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MUSC offers Melody transcatheter valve procedure, quicker recovery

By Dawn Brazell
Public Relations
Laurie Fladd knew the procedure she  was to have done at MUSC was new. She just didn't realize how new. When she found out the day before her Jan. 26 procedure that she was to be the first patient at MUSC and first in the state to have a transcatheter pulmonary valve inserted, it gave her pause.
 
Dr. Laurie Fladd with her family at a Cooper River Bridge Run.

Briefly.

Given that the only other option was open heart surgery, Fladd, Ph.D., decided she was willing. Fladd, department head for physical sciences at Trident Technical College and the active mother of two boys, had known since age 13 that she would have to have another open heart surgery for a valve replacement at some point.

She was thrilled to see that she could wait long enough for technology to provide a less invasive method, she said.

The stented valve being expanded into postion under fluoroscopy. Watch the video at http://bit.ly/MUSC_Melody

Interventional pediatric cardiologists Rani Bandisode, M.D., and G. Hamilton Baker, M.D., performed the procedure and were glad to see Fladd up using her IPad the day after getting her valve. An open heart surgery would have required a week to 10 days for recovery.

The procedure has been done on three patients so far, two of them children, and all were able to leave the hospital the next day. Bandisode said they are treating a larger adult population than they've ever had before. "A lot of our patients with congenital heart disease are well into their adulthood. I think our oldest patient is 76 years old. Our patients are living longer with disease processes that they would like to be able to manage and increase their life spans even longer, or take away other risk factors, such as stroke. It's pretty amazing."

Dr. G. Hamilton Baker reviews Laurie Fladd's images from her Jan. 26 Melody transcatheter valve procedure.

MUSC is the only center in the state so far approved to have the Melody valve procedure, one of 40 to 50 centers nationally. This is a rapidly growing area of treatment and an exciting time to be in their field, she said. Currently, other types of valves are being tested, with the Melody valve the first of many types to be produced.

"Otherwise, it would impact a good portion of the population who would have to undergo their fourth or fifth open heart surgery in their life span. If this could keep them out of the operating room for another open heart surgery–that would be great," Bandisode said.
 
Dr. Rani Bandisode

Phil Saul, M.D., director of the division of  pediatric cardiology and Fladd's primary cardiologist, agrees it's an exciting option to offer patients.

The Melody transcatheter valve procedure is for patients with either damaged or absent valves in the pulmonary position, which handles blood flow from the right ventricle to the lungs. The valve is sewn into a stent with the whole device being crimped down to fit over a balloon catheter. It's placed through a vein and is advanced through a special delivery sheath. The balloon is expanded, which expands the stent, the vein and the valve into place in the correct position. The stent is a stainless steel tube with many little slits that grab onto tissue when the stent is expanded, he said.

Dr. Phil Saul

"In the past these kinds of patients have often gone many years with a leaky pulmonary valve—that's the main valve that goes to the lungs. What would happen is that over time, the right-sided pumping chamber of the heart would dilate. Eventually, it would cause patients to have decreased exercise tolerance, and we would get to the point we'd have to replace that valve surgically. That was really the only option."

The Melody catheter-delivered valve allows doctors to intervene sooner instead of waiting until patients get to the point of having poor exercise tolerance, decreased right ventricular function and an increased risk for the right ventricle to be unable to recover, he said.
 
"This represents another step of the pediatric heart team to take procedures that used to be done exclusively in the operating room and perform them in minimally-invasive catherization procedures."
The hope is to put in devices that will last long enough that patients can have a series of catherizations that will get them through old age. Generally, these bioprosthetic valves last seven to 15 years. "We're thinking 'let's put this in now and see how the technology will catch up.' It doesn't mean that no one will ever need surgery, but we can reduce the amount."

Baker said a difference with the Melody valve is that the device was built to be appropriate for children as well as adults.

"It was built for our specific population. It makes parents extraordinarily happy when their kids get to come the next day instead of a few days to a week with a surgical scar that has to heal over the course of a month or two. They're able to get back to their regular activities in a short period of time."
Saul said it worked perfectly for Fladd in two ways.

"By using the stent expansion, we were able to expand out the narrowed area so that she no longer had any stenosis and put the valve into place so that she no longer had any regurgitation. It worked like a perfect, normal valve."

Fladd, who's already training for the Cooper River Bridge run/walk with her family, said an open heart surgery would have been very disruptive to their family schedule. "We've always joked that the longer I could wait, the likelier they'd come up with something better. I understand it's temporary, but even if I get half of the time I did with the other, I'd be thrilled."

As a baby, she was born blue and had to have a valve replacement. She's had open-heart surgery three times. She said this procedure was much easier and only required an overnight stay. "Everyone from the time I checked in from the time I went home was great. They're fantastic."

She likes it that the procedure served as a preventative measure before she started developing more serious symptoms. She's eager to get back to her fitness activities that range from kayak to yoga.

"We do the bridge run together as a family. I want to make sure that I'm able to keep up with my family. That means the world to me. I don't want be in a wheelchair or not be able to see things because it's too tiring for me to get there. That's really important to me."