, it’s offered to people who are too high risk for surgery, or people that are at higher risk for surgery where then they’re given the options of the two basically.

So again if you have a valve problem it will be a discussion that will be initiated with your cardiologist and surgeons. It might be in your best interest rather than to have surgery, to have the transcatheter implantation.

Those physicians will then initiate a referral to a specialized centre because not all centres do that procedure. And then see if you could be a successful candidate for that.

Presenter: Dr. Guy Fradet, Cardiothoracic Surgeon, Kelowna, BC

Local Practitioners: Cardiothoracic Surgeon