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Virtua Health Cardiac Team First in Region to Perform New Valve Procedure

October 18, 2019 - The Structural Heart team at Virtua Our Lady of Lourdes Hospital is the first in the area to successfully perform a new technique to prevent potentially fatal artery obstruction during heart-valve replacement surgery.

October 18, 2019
Technique prevents fatal obstruction during heart valve replacement, expands hospital’s life-saving use of TAVR
The Structural Heart team at Virtua Our Lady of Lourdes Hospital is the first in the area to successfully perform a new technique designed to prevent potentially fatal artery obstruction during heart-valve replacement surgery. 
Joseph Callahan, 75, of Ocean City, underwent a Bioprosthetic Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery (BASILICA) obstruction procedure as part of a Transcatheter Aortic Valve Replacement (TAVR) on Oct. 11 in Camden.
The procedure employs an electrified guide-wire threaded through a catheter to slice the leaflet of an aortic valve so that it will not block blood flow to the left and right coronary arteries when a new valve is implanted.
“TAVR is an effective and less-invasive approach to treating aortic valve stenosis. However, in some patients, the leaflets of their failing valve can be displaced when the new valve opens inside it, blocking blood flow,” said Ibrahim Moussa, DO, FACC, FSCAI, RPVI, director of the Structural Heart program at Virtua Our Lady of Lourdes Hospital. “By using BASILICA and splitting the leaflet with the electrified wire so it is flush against the sides of the artery when the new valve deploys, we can reduce this complication.”
Such complex, advanced surgery became necessary for Callahan due to a 2016 valve replacement surgery performed in Florida that produced less-than-optimal results. The retired Pennsauken police officer said the replaced valve “wasn’t sitting properly” and that his persistent pre-surgery shortness of breath never improved. “[My previous doctors] told me I would feel like a 40-year-old,” he said. “That never happened.”
In addition to his heart problems, Callahan was also diagnosed with leukemia, prompting him and his wife to move back to New Jersey from Florida. 
Shortly after his return, Callahan met Scott Gabler, MD, of Virtua-Lourdes Cardiology. Dr. Gabler became his cardiologist and determined that one of his valve’s leaflets appeared fixed in place.
“He really had no choice but to get a new valve,” said Dr. Gabler.
As Callahan suffered from a weakened heart, peripheral artery disease, and other conditions, the team at Virtua Our Lady of Lourdes decided TAVR was the best approach. While TAVR is an advanced procedure, it is a minimally invasive approach. Therefore, the patient avoids a major operation that would involve opening the chest cavity.
TAVR involves inserting a catheter through an incision in the upper leg and guiding it through the femoral artery to the heart. A special balloon inflates the new valve, pushing the old valve aside. The new valve immediately restores proper blood flow.
But the standard TAVR procedure presented certain risks given the complexity of Callahan’s case. Tests revealed that his valve had calcified and was placed too close to the mouth of the left artery. The Virtua team feared that when the new valve was placed inside the old one, the leaflets would get permanently stuck over the artery, which could be fatal. 
Drs. Moussa and Gabler assembled a team of experts that included cardiothoracic surgeon Charles Stivala, DO; anesthesiologist Bassem Saad, MD; and Roger Laham, MD, of the Harvard Medical Faculty. Collectively, they identified BASILICA as the best path forward. Developed by the National Institute of Health’s National Heart, Lung and Blood Institute, BASILICA has demonstrated positive outcomes in clinical trials. 
Callahan admitted to some apprehension when told about BASILICA. 
“I was more scared going into this than the open-heart surgery,” said Callahan. “But I didn’t feel a thing.”
On the day of surgery, the team used an electrified wire the size of a sewing thread to slice the valve leaflet so it became shaped like a “V.” As hoped, the reshaped leaflet went around the artery opening when the new valve deployed.
Dr. Moussa believes BASILICA greatly improves the safety of TAVR for patients at risk for coronary obstruction. 
“This technique will greatly increase the treatment options for high-risk patients who need a heart valve procedure,” said Dr. Moussa.