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Heart Breakthroughs: An Alternative to Open-Heart Surgery

November 19, 2010

Margie Weber, RN, is a whirl of blue scrubs in the Hybrid Operating Room at Barnes-Jewish Hospital. As the clinical resource nurse for cardiac and vascular surgery, it is Margie’s job to ensure that more than a dozen people are in place for the morning’s procedure. Very soon, the team will replace a patient’s heart valve without opening the patient’s chest.

The team excels at the procedure—after all, they helped to develop it through clinical research at Barnes-Jewish Hospital that was supported in part by gifts to the Barnes-Jewish Hospital Foundation. It is hard to believe that, only three years ago, these colleagues would not have been in the same room working together.

Giving Patients More Time

For years, the standard of care for deteriorating heart valves has been open-heart surgery. But this is not a safe option for some of the sickest or oldest patients. The PARTNER (Placement of Aortic Transcatheter Valves) trial at Barnes-Jewish Hospital (executed by the team under the leadership of Washington University physicians) offers these patients new hope by taking a small incision approach to valve replacement.
In this approach, the team uses a catheter (tube) to insert a new valve through a small incision in the groin or chest. Unlike open heart surgery, the procedure is performed while the heart is still beating, and without the use of a heart-lung machine to maintain blood and oxygen circulation.

These advances have enabled the PARTNER team to reduce a four-hour procedure to roughly two hours, dramatically reducing recovery time and potential complications. The key to the success of this approach is directly seeing the valve during the procedure. This means that cardiac surgeons and interventional cardiologists (cardiologists who deal specifically with catheter treatment of heart disease) must work together, which is not typical in the operating room setting.

“This is the first time that all of us have gathered at the same table and planned the procedure together. The level of collaboration I’ve experienced during this trial is unprecedented,” Margie says.

Team member Dale Haynes, a catheter lab technician, shares Margie’s excitement about the collaboration that made them part of this clinical trial. “It’s amazing to see, with today’s technology, how we can implant a device without opening up a patient,” Dale says. “This procedure is going to change the way heart procedures are done everywhere.”

Adds team member Nina Kelly, RN, a surgical nurse responsible for providing the right instruments to the surgeon during the procedure, “It’s gratifying to see people who’ve been declined for surgery—people who cannot function—get back to walking, talking and feeling better almost immediately after the procedure. Recently, we performed the procedure on a person who had been told to enter hospice care, and we restored that patient’s heart function by 25%. We are giving patients more time.”

Leaders of the Pack

Several Washington University heart physicians and surgeons lead the PARTNER trial, including interventional cardiologists John Lasala, MD, PhD, and Alan Zajarias, MD; and heart surgeons Hersch Maniar, MD, and Ralph Damiano, MD, the Barnes-Jewish Hospital Foundation’s John M. Shoenberg Endowed Chair in Cardiovascular Disease.
Cardiologist Brian Lindman, MD, is also instrumental in selecting candidates for the procedure. On this morning, Drs. Zajarias and Maniar radiate energy as they gear up for the procedure.

“The PARTNER trial has been one of the most exciting developments in heart surgery in the last 15 years,” Dr. Maniar says. “You need experienced people from both the surgical and cardiac intervention sides to make it work.”

“Because of our expertise, we are one of fewer than 20 centers in the United States performing this procedure,” Dr. Zajarias says. “This collaborative research is clearly saving people’s lives.”

“It’s astounding to watch Dr. Zajarias and Dr. Maniar practice,” Margie observes. “How they learn from each other and come up with new ideas…how they talk with patients and their families…they lead the pack!”

The Hybrid Operating Room

With the randomized portion of the PARTNER trial (in which participants were randomly selected to test the effectiveness of the procedure) concluded, the team is continuing the study within the new Barnes-Jewish Hospital Hybrid Operating Room (OR).

“The Hybrid OR is quickly becoming an ideal place for small incision heart procedures,” Dr. Maniar says. “Its value for patients will only increase as these procedures become more commonplace and demand increases.”

“And we’ll continue developing these procedures as the Hybrid OR enables new collaborations that lead to innovation,” adds Dr. Zajarias.

In the PARTNER trial, the interventional cardiologist, heart surgeon, and echocardiographer (who captures images of the moving heart through ultrasound) have to agree that the valve has been placed correctly. This is achieved using a special x-ray device that provides real-time, radiologic images. And just in case an emergency arises during the procedure, the Hybrid OR can be quickly converted to safely revert to the standard procedure of opening the chest.

“When we work together in the Hybrid OR, our physicians and nursing staff are amazing,” Margie says. “Patients are in highly capable hands.”

Proud to Be Part of the Team

Margie Weber became a registered nurse because she loves people. She chose cardiovascular surgery because she finds it innovative and challenging.

“At Barnes-Jewish Hospital, I work with people who ‘think outside of the box’ when confronted with unique or critical situations,” Margie says. “We are revolutionizing cardiology and cardiac surgery, and our potential for medical accomplishments is unlimited. I am proud to be part of this very talented team.”

To support innovative research like the PARTNER trial, please give to the Barnes-Jewish Hospital Foundation's Medical Research Fund (#7134) by clicking on “Give Now” above. If you have questions, please call David Sandler at 314-362-3499 or e-mail givingbarnesjewish@bjc.org.

To see pictures of the PARTNER team in action, check out the online photo album at www.GivingBarnesJewish.org/PARTNER

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