Kalispell Regional touts 'revolutionary' heart procedure

Cardiac specialists at Kalispell Regional Medical Center are the first doctors in Northwest Montana to perform a heart valve replacement procedure that circumvents open-heart surgery. 

Trans-catheter aortic valve replacement is a relatively new procedure that treats patients with a tight aortic valve, known as aortic stenosis, who are too fragile for open-heart surgery.

Once the valve starts to fail, it restricts blood from pumping out of the heart to the rest of the body. The blockage can take years, but once a patient starts to feel symptoms, it can be life threatening.

Cardiac surgeon Dr. Drew Kirshner with Kalispell Regional said before new value replacement surgery, if a patient was too weak for surgery many eventually died from the illness.

“This is without question the most exciting advance our field has seen since the ’70s. This is revolutionary,” Kirshner said.

Kirshner has repaired aortic valves for 25 years. He said in that time, he’s seen an unknown number of patients he couldn’t save through surgery. One of those patients was Poul Houlberg. On Nov. 9, Houlberg, 87, was one of the hospital’s first trans-catheter aortic valve replacement recipient.

“I saw Mr. Houlberg ... I knew if I took him to the operating room, we’d get him through the operation, but I knew he would not leave the hospital,” Kirshner said.

Last year, the Rocky Mountain Heart and Lung clinic sent more than 30 patients to other hospitals for the procedure. Kirshner said he expects between 45 to 50 trans-catheter aortic valve replacement patients a year as understanding around the procedure continues to grow.

So far, the team has completed five such procedures.

“Every week we get referred one or two or three people who never would have been considered for surgery … people that primary care docs never sent to us because they knew they were too high-risk,” Kirshner said.

Kirshner works alongside interventional cardiologist Dr. Mayank Agrawal, who was recruited by Kalispell Regional in September in order to offer the procedure in the valley. “About one in eight patients in the United States who are more than 75 years old have either moderate or severe valve disease,” Agrawal said. “Once the symptom of the aortic valve starts, then about 50 percent of the patients don’t make it more than two years.”

The newly assembled team works in Kalispell Regional’s new hybrid operating room. The more than $4 million expansion wrapped up this month in time for the first scheduled procedure.

Kirshner said the trans-catheter aortic valve replacement procedure is the reason why the room was built, “but it’s not going to be the only reason why it’s used,” he said. “It’s going to be applicable to neurosurgery, vascular surgery … its role is going to evolve, but it’s still being defined.”

The hybrid room includes a portable X-ray machine hanging above an operating table. If something in the procedure starts to fail, the surgeons can move the trans-catheter aortic valve replacement equipment out of the way and convert their surroundings to perform open-heart surgery.

Agrawal said there are roughly 400 hospitals in the nation registered to perform the procedure that was first successful in Europe in 2002. It arrived in the U.S. in 2011. As doctors have recorded its success, the U.S. Food and Drug Administration has expanded its use from inoperable patients to high-risk and now to intermediate-risk patients.

Patients in need of the procedure often have been separated from the care they need by hundreds of miles. He said the procedure’s arrival in Kalispell is an example of the technology spreading from large medical destinations in the heart of major cities to frontier centers.

“The beauty about this procedure is that [the patients] start feeling well right after that,” he said. “They can talk, they are not in much pain … [one] patient came out of the operating room singing.”

Less than two weeks after the hospital’s first trans-catheter aortic valve replacement procedure, Houlberg sat in a room alongside his doctors and talked about the onslaught of pre-existing conditions he faced that intensified his tight aortic valve.

Houlberg said felt his endurance weaken for years before the surgery. He laughed as he said he looked forward to being able to chase his wife around their living room again.

“I didn’t know I was singing when I left the operating room, but I knew I was singing when I entered it,” Houlberg said before he repeated his pre-procedure song, “Oh what a beautiful morning, oh what a beautiful day, I’m so happy that Dr. Agrawal is doing the operation today.”

Reporter Katheryn Houghton may be reached at 758-4436 or by email at khoughton@dailyinterlake.com.