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Fall 2010

Reducing Open-Heart Surgeries

"No cutting, no surgery" with new valve procedure

By: Gary Logan
Date: October 1, 2010

Rich Ringel
Ringel’s heart procedure starts in the leg.
photo by Keith Weller

Open-heart surgery is no stranger to patients like Alex Compton, 17. Born with tetralogy of Fallot, Compton has endured several invasive surgeries with long hospitalizations and recoveries, most recently when he was 8 and needed his pulmonary valve repaired. It meant 10 days in the hospital.

This past May, Compton needed another pulmonary valve repair. But this time, a minimally invasive approach required only a one-night stay. Two days later, he attended rehearsal for his high school graduation.

The new catheter procedure is called percutaneous pulmonary valve replacement, and Johns Hopkins pediatric cardiologist Rich Ringel is one of a handful of interventionalists nationwide who perform it. “There is no surgery, no cutting of anything,” he says.

With the patient under general anesthesia, Ringel places a stent-mounted bioprosthetic valve onto a balloon-tipped catheter and threads it through the leg’s femoral vein and up to the pulmonary valve. He then expands the bioprosthetic valve to prop open the poorly functioning existing valve.

Ringel explains that in patients with left-sided congenital heart disease, surgeons typically replace the aortic valve with the patient’s own pulmonary valve, which in turn is replaced with a cadaveric pulmonary valve. But over time, the cadaveric valve—known as a “conduit”—scars and narrows, requiring another valve replacement through open-heart surgery.

“When the surgeon puts in a conduit,” says Ringel, “we hope that it will last 15 or 20 years. But too often it lasts only a few years. So we insert this valve in the hope of giving that conduit the years it was designed to get and to reduce the number of open-heart surgeries patients need over a lifetime.”

The procedure, says Ringel, has proved successful enough in U.S. and European trials for the FDA to approve the valve as a humanitarian-use device for patients like Compton.