Released by Longview Regional Medical Center:
LONGVIEW, TEXAS (December 30, 2010) — In October of 2010 at 82 years of age, Mr. John Scasta was told his options were limited when his aortic heart valve started to fail. Having already survived a triple coronary bypass surgery in 2005, local doctors were less than optimistic about what could be done to fix his heart since he was not a good candidate for another open heart surgery. His cardiologist, Dr. Ronald Scott, pursued a second opinion by doctors in Dallas for a minimally invasive procedure that would replace the valve using a catheter, but he was turned down twice due to pre-existing conditions. He developed congestive heart failure where his lungs were filling with fluid because the aortic valve was barely opening to pump blood out of the heart. He was so weak he didn't even feel like shaving. Luckily, knowing about the recent advances in cardiac services at Longview Regional Medical Center (LRMC), Dr. Scott aggressively pursued a third opinion from Dr. David Jayakar, Director of Cardiovascular Surgery at the Heart and Vascular Institute of Longview Regional.
Valve replacements are typically performed by opening up the chest, stopping the heart, and replacing the defective valve with a new one. Doctors had been reluctant to suggest a valve replacement because, in his fragile state, Mr. Scasta was not a good candidate for having his heart stopped while a valve replacement surgery was performed. There were also potential complications presented by scar tissue around his heart from the prior bypass surgery. In spite of these challenges, Dr. Jayakar felt that Mr. Scasta would be a candidate for an innovative heart valve procedure currently being performed in only a few centers in the United States.
To avoid complications related to the scar tissue from the prior surgery, Dr. Jayakar decided the best option would be going through the ribs so that the chest did not have to be re-opened. And due to the other pre-existing conditions, Dr. Jayakar also felt that the best option would be to keep Mr. Scasta's heart beating throughout the surgery. While beating heart surgeries are performed on about 20% of all coronary bypass patients, they are still very rare for heart valve replacements. Dr. Jayakar likens the traditional heart valve surgery to a contractor replacing a doorway by removing the entire frame and door then re-installing a new one. While work is in progress the doorway cannot be used. For similar reasons, the heart is usually stopped for the valve replacement.
However, there is another way to give patients a new valve with the heart still beating, and that is to leave the old valve in place and basically create a "window" in the heart where a new valve can be added. Once the new valve is in place, a bypass to the aorta is created so that the new valve now functions as the primary aortic valve even while the old, non-functioning valve remains in place. In Mr. Scasta's case, this alternative surgical procedure was really his last hope.
And it was more than a hope—it was a success! Today he is back to walking two laps, riding his bike, and walking down to the barn to tend to the cows on his farm. He's come a long way since he couldn't muster the energy to shave, and his heart failure is completely reversed. His wife, Mrs. Ruth Scasta, says that one of the most remarkable things about his surgery was the lack of pain that he felt afterward due to the excellent care given by the pain management/anesthesia team at Longview Regional. The area where his ribs had been spread and the incision did need some time to heal, but it was nothing like what he had experienced when his chest had been opened up for the bypass surgery years earlier.