UBC Reports | Vol.
50 | No. 2 | Feb.
Old Skill Provides Modern Solution to Heart Valve Replacement
New technique may mean no more broken breastbones
By Hilary Thomson
A traditional sailors' craft was the inspiration for a new
technique to replace heart valves without major surgery.
Much like a ship in a bottle, the procedure involves inserting
a foldable valve through a small incision and
running the valve along a blood vessel into the heart where
it is 'unfurled' and attached remotely -- a virtually non-surgical
Valve replacement surgery currently requires breaking ribs
and breastbone to access the heart, a minimum of a week's
hospitalization and considerable recuperation time.
Called Percutaneous Valve Replacement, the new procedure
is being developed by Dr. John Webb, director of the cardiac
catheterization laboratory at St. Paul's Hospital in Vancouver.
Still in the experimental stages, the technique offers promise
for patients who are too ill to survive traditional valve
The new method involves a small incision made in the thigh
to allow a tube the size of a pencil to be inserted. The tube
is threaded along the veins up to the heart. Once the folded
valve has been opened and attached in the heart, the tube
is withdrawn. After a couple of stitches for the incision
and a day's rest, the patient would be able to go home.
Sound simple? Not quite, says Webb, who is also a UBC associate
clinical professor of cardiology.
"The new remote procedure is still highly experimental. We
haven't yet tried it on a patient. The tube is about three
feet long and the placement of the valve within the complex
structure of the heart is critical. A few hair widths out
of place and the whole thing is wrong. We have to get it exactly
right every time."
If the technique can be perfected, it would mean huge health-care
savings compared to current methods requiring an operating
room and long hospital stays. Most importantly, it would mean
that individuals who are too weak for surgery and unlikely
to survive might be saved.
Also, patients would be able to avoid the significant pain
and discomfort of heart valve replacement surgery.
"When they broke my breast bone and ribs to get at my heart
it really hurt," says 86-year-old Eleanor Wetherly.
"I was in the hospital for a long time. It was two or three
months before I felt better."
Four valves direct blood to and from the body through the
heart: the aortic valve, the pulmonic valve, the tricuspid
valve, and the mitral valve. Any of these valves may malfunction
because of a birth defect, infection, disease, or trauma.
When the malfunction is so severe that it interferes with
blood flow, an individual will have heart palpitations, fainting
spells, and / or difficulty breathing. These symptoms will
progressively worsen and cause death unless the damaged valve
is replaced surgically.
Webb expects it will be at least two years before patients
can benefit from the procedure.
About 80 per cent of Canadians have at least one risk factor
for cardiovascular disease and 11 per cent have three risk
factors or more, according to the Heart and Stroke Foundation
of Canada. Risk factors for cardiovascular disease include
smoking, lack of exercise, being overweight, and high blood
For more information on heart disease and treatment, visit