Ship-in-a-Bottle Heart Surgery to Save Lives and Dollars

August 13th, 2003

It’s a dilemma. You’re too sick for the life-saving surgery you need. Your heart’s own valve is giving out and you need a new one soon. In your weakened condition the operation could kill you. Doctors at St. Paul’s’s leading-edge Heart Centre see a solution on the horizon, a way to replace dying valves without surgery. They’ve taken their cue from an old seaman’s hobby – ships in a bottle.

In the old days, intricate models of ships were made to be folded small enough to slip through the neck of a bottle, then unfurl inside the flask to their full glory.

The new medical twist is a foldable heart valve that can be threaded into a tiny incision, up through a blood vessel to the heart then unfolded and installed remotely, without major surgery.

The savings in patient discomfort are immense, but so are the dollar savings. No large operating room and no long hospital stay means saving thousands of dollars per patient. It also means saving the lives of those too weak for open-heart surgery. The new procedure is called Percutaneous Valve Replacement. A small incision is made at the top of the leg to allow a tube the size of a pencil to be inserted. The tube is threaded along the veins up to the heart. Veins don’t have a sense of touch inside them so the patient feels very little. The folded valve goes in through the tube to the heart. It’s then unfurled and fixed in place exactly. When that’s done, the tube is pulled back out. The leg incision is so small it only needs two or three stitches. After a rest, the patient is free to go.

Today, many people benefit from the traditional expensive and painful heart-valve surgery pioneered over 40 years ago. Hundreds of thousands of people worldwide have artificial valves. At age 85, Mrs. Eleanor Wetherly had symptoms that her own valve was failing.

“A few years ago I started getting so short of breath and so tired. When I walked to the store I had to stop and sit down so often just to catch my breath. The doctor said if I didn’t have the surgery, I’d have 6 months to live.”

Luckily, Mrs. Wetherly was a good candidate for traditional replacement surgery. Unfortunately many patients with failing heart valves aren’t eligible for this traditional operation.

“Sometimes their hearts are just too far gone,” says Heart Centre specialist, Dr. John Webb. “Sometimes they have some other condition that makes them a poor candidate for major surgery. So at first we’ll just be trying this new surgery on the sickest patients, those who have no options left to them. In time, we hope to offer this more widely.”

Mrs. Wetherly didn’t enjoy her traditional valve replacement surgery.

“Where they broke my breast bone and ribs to get at my heart it really hurt. I was in the hospital for a long time. It was two or three months before I felt all better.”

Because of the reduced risk, pain and cost, non-surgical valve replacement is the hope of the future.

“But,” cautions Dr. Webb, “the new remote procedure is still highly experimental. It’s not available just yet. The tube we thread it through is three feet long. The placement of these folding valves is crucial. A few hair widths out of place and the whole thing’s wrong. ‘Close enough’ isn’t good enough when you’re dealing with something as intricate as the human heart. We have to get it right every time.”

Although widespread use is likely some years away, Webb adds that initial limited use of the new technique on humans is expected within one or two years.

So a delicate ship in a bottle from centuries past points the way. Those with failing hearts are given new wind in their sails thanks to an old art form gone high tech. Folded valves that unfurl in the heart are set to save lives in the years to come.