The Associated Press
Niagara Gazette — SAN FRANCISCO — Have a heart problem? If it's fixable, there's a good chance it can be done without surgery, using tiny tools and devices that are pushed through tubes into blood vessels.
Heart care is in the midst of a transformation. Many problems that once required sawing through the breastbone and opening up the chest for open heart surgery now can be treated with a nip, twist or patch through a tube.
These minimal procedures used to be done just to unclog arteries and correct less common heart rhythm problems. Now some patients are getting such repairs for valves, irregular heartbeats, holes in the heart and other defects — without major surgery. Doctors even are testing ways to treat high blood pressure with some of these new approaches.
All rely on catheters — hollow tubes that let doctors burn away and reshape heart tissue or correct defects through small holes into blood vessels.
"This is the replacement for the surgeon's knife. Instead of opening the chest, we're able to put catheters in through the leg, sometimes through the arm," said Dr. Spencer King of St. Joseph's Heart and Vascular Institute in Atlanta. He is former president of the American College of Cardiology. Its conference earlier this month featured research on these novel devices.
"Many patients after having this kind of procedure in a day or two can go home" rather than staying in the hospital while a big wound heals, he said. It may lead to cheaper treatment, although the initial cost of the novel devices often offsets the savings from shorter hospital stays.
Not everyone can have catheter treatment, and some promising devices have hit snags in testing. Others on the market now are so new that it will take several years to see if their results last as long as the benefits from surgery do.
But already, these procedures have allowed many people too old or frail for an operation to get help for problems that otherwise would likely kill them.
"You can do these on 90-year-old patients," King said.
These methods also offer an option for people who cannot tolerate long-term use of blood thinners or other drugs to manage their conditions, or who don't get enough help from these medicines and are getting worse.
"It's opened up a whole new field," said Dr. Hadley Wilson, cardiology chief at Carolinas HealthCare System in Charlotte. "We can hopefully treat more patients more definitively, with better results."
For patients, this is crucial: Make sure you are evaluated by a "heart team" that includes a surgeon as well as other specialists who do less invasive treatments. Many patients now get whatever treatment is offered by whatever specialist they are sent to, and those specialists sometimes are rivals.
"We want to get away from that" and do whatever is best for the patient, said Dr. Timothy Gardner, a surgeon at Christiana Care Health System in Newark, Del., and an American Heart Association spokesman. "There shouldn't be a rivalry in the field."NEW TREATMENTS HEART VALVES -- Catheter-based treatments are in testing. One for the mitral valve -- Abbott Laboratories' MitraClip -- had a mixed review by federal Food and Drug Administration advisers this week; whether it will win FDA approval is unclear. It is already sold in Europe. HEART RHYTHM PROBLEMS -- Catheter ablation is being used for the most common rhythm problem -- atrial fibrillation, which plagues about 3 million Americans and 15 million people worldwide. HEART DEFECTS -- Some people have a hole in a heart wall called an atrial septal defect that causes abnormal blood flow. St. Jude Medical Inc.'s Amplatzer is a fabric-mesh patch threaded through catheters to plug the hole. CLOGGED ARTERIES -- The original catheter-based treatment -- balloon angioplasty -- is still used hundreds of thousands of times each year in the U.S. alone. A Japanese company, Terumo Corp., is one of the leaders of a new way to do it that is easier on patients -- through a catheter in the arm rather than the groin. Newer stents that prop arteries open and then dissolve over time, aimed at reducing the risk of blood clots, also are in late-stage testing. HIGH BLOOD PRESSURE -- About 75 million Americans and 1 billion people worldwide have high blood pressure, a major risk factor for heart attacks. Researchers are testing a possible long-term fix for dangerously high pressure that can't be controlled with multiple medications. It uses a catheter and radio waves to zap nerves, located near the kidneys, which fuel high blood pressure.