NEWSROOM

 

June 4, 2008, ST. LOUIS – The number of patients having minimally-invasive, “interventional” cardiac procedures has grown dramatically over the past decade.

 

“Most of the things we’re doing now, I couldn’t have predicted 10 years ago,” says John Lasala, MD, PhD, chief of interventional cardiology at Barnes-Jewish Hospital and Washington University School of Medicine.

 

The movement began in 1977 when Andreas Gruentzig performed the first successful coronary angioplasty in Switzerland. In the past 10 years, though, the field has seen dramatic breakthroughs. Interventional cardiologists like Dr. Lasala have seen changes in treatment ranging from drug-coated stents to valve repair and replacement.

 

“Eight years ago we started closing heart defects inside the heart without surgery,” says Dr. Lasala. “That really got us on our way into looking at other areas where we could help patients without open procedures.”

 

For example, patent foramen ovale (PFO) is a hole between the two chambers of the heart that closes in most people shortly after birth. However, in approximately 25 percent of people, it remains open. While most of these people survive with no risk or symptoms, PFO is the most likely cause of stroke in patients under 55.

 

Typically the procedure to repair the PFO is an open surgery. However, Dr. Lasala is now able to repair the PFO without opening the chest wall. He inserts a catheter through a vein in the leg, in turn reducing a recurrence of clots to approximately one percent or less.

 

This manner of treatment, where physicians go through the skin with a needle puncture or tiny incision and access to the clogged coronaries or areas in the heart with a catheter, is called a “percutaneous” procedure. These types of procedures have led to what Dr. Lasala sees as a “groundbreaking” trial replacing leaky heart valves.

 

“This might reshape the whole approach surgeons and cardiologists take toward treating aortic valves,” says Dr. Lasala.

 

In the nationwide PARTNER (Placement of AoRTic traNscathetER valves) trial, Dr. Lasala and his Washington University colleagues are for the first time able to replace aortic valves percutaneously. Instead of opening a patient's chest, physicians thread a catheter, mounted with a compressed replacement valve on a tiny balloon, through an incision in a vein in the groin. Once in position, the stent-like valve is inflated within the aorta, where it adheres to the blood vessel’s walls, and the balloon and catheter are withdrawn.

 

While the PARTNER trial is currently not available to all patients, the future for the procedure holds great promise.

 

“Down the road, as the technology improves and the valve shows it has longevity, this may become the main form of therapy for valve replacement,” says Dr. Lasala.

 

He says he feels fortunate to have been on the forefront of watching these technologies advance.

 

“At a teaching institution like Barnes-Jewish and Washington University, we can serve as bridge as these procedures move into mainstream therapy,” says Dr. Lasala. “It’s exciting.”

 

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