Joan Miró (17 years old) had a smile on his face when he found out, a few months ago, that he would be spared a new open-heart intervention. With a few days to live, he already had to undergo one to alleviate the congenital heart disease that he suffers (called Tetralogy of Fallot). Now, 17 years later, he had to face a second one to change the pulmonary valve of his heart. But thanks to a new technique that has been used for the first time in Europe at the Vall d'Hebron hospital, the new valve has been able to be implanted using a catheter, thus saving on open heart surgery that would have meant, among other things, a big scar on the chest and a long recovery period. The day after the intervention, carried out last May, Joan left the hospital under her own power.
The disease suffered by this young man is characterized by a narrowing at the outlet of the heart to the lung (in the pulmonary valve and artery) that means that patients who suffer from it may have to undergo surgical treatment, even in newborns. . As a consequence of these treatments, it is common for the pulmonary valve to stop working optimally and its replacement is necessary, years later.
Technology makes it easier for this valve to be implanted by catheter, but an important number of patients are not candidates for this intervention due to the great dilation of the area to be treated, which makes it impossible for the new valve, implanted via catheter, to be able to stay well anchored and stable. The new technique that they have put into practice in Vall d'Hebron, however, solves this problem. It does this using a self-expanding stent (Alterra Adaptive Present) that works as an adapter, thus overcoming excess dilation.
Patients who, like Joan, suffer from this pathology suffer from lung failure. "This means that part of the blood that leaves the right side of the heart in the direction of the lungs returns to the heart," explains Dr. Pedro Betrián, head of the pediatric hemodynamics unit at Vall d'Hebron who, together with his team , has operated on Joan and a second patient (also 17 years old) with this new technique, presented today in society. "That means -he continues- that this organ has to manage a large volume of blood, the amount that it would receive under normal circumstances and the amount that returns, which causes the entire area to dilate."
Joan, who will turn 18 in October and who attended the presentation ceremony, underwent this new procedure in May and was able to return home on her own two feet the day after the operation. Even three weeks later she was able to present herself completely normally for the selectivity, which he ended up passing. In September she will start the degree of industrial design.
He admits that he was "very happy" when he learned that a new open-heart intervention could be saved. “Since he was little, he already knew that at the age of 18 or so he would have to go through open heart surgery again. An intervention like this leaves a fairly large scar and the recovery is quite long, ”he says.
The difference, with respect to the recovery period, between this new technique and open heart surgery "is very important," Betrián emphasizes. “We do the entire procedure through a puncture in the femoral vein at the level of the groin. This allows the patient to walk home the day after the intervention. If it is done with an open heart, he has to be hospitalized for about ten days, adding the days of the ICU and the ward”.
The valve that is implanted in this new technique (also through open-heart intervention) is biological. That means it's not forever: it has a half-life of ten years. The good news is that, after this time, a new one can be implanted in the patient within the one that is already useless using the same technique, which is very minimally invasive.
This new system will allow between 30% and 35% of patients with a pathology similar to Joan's and who could not receive the new valve through a catheter (it is estimated that 50% of them) can avoid open heart intervention. Joan's disease (Tetralogy of Fallot) is one of the most common congenital heart conditions treated in Vall d'Hebron.
The Catalan hospital was the first center in Europe to perform this technique, which has been used for about five years in the United States. The center, as Betrián explained, has received a special permit for its use, and the fact is that the new mechanism still does not have all the necessary permits approved in Europe.
Joan, after the intervention, leads a completely normal life. His pathology does not prevent him from doing anything. "His heart has a prosthesis, but it works completely normally," argues Betrián. He can practice sports as he did before the intervention. Fortunately, his two sisters do not suffer from his congenital heart disease.
