Replacing Aortic Valve (with Catheter and Cow's)

choi

Gina Kolata, Replacing Heart Valve (with Catheter and Cow). New York Times, June 22, 2015 (front page; in the Series: Mending Hearts, with subtitle “Pioneering a new method”).
www.nytimes.com/2015/06/22/healt ... e-disease-tavr.html

Quote:

"The procedure, called TAVR, for transcatheter aortic valve replacement * * * With the procedure, a new valve is folded up and slipped into a catheter — a thin, flexible tube — which is then put into a blood vessel in the groin. When the catheter reaches the base of the aorta — the large blood vessel that carries blood from the heart to the rest of the body — the doctor opens a balloon that inflates the valve. The old valve remains, pushed aside by the new. Patients are awake and only lightly anesthetized.

"There is some question about whether the process of inserting the new valves loosens debris that can cause strokes. * * * Dr [Lawrence H] Cohn, the Harvard heart surgeon, said he and his colleagues had good reasons to look askance. They thought it was strange that the old valve would just remain in the heart. They wondered why the new one would not fly off into the rush of blood being pumped into the aorta — after all, it was not being sewn in. And pushing a valve into an atherosclerotic artery? Pieces [‘debris’ in sentence 1] of [atherosclerotic] plaque could break off and cause blood clots and strokes. Finally, he added, it would take patients away from surgeons. 'We were skeptical,' he said.

"And the procedure is costly. * * * $32,500 goes right out the door to Edwards, the valve manufacturer * * * The hospital gets about $40,000 from Medicare, which is fine if there are no complications.

Note:
(a) "His cardiologists, led by Dr Howard C Herrmann" at the Hospital of the University of Pennsylvania in Philadelphia

The German surname Herrmann is a variant of Hermann. The latter is "from a Germanic personal name composed of the elements heri, hari ‘army’ + man ‘man.’ "
(b) "Henry Kissinger, 92 [said:] 'I was getting out of breath more easily, and my cardiologist said something had to happen * * * He said I would be in a wheelchair if I didn’t have it, and my survival rate in a year would be only 50-50 [without a new aortic valve].' ”

choi

(c) two trailblazers:
(i) cardiologist "Henning Rud Andersen of Aarhus University in Jutland" experimented on pigs.
(A) Aarhus University
en.wikipedia.org/wiki/Aarhus_University
(public; located in Aarhus, Denmark [qv: especially section 1 Etymology]; Founded in 1928)
(B) Jutland [Latin: Iutum] was the homelands of Jutes.
(ii) "Around that time, in France, Dr Alain Cribier, a cardiologist at Hôpital Charles Nicolle, in Rouen, was thinking along the same lines" and practiced on sheep
(A) Charles Nicolle
en.wikipedia.org/wiki/Charles_Nicolle
(1866 – 1936; born in Rouen; a French bacteriologist who received the Nobel Prize in Medicine for his identification of lice as the transmitter of epidemic typhus [caused by Rickettsia bacteria])

* pronunciation of the surname Nicolle
dictionary.reference.com/browse/nicolle
(B) Rouen
en.wikipedia.org/wiki/Rouen
(a city on the River Seine; historic capital city of Normandy)

* In terms of River Seine, Rouen is downstream from Paris. View the map in Seine
en.wikipedia.org/wiki/Seine
(map caption: "Topographic map of the Seine basin")

choi

(d) a doubter: Lawrence H Cohn, MD
Virginia and James Hubbard Professor of Cardiac Surgery, Harvard Medical School;
Senior Surgeon, Department of Surgery, Brigham and Women's Hospital (which is a -- there are many -- teaching hospital of Harvard Medical School)
physiciandirectory.brighamandwomens.org/Details/1860

Take notice: Catherization is done by a cardiologist 心臟內科醫師, not a heart surgeon.

(e) "But the [Cribier] procedure was risky. It required threading a catheter up through a vein in the groin, going across the heart from the right to left side, passing the catheter through the mitral valve between the upper and lower left chambers of the heart, turning a corner in the lower left chamber and then heading into the aortic valve [so is now switched to catheterization through an artery]. * * * in 2004, Edwards Lifesciences [based in Irvine, Calif; founded in 1958 by Miles ‘Lowell’ Edwards] bought PVT, the company started by Dr Cribier * * * The FDA approved the method with the Edwards device for patients at extremely high risk in 2011."
(i) circulatory system
en.wikipedia.org/wiki/Circulatory_system
(view both the circulatory system (the first scheme) and section 1.1.6 Heart (the scheme of a heart))

* The clause "going across the heart from the right to left side" means from right atrium 心房 to left atrium--by puncturing a hole--which hopefully will heal (the ventricular septum 心室中隔 is too thick to safely puncture).
(ii) Quotations 1 & 2: “The old valve remains, pushed aside by the new. * * * They [cardiac surgeons] thought it was strange that the old valve would just remain in the heart [because in surgery, the old valve is removed before the new valve is sewed in].”

I did not understand what the text meant. After seeing the scheme below, the conceptualization becomes so intuitive. See Transcatheter Aortic Valve Replacement (TAVR). Raney Zusman Medical Group, undated
www.raneyzusman.com/endovascular ... placement-tavr.html

(f) "In June 2014, after another company, Medtronic, did similar studies, its device was approved, too, for high-risk patients."

Medtronic
en.wikipedia.org/wiki/Medtronic
(founded in 1949 in a garage in northeast Minneapolis by Earl Bakken and his brother-in-law Palmer Hermundslie as a medical equipment repair shop; In "2014, Medtronic announced its acquisition of Covidien, PLC [for Public Limited Company] of Ireland for $42.9 billion in cash and stock" and then moved to low-tax Ireland)

(g) Ageing in and of itself does not cause aortic (valve) stenosis 主動脈瓣膜狹窄, which is illustrated in
Aortic Stenosis. Edwards Lifesciences, undated (under the heading “Procedures”).
www.edwards.com/Procedures/Aorti ... aorticstenosis.aspx
(right in the top row;
(i) Edwards SAPIEN XT Transcatheter Heart Valve
www.edwards.com/products/transcathetervalve/Pages/sapienxt.aspx
(lateral view of the aortic valve; the scheme to the right of the section heading "Frame Design" is an artist's rendering of the old valve pushed outward by the new valve)
(ii) Human heart valves mostly last a lifetime. Back in Taiwan, I learned that animal valve (eg, from pigs) last a decade, and must be replaced with repeated operations (every decade). Long-term studies (on younger, healthier patients) of TAVR will determine how long this kind of valve will last.
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