Available at only four hospitals nationwide, a new minimally invasive hybrid procedure saves lives, reduces complication risks

By Jeni Baker

Fifty-eight-year-old Roberta Ogden has a long history of heart problems. The mother of three and grandmother of six underwent an angioplasty after suffering a heart attack at age 45, and went on to have quadruple coronary bypass surgery the following year.

In 2002, three years after the New Jersey native moved to Newport, N.C., a local cardiologist placed four cardiac stents to alleviate her increasingly labored breathing.

But within five years, her problems had returned with even greater severity.

“One of the Best in the World”

“It had gotten to the point where I couldn’t stand or walk two or three steps without being out of breath, and I almost collapsed several times,” Ogden says. “In August 2007, after being seen at two different hospitals, I was told I’d probably need a valve replacement or a heart transplant and was referred to Duke for a second opinion.”

Ogden initially saw Peter K. Smith, MD, Duke’s chief of cardiovascular and thoracic surgery, who reviewed images recently taken of her heart at the other hospitals. The images revealed recurrent blockages in several coronary arteries, as well as mitral regurgitation, or leakage of the mitral valve.

“Dr. Smith said that [cardiothoracic surgeon Donald Glower, MD] could perform a mitral valve replacement the following week,” Ogden recalls. “He emphasized that Dr. Glower was one of the best in the world at performing that surgery, so I was surprisingly calm and comfortable going into it.”

On September 4, 2007, Ogden became one of the first people in the Southeast to undergo a revolutionary minimally invasive cardiac surgery known as a hybrid procedure -- best described as part angioplasty and part valve surgery.

“The minimally invasive nature of the hybrid procedure dramatically reduces the risk of surgery-related complications and death,” Glower says. “There’s a lot less scarring, which can damage the heart and bypasses, as well as less bleeding, reducing the need for transfusions -- and less chance of infection.”

Glower says his team looked at several options for Ogden: doing nothing -- which would have put her at even greater risk; treating her with medications; getting her on the heart transplant list; and performing a second open-heart surgery to repair her mitral valve.

“But because she had severe damage that probably originated with her heart attack and got worse from the mitral valve leakage, none of those options were great for her particular situation, and we decided she was a good candidate for the hybrid,” he says.

Ogden first went to Duke’s catheterization lab, where Lawrence Crawford, MD, placed a small catheter in her groin, through which he performed an angioplasty and placed two drug-eluting stents -- one to replace one of Ogden’s existing stents, plus a new one -- leaving her with five stents total.

Ogden was then immediately moved to an operating room, where Glower made a two-inch incision under her breast and replaced her mitral valve with a heart valve made from cow tissue in another minimally invasive surgery known as a minithoracotomy, port-access, or keyhole procedure.

The back-to-back nature of the two-part procedure prevents most patients from having to undergo open bypass surgery, which involves cutting through bone, Glower explains.

The fourth U.S. medical institution to ever perform the port-access procedure, Duke Heart Center now performs the world’s second-highest volume of the surgery, Glower says, adding that because both components of the hybrid procedure are still relatively new, it is not yet widely available.

Dancing to Her Heart’s Content

Ogden’s surgery went so well that she was able to go home only five days later. And two weeks post-surgery, she was given the okay to drive -- something that open-heart surgery patients typically must wait six weeks to do.

“I saw Dr. Glower in December, and he said I was good to go,” Ogden says. “He released me to my doctor in Morehead City and said I only need to see him again if I want to.”

In January 2008, Ogden passed a stress test “with flying colors,” she says, which was necessary to graduate from the cardiac rehabilitation program in which she participated.

Now in a two-day-a-week cardiac maintenance program, she has no activity restrictions, although she’ll continue to watch her diet. Her new heart valve should last about 15 years.

“In terms of her arteries and valves, Ms. Ogden is doing fine,” says Glower. As if to prove his point, Ogden is kicking up her heels for the first time in many years.

“I feel great,” she says. “I recently went to a dance at the local lodge I belong to, and I got out there and danced like crazy.”

Not bad for someone who had a hard time standing just a few short months ago.