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Last spring, Philip Good’s tricuspid valve was failing—again. The New Hampshire resident received a heart transplant at BWH in 1998, and had already required one subsequent surgical valve replacement.
This time, his care team wasn’t sure that Good would survive the surgery needed to mend his valve. Yet, without a second valve replacement, Good would likely succumb to heart failure. Knowing the risk of performing the surgery and the risk to Good’s health if they didn’t, his care team devised an innovative way to set him on the road to recovery.
In January, Andy Eisenhauer, MD, a BWH interventional cardiologist, led the multidisciplinary team in performing a first of its kind transcatheter valve replacement procedure. These “valve-in-valve” cases are becoming a possible alternative for patients at excessive risk for an additional valve replacement operation. Overall, transcatheter aortic valve replacement is an increasingly more common and less invasive treatment option in patients with stenosis (an abnormal narrowing) of their native aortic valves. The team has performed more than 60 of these to date.
“However, this is the first time we have ever performed a transcatheter valve replacement in the tricuspid valve,” said Eisenhauer. “Complicating this was the fact that Mr. Good had a transplanted heart and had already undergone a surgical valve replacement.”
The multidisciplinary team included Michael Davidson, MD, and Greg Couper, MD, of Cardiac Surgery; Fred Welt, MD, of Interventional Cardiology; and Luigi Nascimben, MD, PhD, of Cardiac Anesthesia, as well as staff from the Cardiac Catheterization laboratory, Cardiac Perfusion and the Hybrid OR. The team proposed trying to replace the valve using a less invasive technique than surgery. They would insert a catheter into the area of the damaged valve and replace it with an artificial valve. The idea was supported by Cardiac Transplant team lead Michael Givertz, MD.
Upon hearing the team’s idea, Good and his wife, Lorraine, were hopeful. “There was lots of discussion about what was the best thing to do,” said Lorraine Good. “The entire team made sure they dotted all the Is and crossed all the Ts, and we were confident this was the right plan.”
The team performed the procedure in the Shapiro Cardiovascular Center’s Hybrid Operating Room. That way, if necessary, the team could change direction quickly and conduct a valve replacement. The procedure, however, went as smoothly as the team planned.
“Things went off without a hitch, largely thanks to the Cath Lab and OR nursing, the technical and radiographic staff, as well as the coordinated efforts of the physicians involved,” said Eisenhauer.
Good was thrilled with the results, which led to a speedy discharge from the hospital two days later.
“I’m feeling better than I did before,” he said.
The Goods expressed their gratitude to all those who played a role in their care. “The Brigham is very special to us,” said Lorraine, adding that she and her husband have been coming to BWH for care for 13 years. “We are so thankful to all of the people who have taken care of us.”