LINCOLN — Simply walking from his house to his driveway was a chore for Ted Kimminau.
The Hastings, Neb., man struggled to breathe. He used 5 to 6 liters of oxygen every day. His body couldn't clear itself of fluid, which built up in his lungs and tissues.
Among other ailments, Kimminau, 79, was suffering from aortic stenosis, a narrowing of the aortic valve that restricts blood flow. Without aortic valve replacement, his chances of surviving long weren't good.
But he had already had triple-bypass surgery, back in 1999. Because of that and his lung problems, he wasn't a candidate for another open-heart surgery.
A new procedure performed at Lincoln's Nebraska Heart Hospital gave Kimminau a new aortic valve. Cardiologists, surgeons and other medical staff worked together to replace the faulty valve using a catheter, threading an expandable heart valve up an artery from the groin and maneuvering it into position within the heart.
The hospital is the first in Nebraska and one of the first in the United States to treat patients with what's called an Edwards SAPIEN transcatheter heart valve. The device was approved in November by the U.S. Food and Drug Administration but has been used in Europe for years.
Kimminau's procedure was one of two that the Nebraska Heart Institute & Heart Hospital heart team performed in mid-December. They did another one on Wednesday.
The procedure is a “game-changer” for people with the condition, said Dr. Deepak Gangahar, one of the institute's founders.
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Up until recently there was no option,” said Dr. James Wudel, a surgeon who operated on Kimminau. “These people had a terrible prognosis.” The procedure, he said, “has been shown to dramatically improve survival, but not just that — improve the quality of life.”
Severe aortic stenosis often is caused by the buildup of calcium on the aortic valve's leaflets, which are flaps of tissue that open and close to regulate the one-way flow of blood through the aortic valve. This calcium buildup on the leaflets impairs their ability to fully open and close, hospital officials said. As a result, the narrowed valve allows less oxygen-rich blood to flow from the lungs to the brain and the rest of the body, which may cause symptoms such as shortness of breath and extreme fatigue.
As many as a third of the 1.5 million people in the United States with aortic stenosis never undergo valve replacement therapy, Wudel said, because they're too frail, they have had multiple previous operations or they have some other medical problem that makes surgery impossible.
Kimminau's procedure took about 2½ hours, about as long as an open-heart surgery would take. “It takes a couple of sets of hands as we steer this device inside the body around the aorta under X-ray guidance,” said Dr. Steve Martin, a cardiologist.
The stainless-steel frame of the replacement valve is crimped around a device, a balloon catheter, that's about the size of a drinking straw. Imaging physicians and a cardiac anesthesiologist tell the team when the device is in place, Martin said. The balloon is then deflated and the catheter withdrawn.
Many hours of preparation outside the operating room preceded the actual procedure. “It's a well-rehearsed dance,” he said.
The risks of stroke and vascular complications are higher with the procedure than with open-heart surgery, Wudel said, and the valve won't work as long. But the risk of bleeding is lower than with surgery, he said.
Gangahar said the procedure costs between $50,000 and $60,000 instead of the $20,000 to $30,000 cost of open-heart surgery. The price likely will drop, he said, as competitors develop their own devices.
Kimminau said his recovery time was much shorter after the procedure — a matter of days — versus the one or two months it took to recover from the open-heart surgery. He said he was a little nervous about being one of the first in the U.S. to undergo the procedure, “but I'm sure happy that it went real well.”
Kimminau's weight dropped from 270 pounds to 210 pounds after the procedure — his body was able to rid itself of the excess fluid that had built up. He now uses 1 to 2 liters of oxygen per day, and he's able to walk to the grocery store. He can lie down to sleep instead of sleeping in a recliner. He can drive again, and he said he may even try to play a little golf.
“I think it was a great procedure,” Kimminau said.
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