Sunday, June 10, 2012

New Heart Valve Procedure Kindles Memory of a Visionary Surgeon

The following article appeared in The Morning Call newspaper on Sunday, June 10, 2012:,0,7032353.story

Dr. Horace Smithy (circa 1948)

I often wonder how amazing it would be if we could somehow show the great inventors of the past, just how far their ideas have come.  Imagine the faces of Orville and Wilbur Wright if they were able to see the powerful and majestic takeoff of a Boeing 747.  What would Thomas Edison think if he were able to see the Met Life Giants Stadium fully lit at night with the New York skyline lit up in the background?  Certainly Alexander Graham Bell would be in awe of cell phones and instant text messaging.

Dr. Horace Smithy was not as famous as these great inventors, but in light of the recent advancements in heart valve surgery, Dr. Smithy’s legacy is certainly worth noting.

During the early 1900’s, rheumatic heart disease caused the early death of many young people. Since antibiotics had not yet been developed, a simple strep throat infection could lead to damage of heart valves, joints, and the brain.  Typically, the heart valve damage would start as early as age 5 and progress to a point where a person’s heart valves were critically blocked in young adulthood.  Bobby Darin, the famous crooner, died from complications of rheumatic heart valve disease as late as 1973.

Dr. Smithy was a young surgical resident at the Medical College of South Carolina in 1938.  He had a keen interest in rheumatic heart valve disease because unfortunately, he was suffering from the disease as well.  Keep in mind, there was no open heart surgery in those days.  The heart-lung machine and modern heart surgery techniques wouldn’t be developed until 1953. Having your heart valve replaced was simply not an option at that time.

Therefore, Dr. Smithy performed experiments on animals whereby he would blindly insert a wire-like instrument (known as a barbed valvulotome) through the aorta, or even directly through the heart, in hopes of opening the blocked valves.  It was a very high risk idea and one third of his laboratory animals died from the procedure. Dr. Smithy persevered though and successfully performed his new procedure on a 21-year old woman on January 30, 1948.  In this operation, Dr. Smithy blindly inserted the wire device across her mitral valve –without the use of x-rays for guidance and without stopping the heart.

The New York Times reported his success on February 10, 1948, with the following headline, “New Heart Operation Saves Life of a Woman as Surgeon Cuts into Valve He Cannot See.”

New York Times Headlines Announcing Dr. Smithy's Successful Operation

Dr. Smithy went on to perform eight more successful operations that year. Sadly only a few months later, at the young age of 34, Dr. Smithy died from his own rheumatic heart valve disease on October 28, 1948.

Dr. Horace Smithy's Obituary

Almost sixty-five years later, Dr. Smithy’s vision of repairing heart valves by passing a catheter into the heart has finally come true.  A new procedure has recently been approved in the United States known as “trans-catheter aortic valve replacement” or TAVR.  This procedure uses a combination of catheters, balloons, and stents, along with fluoroscopic guidance to break open a patient’s blocked valve. The modern procedure goes one step further by actually replacing the old valve with a new one.  The beauty of this procedure is that it can be done without the need for an incision in the chest and without stopping the heart.

Edwards Lifesciences SAPIEN Valves (Sizes 26mm and 23mm)

Recently, we successfully performed this remarkable new procedure on two patients at Lehigh Valley Health Network.  Both patients were deemed too high risk for conventional surgery and were offered the trans-catheter approach instead.  The results were impressive.  Both patients were awake immediately after the procedure and were sitting up in bed just an hour later –no more shortness of breath or chest pain, and no chest incision either!

No doubt, this new technology has a long way to go.  Indeed, most patients requiring heart valve surgery today are still better served with conventional open heart surgery.  And, we shouldn’t lose sight of the fact that conventional heart valve surgery procedures have excellent outcomes, even for high risk patients according to the yearly reports from PHC4, Hospital Compare, and so on.

And yet, it is equally clear that this new catheter-based valve technology works well and will only get better.  The catheters will continue to get smaller and the techniques will get safer, thus allowing more patients to benefit from the procedure.  Currently in Europe, approximately 25% of all patients with aortic valve disease are being treated with this transformative procedure.  Just like the other great inventors, Bell, Edison and the Wright brothers, I wish that somehow the young and visionary Dr. Horace Smithy could see what has become of his vision of repairing heart valves.

Dr. Smithy Saying Goodbye to Betty Lou Wooldridge After Performing the First Successful Operation in 1948 

Mr. Check --Our First Successful TAVR Patient at LVHN (Less Than 2 Hours After Surgery)

Friday, June 8, 2012

First Trans-Catheter Patient Interviewed

Here is a video that I took of our first trans-catheter aortic valve replacment (TAVR) patient less than 2 hours after his surgery.  Mr. Check has given us permission to show you this video and tell his story.  Mr. Check was considered too high risk for conventional open heart surgery and therefore he was referred to our team for consideration of our new, minimally invasive heart valve replacement procedure known as trans-catheter aortic valve replacement (TAVR).  Mr. Check was the first patient at Lehigh Valley Health Network to undergo the new trans-catheter aortic vavle replacement surgery and thus the first patient in our region to receive the new SAPIEN valve locally!