Newmarket, Ontario (December 5, 2012) – When 94-year-old Victor Lawrence visited Southlake Regional Health Centre in Newmarket, Ontario, for an aortic valve replacement (AVR) earlier this year, he was the oldest patient to undergo surgery that day. Remarkably, he was also the first to leave the intensive care unit afterwards, thanks to a novel approach to AVR being pioneered by a Toronto-area surgeon.
The procedure uses a first-of-its-kind device called a sutureless aortic valve, primarily used to treat aortic stenosis, a condition in which the valve narrows and becomes stiff, restricting blood flow out of the heart. In traditional AVR surgery, a damaged valve is replaced with a sutured valve which requires time-consuming and sometimes difficult-to-thread sutures to hold the valve in place. The revolutionary sutureless valve is held in place using a special titanium alloy ‘frame’ that expands once it is released into the heart, removing the need for sutures and providing a better fit due to its unique design.
“For patients considered to be at high risk for cardiac surgery, including the elderly or those who suffer from other conditions such as lung disease, kidney disease or poor heart function, the sutureless valve is a valuable tool,” said Southlake cardiac surgeon Dr. Kevin Teoh, one of the first to adopt the procedure in North America. “It allows us to perform a very straightforward surgery that reduces the operating time as well as the risk to the patient when compared to traditional sutured valves.”
Southlake is one of only five North American hospitals that have adopted the device, formally called the Perceval sutureless valve by Toronto-based Sorin Group, which is approved for use in Europe but not yet available in the U.S. In Canada, the sutureless valve is accessible through Health Canada’s Special Access Program and is currently being used at Southlake, Sunnybrook Health Sciences Centre, Trillium Health Centre, the Montreal Heart Institute and London Health Sciences Centre as it awaits approval for general use. To date, more than 100 sutureless valve replacements have been performed in Canada, including 25 by Dr. Teoh.
For patients like Lawrence, a resident of Thunder Bay, Ontario, the sutureless valve is providing an opportunity that might not be available otherwise due to his age. As Dr. Teoh explains, surgery times are cut in half due to the fact that there are no sutures – the valve is held in place using radial force – and the procedure itself is less complex, requiring smaller incisions. That means patients who were considered too high risk for traditional sutured valve replacement now have an alternative.
“The more we can make an aortic valve replacement simpler, shorter and less damaging to patients, the more potential we have to operate on a wider audience with better outcomes,” says Dr. Teoh, noting that the target group for the new device is patients over the age of 75.
People who suffer from aortic stenosis may have difficulty climbing stairs, experience chest pain or discomfort and may even blackout, he explains. Once the patient becomes symptomatic, survival is typically limited to two years and quality of life declines rapidly.
“By performing this procedure, we’re helping high-risk patients to maintain their quality of life as they age,” says Dr. Teoh, noting that without treatment, they are likely to be in and out of hospital.
For patients like Lawrence, receiving the sutureless valve is like getting a new lease on life. Prior to his valve replacement, Lawrence was weak, short of breath and barely able to walk a few hundred yards. When he returned home following the procedure, he was “hopping, skipping and dancing” and “breezed through” his driver’s test just six weeks later, says his son Doug Lawrence.
“We couldn’t believe my father was back in his room 13 hours after surgery and walking the next day,” he says. “For somebody who’s five-and-a-half years away from 100, it really makes you stop and think. He had more energy following his surgery than he did three to four years ago.”
Everton Penrose, an 87-year-old from Parry Sound who underwent a sutureless valve replacement at Southlake last week, says the experience has changed his outlook on life.
“I have three great grandkids and another one on the way, and I want to see them grow up. I knew if I didn’t get the help, I wouldn’t have a chance to do so,” says Penrose, noting that before receiving the sutureless valve he suffered from dizzy spells, chest pain and extreme exhaustion. “I feel like I can smile today. I don’t think I’ve smiled in a whole year,” he says.
In October, Dr. Teoh presented preliminary findings for use of the sutureless valve at the Canadian Cardiovascular Congress in Toronto. He reported that among patient benefits are: improved blood flow and no dislodgement or leakage of the valve despite the lack of sutures. He also stated that the sutureless valve is very well suited for minimally invasive surgery with smaller incisions, and is a cost-effective option when compared to valves used in minimally invasive implant surgeries that are more than double the cost.
“Clearly this is a major advance in terms of valve technology and my hope is that our early success will encourage further research and development in the future,” said Dr. Teoh.
As part of its ongoing education and research process, cardiac surgeons from across Canada and the U.S. will visit Southlake in the coming months to observe sutureless valve surgery at the hospital. The sutureless valve is considered an important addition to the full spectrum of cardiac care offered at Southlake, which is also the first community hospital to offer Transcatheter Aortic Valve Implantation (TAVI), a minimally invasive procedure which involves inserting a replacement valve via a catheter in the femoral artery (groin).