Providence and 91-year-old patient make heart history in Oregon

February 07, 2012

Cardiac history has been made in Oregon, as an internationally trained team of heart experts implanted a collapsible Sapien heart valve in a patient at Providence St. Vincent Medical Center. This pioneering procedure – the first of its kind in Oregon – was performed Feb. 1 on 91-year-old Benjamin Wiener, a pioneer of medicine in his own right. The Vancouver resident was an early developer and producer of generic drugs who helped supply affordable medicine to those in need.

“Mr. Wiener has given a lot in his life, and has served the greater good through his work with generic drugs and people in poverty around the world,” said Todd Caulfield, M.D., interventional cardiologist and medical director of cardiovascular research for Providence Heart and Vascular Institute “It is a privilege to give back to him and I am honored we can do that.”

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Todd Caulfield, M.D. talks about Providence's first Sapien valve patient.

The Sapien valve received FDA approval late last fall, and Providence was selected as the first location in Oregon to perform the groundbreaking minimally invasive procedure. Providence prepared for five years for this opportunity, establishing a multi-disciplinary clinic for valve patients, and sending surgeons, cardiologists and an anesthesiologist to train with top experts in the field in Canada and Germany. The Sapien valve has been available outside of the United States since 2007.

“This is a game changer. This is the beginning of a transformational change in the care of patients with valvular heart disease,” said Dr. Caulfield. “In the future we will see more patients treated at younger ages and with better results by using these transcatheter procedures rather than open-heart techniques.”

The valve is used in the treatment of severe aortic stenosis for patients who are too ill for conventional open-heart surgery. The device can be delivered percutaneously or with a minimally invasive two-inch incision in the groin – compared to traditional surgery that involves a much longer incision in the chest and sawing of the breast plate.

“This new FDA-approved minimally invasive heart valve replacement procedure is not meant to replace conventional open-heart surgery. It is meant to be one more tool in caring for people too ill for open-heart surgery,” explained Dr. Caulfield.

Wiener received his new Sapien valve in an early morning procedure lasting just over two hours. It was performed by a team of surgeons, cardiologists, physicians and nurses in a hybrid digital surgical suite. The team includes Dr. Caulfield, surgeons Jeffrey Swanson, M.D. and Eric Kirker, M.D., interventional cardiologist Robert Hodson, M.D., cardiologists Aly Rahimtoola, M.D. and Craig Walsh, M.D., and anesthesiologist Steve Kelly, M.D.

Wiener has a unique appreciation for the nature of the work that led to his implant. He served as a senior research scientist on the Manhattan Project that led to the development of the atomic bomb. He later joined the group Scientists for Peace.

“I am glad I am able to contribute to science; I knew my going through this would be of immense value for others who face the possibility of this groundbreaking procedure,” said Wiener. “I admire the medical team members who cared for me; I admire their humanity and caring as well as their technical skills.”

In a traditional open-heart surgery, the patient’s heart is stopped while the diseased valve is cut out and a replacement valve sewn in to surrounding tissue. Patient recovery sometimes takes weeks.

It was very different for Wiener.

In using the collapsible Sapien valve, surgeons implanted a temporary pacemaker to control the beat of Wiener’s heart. Interventional cardiologists and cardiovascular surgeons then worked together to thread a catheter slightly larger than the width of a pencil to his heart through a small incision in a groin artery. The Sapien valve was attached to a balloon at the end of the catheter. Just before implantation, the pacemaker sped up Wiener’s heart to 180 beats a minute, causing the heart to quiver. At that point, the balloon was expanded, pushing aside the leaflets of the diseased valve. The Sapien valve then was opened with its metal stent walls embedding into the original valve, locking it into place. The balloon was deflated and removed, along with the catheter and the pacemaker. After a short time in critical care, Wiener spent several days recovering in the cardiac unit; he was sitting up and walking the hallway within 24 hours of the procedure. He is expected to be released from the hospital later this week.

Wiener will continue to receive care through Providence Valve Center, the interdisciplinary clinic established to care for all valve patients, including those who qualify for the Sapien valve.

In addition to being the first site in Oregon to implant the Sapien valve, Providence also is the only medical center in Oregon selected to participate in research trials for Partner II – the next generation of the balloon expandable valve. “We were chosen to participate in the trials because we serve a high volume of cardiac patients, we have excellent outcomes and we receive strong community support for our programs – including Providence Valve Center,” said Dr. Caulfield.

Providence Heart and Vascular Institute serves 13,000 cardiac patients annually from throughout the Pacific Northwest.