UAB Medicine

September 25, 2012

Transcatheter Aortic Valve Replacement Proves WWII Vet a Hero Again

Charles Estes is a hero.

Earlier this summer he volunteered to be the first person at a hospital in Alabama to undergo  transcatheter aortic valve replacement , a new minimally invasive procedure for replacing heart valves in people with aortic stenosis — severe hardening or narrowing of the aortic valve. One month later he is thriving.

For the 89-year-old Hackleburg, Ala., resident, service to others is nothing new. He volunteered for the Marines in 1942 and within three years he had fought in three campaigns in World War II’s Pacific Theater. Then the father of three came home and before retiring spent 39 years as a teacher and principal throughout the Southeast.

Estes’s service to others has now taken a different direction.

“My aortic valve had deteriorated and was not pumping like it should. I reached the point where I couldn’t do anything,” Estes says. “If I walked a little bit, I got short of breath. I could take care of small activities and I got along fine. But I couldn’t exert myself.”

On Aug. 6, physicians in  UAB Heart and Vascular Services , home to the state’s largest and oldest  heart valve disease treatment program , gave Estes a new aortic valve using the Edwards Lifesciences SAPIEN transcatheter heart-valve-replacement system — the only transcatheter aortic valve replacement therapy approved for commercial use in the United States. UAB’s doctors are the only ones in Alabama trained to do it.

“I first saw Mr. Estes about 10 months ago when he was referred for surgery because he was developing worsening symptoms of aortic stenosis,” says surgeon James E. Davies, Jr., M.D., assistant professor in the UAB Division of Cardiothoracic Surgery. “Before then he had been very active and otherwise a pretty healthy man but he was becoming severely limited in what he could do.”

transcatheter aortic valve replacement surgery - Birmingham, Ala.

Davies discussed the treatment options with Estes. Open-heart surgery to replace the valve — the gold standard of treatment for most patients — was a no-go because of Estes’s age and other health concerns. Valvuloplasty — where a balloon is inserted into the valve then inflated in an effort to increase the opening size of the valve and improve blood flow — wasn’t a good choice either. Davies didn’t think it would keep Estes’s valve open for more than a few months. He offered Estes the option of traveling out of state for a valve replacement using the Edwards system, since at the time no one in Alabama offered the procedure. But Estes decided to wait to see how his symptoms progressed before making the decision to travel.

In the meantime, Davies and Massoud A. Leesar, M.D., professor and section chief of UAB Interventional Cardiology, were getting a new valve replacement program off the ground at UAB. The effort, four years in the making, began as a partnership between Davies and former interventional cardiologist Vijay Misra, M.D., who passed away in 2011.

“We saw Mr. Estes in clinic in June and told him we were going to start doing the procedure in early August,” Davies says. “He was very interested in being the first patient here at UAB.”

In fact, you could say that the former Marine was gung ho. “The opportunity was there, so I said, ‘Let’s go. Let’s do it,’” Estes says. “I’m so proud to be able to do this.”

Leesar says Estes was the perfect candidate for the Edwards Lifesciences SAPIEN transcatheter heart-valve-replacement system: He was considered a high risk for surgery because of his age and other health problems that come with getting older. He also had blockage in an artery that required angioplasty, which was performed by UAB interventional cardiologist Mark Sasse, M.D., a month before the aortic valve replacement.

“Patients like Mr. Estes are functional people but because their aortic valve is so tight they can’t walk, exercise or breathe well even sitting at home,” Leesar says. “Typically about 30 percent of the patients referred for heart surgery to replace their aortic valve cannot have open surgery done because they are high risk.” But patients who don’t have surgery face severe risks, Leesar continues—mortality for these patients is estimated at about 50 percent in one year. “The first study published two years ago showed the SAPIEN procedure reduced their rate of dying from 50 percent to 30 percent, which is a big reduction,” Leesar says.

So in the early morning hours of Aug. 6, Davies and Leesar, along with SAPIEN team members Sasse, cardiothoracic surgeon Spencer Melby, M.D., interventional cardiologist Seun Alli, M.D., echocardiologist Julian Booker, M.D., and radiologist Satinder P. Singh, M.D., made medical history at UAB and in the state, flawlessly implanting Edwards’ SAPIEN valve in Estes. He spent less than 24 hours in intensive care, typical after this procedure, and the following afternoon was sitting in a chair in his hospital room doing his leg exercises.

“His prognosis now is good,” Davies says. “He’s still an 89-year-old man with the same limitations you have at that age, but the outlook is much better. We want to add life to his years, not just years to his life. The hope is that his shortness of breath, his chest pain and his limitations will be relieved.”

Estes, a former preacher, says he already noticed a difference in how well he could breathe the day after surgery, and he has a lot to do in the coming months. He’s ready to get back to church — he has not been able to attend in a while because of his health — and even has an offer to preach at a church in the Hackleburg area when he’s ready. He also loves gardening and is looking forward to planting, harvesting, canning and freezing what his garden produces next spring and summer.

“I love life. I love people. I enjoy being with people,” Estes says. “These things have been denied to me for some time and I thought they were gone forever. But now I have hope, and hope is a wonderful thing. I’m not defeated anymore. I’m ready to live.”

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