Dr. Charles M. Zacharias Jr. of Virginia Cardiovascular Specialists shows WilbertStory images from his valve-replacement procedure. Photo courtesy HCA Virginia
In late July, an ailing Wilbert Story showed his son, Michael, where he kept his extensive state quarters collection.
"I think he thought this was it," Michael recalls.
The 88-year-old widower had been experiencing progressive symptoms of heart failure for the past year. He spent his days and nights alone in his Hopewell apartment, attached to an oxygen mask.
"I've lived by myself since my wife passed away," Story says. "I do the cooking, washing, everything. I just got so I couldn't do nothing. They found out that I didn't have too much longer to go before I kicked the bucket."
Story took almost a year to recover from coronary artery bypass surgery after suffering from a heart attack in 1995. Almost two decades later, doctors determined that he could not withstand another open-heart surgery to replace his weakened heart valve — even if he survived the surgery, he wouldn't make it through the recovery.
A year ago, Story's tale would have ended there, but in November 2011, the Food and Drug Administration approved a nonsurgical procedure to replace weakened heart valves in patients who are deemed inoperable for open-heart surgery. During the procedure, interventional cardiologists and cardiothoracic surgeons use minimally invasive techniques with state-of-the-art imaging equipment to thread a delivery catheter through the artery in the groin up to the femoral artery in the heart. A replacement valve is expanded with a balloon and immediately functional, according to the FDA.
HCA Virginia's heart valve department was the first team in Central Virginia to offer the procedure. The VCU Medical Center will start offering it on Nov. 1.
On July 26, Wilbert Story became the first patient in the Richmond region to undergo the operation. Cardiologists and cardiac surgeons worked together in a hybrid operating room at Henrico Doctors' Hospital that was built specifically for the valve-replacement procedure. A few weeks after the operation, he was on his feet again.
"It revolutionizes the treatment of heart valve disease," says Dr. Thomas Christopher, a surgeon with Cardiothoracic Surgical Associates who is on the HCA Virginia Heart Valve Team. "This is the first procedure where you can replace a person's heart valve without an incision on the chest and without stopping the heart, so it's a huge quantum leap."
Aortic valve stenosis is a common age-related disease caused by calcium deposits on the aortic valve that progressively narrow the heart valve, increasing the risk of heart failure. When the aortic valve becomes excessively obstructed or leaky, it must be repaired or replaced. Besides age, aortic valve calcium risk is associated with factors such as male sex, body mass index and smoking, according to the American Heart Association (AHA).
"The Medicare population is going to double between 2000 and 2025 because of the baby boomers," says Dr. Irving Kron, chair of the department of surgery at the University of Virginia medical center and a national spokesman for the AHA. "There's going to be a lot of people who are going to need these procedures."
As of press time, the FDA had only approved the procedure for patients who could not undergo open-heart surgery, but doctors foresee the eligibility requirements expanding in the near future.
"We fully anticipate that by January, the indication will be broadened to people who are at high risk for the heart surgery," Christopher says. "Not necessarily inoperable, but at high risk. I would imagine going forward that eventually, it will be approved for most with the disease."
In late August, a week before his birthday, Wilbert Story joked around with his four sons. Since the procedure, he hasn't had to use oxygen and is back to his daily routine, spending much of the day tinkering on his car that he expects to be back to driving soon.
"They gave us our dad back," says his son Howard.