William Hribal was having shortness of breath and some chest pain. The 75-year-old couldn’t sleep at night because of these nagging symptoms. He was also having a hard time performing everyday activities, getting winded easily. He knew it was time to see his heart doctor, Brian Staub MD of Washington Health System.

“My regular heart doctor, Dr. Staub, said it was time to have the valve worked on,” said Hribal.

Mr. Hribal was not a stranger to heart issues, having had open-heart surgery to replace his mitral valve eighteen years ago. Dr. Staub had implanted a bioprosthetic valve during the procedure, a type of valve which can deteriorate over time. Dr. Staub told him that it was time for a new one.

Eighteen years is a long time in terms of medical technology and Mr. Hribal was thrilled to hear that a novel catheter-based heart valve replacement could be performed to implant a new valve inside his failing surgical valve that would not require open-heart surgery. The heart is not bypassed and never stops beating throughout the procedure. He remembered the difficult and painful recovery period from his initial surgery, and this newer non-surgical option was an appealing alternative. Dr. Staub referred Mr. Hribal to his colleague, Dr. Rekhi Varghese, a fellow cardiologist at WHS.

“The doctor drew a diagram and explained how it would go into the first heart valve and insert the new and smaller valve into the old valve,” said Hribal. “The doctor asked if I had any concerns or questions for him. He explained everything.”

This transcatheter heart valve procedure is a great therapeutic option for the treatment of symptomatic heart disease due to a failing bioprosthetic mitral surgical valve in patients with prohibitive conditions or high surgical risk. The advantages are that the procedure is less invasive, requires a shorter hospital stay and offers the patient an easier recovery. Like any procedure, there are possible risks, which include groin complications and thrombus on the valve, which is why patients usually go on a blood thinner for at least six months post-surgery.

The technology in itself is remarkable, but what is particularly impressive is that this advanced procedure is being performed at a small local hospital. Most of the surgeons who have acquired the technology and training are at large city hospitals.

The valve itself is comprised of a cobalt-chromium frame and bovine (cow) pericardial tissue leaflets. Edwards Lifesciences makes the valve used at WHS, called the SAPIEN 3 Ultra. Edwards provides training for the physicians and a proctor oversees the first few surgeries

On May 5th, 2020, Dr. Varghese completed the first valve-in-valve transcatheter mitral valve replacement surgery at Washington Health System on Mr. Hribal. The approximately hour-long surgery was a success and Mr. Hribal was able to leave the hospital the next day and recover at home.

“I went in for surgery one day and out the next. Everything went great, almost unbelievable,” he said. “The doctors and nurses were great.”

If you would like to learn more about valve-in-valve TMVR and find out if you are a possible candidate, please contact Kimberly McCrerey RN BSN. As the Structural Heart Coordinator at WHS, she oversees the valve program and clinics and helps guide patients through the process of heart valve replacement. You can contact her directly at 724-229-2306.