DECATUR ― The miracle man. That's what doctors call Clifton Pogue.
After a history of heart problems and three bypass surgeries, the 87 year old Decatur man struggled to breath last spring.
“I was panting like a dog in summer,” Pogue said.
Unable to catch his breath and often tired, the once-active man went to his cardiologist. The diagnosis: His aortic valve was giving out. The crucial heart valve was functioning at 20 percent capacity, unable to open enough to send oxygenated blood throughout his body.
“(The doctor) said he had less than a year,” said Nelda, his wife of nearly 64 years.
Up to 1.5 million people in the U.S. suffer from aortic stenosis. Many can't be treated because they're too sick or at risk for surgery.
Pogue is a former smoker with a history of heart disease, lung disease, diabetes, a stroke in 1987, a pacemaker and scars running down his chest from three open-heart surgeries, the first in 1979. The door on invasive surgery was closed, but his long list health problems actually opened a window.
St. John's Hospital in Springfield has been replacing aortic valves with artificial ones through a new, less-invasive procedure called TAVR, transcatheter aortic valve replacement, since early 2012.
Dr. William S. Stevens, with the Southern Illinois University School of Medicine, was Pogue's cardiac surgeon. Aortic stenosis is when the valve opening narrows, restricting blood flow. It can be caused by a birth defect, rheumatic fever, radiation therapy or old age.
“The valve is opening and closing thousands of time a day and over time it just gets beat up and starts to scar and gets calcified,” Stevens said.
Before TAVR was available, the only option was to re-inflate the valve by ballooning it, but after several months it would tighten again.
“After that there’s nothing else to do,” Stevens said.
With the new surgery, an incision is typically made in the groin, or laterally across the chest in Pogue's case because his vein wasn't big enough. With the help of new technology the implant is moved up to the heart through an artery.
“It’s 100 percent technology; this couldn’t have happened 20 years ago,” Stevens said.
The advancements are so new that two or three years ago, surgery wouldn't have been an option for Pogue at all. “The technology was the only option for him,” Stevens said.
Discussion over whether to have the surgery out of state in St. Louis and doctor vacations delayed the procedure into July. His cardiologist was worried the doctors didn't have enough experience yet and they were weighing worries about his age and medical conditions against the aortic stenosis.
“It was really a touch-and-go situation,” Nelda said.
In order to qualify for the valve procedure, a team of cardiologists and surgeons had to determine each patient was too risky for open heart surgery. Pogue was choosen as the 66th patient. In the fall the hospital hosted a celebration for the 100th surgery. In the current trial stage, the surgery is limited to high risk patients such as Pogue.
“That’s why Dr. Mishkel calls this the hope procedure, that was the big advertising campaign,” Stevens said, referring to his cardiologist colleague.
Cardiologist Dr. Gregory J. Mishkel was the driving force behind bringing the procedure to Springfield.
“We really embarked on this because we see this as important part of cardiovascular health moving forward,” Mishkel said.
The TAVR valve is American technology that has been used in Europe for several years before being commercially released by the U.S. FDA late 2011. The company Edwards LifeSciences makes the valves. The replacement heart valve has a steel frame, about the size and shape of the metal piece on the end of a pencil. The interior is made from cow heart tissue. The FDA only released the valve for use in 150 hospitals at first after following a screening process analyzing positive results from high-risk surgeries.
“This area of cardiology is probably one of the major advancements in the last decade,” Mishkel said.
In March 2012, Edwards asked St. Johns to participate in a study involving high-risk patients and updated versions of the implant. They have had patients from across the state, many of whom had run out of options.
“When we do the surgery,” Stevens said. “There’s two cardiologists and a surgeon present, we’re all working together, which is pretty unusual.”
Mischel sees teams of doctors developing plans together as the future of health care. As many as 20 people are in the operating room for the procedure, which takes about under three hours.
The implant costs $35,000, but most patient's bills are covered by Medicare and Nelda and Clifton Pogue's health insurance covered all but about $17 of the surgery.
Now, more than six months out, Pogue's struggles to breathe has unfortunately returned and he relies heavily on a cane. The cold weather has kept him indoors.
“I believe it's worse (than before),” Pogue said.
Dr. Stevens said that usually doesn't happen, but it may be caused by the heart muscle being too thick from working so hard in the past that now it doesn't move very well and they hope it can be fixed with medication and contributing therapies.
“The people that did well did incredibly well – they have a whole new life,” Stevens said.
Mishkel said although Pogue's heart function doubled after the surgery, he has so much heart disease and health problems it was hard to diagnose what the main cause was for his difficulty breathing.
The surgery is not a fix for every aortic issue. Stevens said TAVR surgery is less invasive, but has an increased stroke rate. However, out of the more than 100 patients who have had the surgery, so far only two deaths have been reported through the program at St. John's.
The valve is still in its early stages, so no one can predict the long-term outlook. Upcoming medical trials are opening up to patients of intermediate risk and younger patients to test how long the valves last. New technologies are also in the works for different aortic problems.
“The hope is it puts people on their normal life span,” Stevens said.