Success of experimental technique may open new route for transcatheter valve replacement

Main Category: Cardiovascular / Cardiology
Also Included In: Medical Devices / Diagnostics
Article Date: 15 Aug 2013 - 1:00 PDT Current ratings for:
Success of experimental technique may open new route for transcatheter valve replacement

Doctors at Henry Ford Hospital have created a new route to the heart to implant an artificial heart valve by temporarily connecting major blood vessels that do not normally intersect.

In a July 3 operation on 79-year-old Viola Waller of Charlevoix, physicians performed a world-first cardiac procedure when it became evident that other means would not work.

"I knew of an experimental technique that had not yet been done in humans, and I had a patient with no other options who was failing rapidly," says William O'Neill, M.D., medical director of the Center for Structural Heart Disease at Henry Ford Hospital.

The new approach, called transcaval, involves threading a guide wire through a vein in a leg, and passing it from the main vein in the body into the main artery, the abdominal aorta. Then, by gradual dilation, the openings of the vein and artery are widened to the point of allowing a catheter to connect them, continue to the heart, and implant the new artificial heart valve.

As the catheter is removed, plugs are inserted in the artery and the vein to close the holes made for the temporary connection of the two major blood vessels.

Approximately 5 million people in the U.S. are diagnosed with heart valve disease each year. With an aging population that is often too frail for open-heart surgery, more than 20,000 Americans die of the disease each year, according to the American Heart Association.

Dr. O'Neill estimates that this new procedure could help 25,000 - 50,000 patients a year in the U.S.

Waller was transferred from northern Michigan to Detroit by medical helicopter in critical condition. Her aortic valve, a previous implant done through open-heart surgery many years ago, was failing.

The preferred access for transcatheter aortic valve replacement (TAVR) is through the leg arteries. However, Ms. Waller's arteries were too small in diameter for the catheter due to prior plaque buildup and stents that had been previously placed in them. Cardiologists made an attempt to reach her heart through a minimally invasive chest incision, but fatty deposits near the patient's heart could not support the necessary structure for a catheter.

"Since all traditional options were not feasible our multi-specialty team felt the new technique could be the answer for this patient," says Adam Greenbaum, M.D., director of the Cardiac Catheterization Lab at Henry Ford Hospital and leader of the team. "She could not have open-heart surgery, and her condition was deteriorating daily."

Robert Lederman, M.D., an interventional cardiologist and senior investigator at the National Institutes of Health who developed the technique in pigs, came to Detroit to observe the procedure and share his insights.

Waller is making a remarkable recovery, and has returned to her home in northern Michigan.

"The success of this new procedure may open a new route for transcatheter valve replacement," adds Dr. O'Neill.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Greater success in personalized medicine class by students who underwent genetic testing

Main Category: Medical Students / Training
Also Included In: Genetics
Article Date: 25 Jul 2013 - 0:00 PDT Current ratings for:
Greater success in personalized medicine class by students who underwent genetic testing

Students who had their genome tested as part of a groundbreaking medical school course on personalized medicine improved their knowledge of the class materials by an average of 31 percent compared with those who didn't undergo the testing, according to a study by researchers at the Stanford University School of Medicine.

While the sample size was small - 23 students sent their saliva to a commercial genetics testing company; eight did not - the results may encourage educators to consider this approach in the future, the authors said.

"These results indicate that learning principles of human genetics is more powerful, and learning is more sustained, when exploring your own data," said Keyan Salari, MD, PhD, a former Stanford student who initially proposed the course, called "Genomics and Personalized Medicine." Salari, who is the lead author of the study, is now a urology resident at the Massachusetts General Hospital in Boston. The study was published in PLOS ONE.

The eight-week elective course was the first in the country to give students in advanced-degree programs the option of personal genotyping as part of the curriculum. It was designed to teach them how the explosion of knowledge about genetics over the past 10 years could affect the treatment of patients. Since the course was first offered in 2010, the use of genetic testing in clinical care has grown.

The course, which is still being taught, was designed as a way to train future doctors and scientists in the skills necessary to use this new tool. The study, which was based on a pre- and post-course survey taken voluntarily by the majority of the students in the class, also showed that personal testing and the use of personal genotype data in the classroom did not appear to cause significant anxiety.

"This was a novel teaching approach," said Kelly Ormond, co-author of the study and associate professor of genetics. "There is always a lot of interest in whether personalized learning can influence education. ... What our study shows is that it might have benefits for some self-selected students, and is worthy of cautious consideration."

Initially controversial, the course was only approved after a campus task force met regularly for a year to debate the pros and cons of students undergoing genetic testing as part of a class. A number of concerns were raised, including the possible anxiety of learning they could be more susceptible to certain diseases, such as diabetes or Parkinson's. A number of safeguards were subsequently included as part of the course plan, including complete anonymity as to which students chose to undergo testing.

Salari conceived of the idea for the course in 2009 as a PhD student in genetics. He was working as a teaching assistant in the first-year human genetics course for medical students. At the time, the course curriculum consisted primarily of traditional genetics and didn't reflect the genomics revolution of the past 10 years. Salari had also recently undergone his own genetic testing, and saw the educational benefits.

"I was curious about what stories were hidden in my genome, what health risks, what responses to drugs that might be predicted," Salari said. "For instance, I learned I might have a higher risk for age-related macular degeneration. That led me to read and learn a lot more about the genetics of that disease than I probably would have otherwise."

He added: "I wanted to find a way to translate my passion for genomics to all these medical students."

Study results also showed that 83 percent of students who chose to undergo testing were pleased with their decision. Seventy percent of those who underwent the testing reported a better understanding of human genetics on the basis of having undergone testing. The post-course survey also asked students who underwent the testing whether they made any behavioral changes based on the results, such as lifestyle changes or making appointments with doctors. Some initial behavior changes were reported. Yet in a previous study involving face-to-face interviews with the same students, no behavior changes were reported six months after the end of the course.

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Other Stanford authors included Konrad Karczewski, a bioinformatics PhD student, and Louanne Hudgins, MD, professor of pediatrics and of medical genetics.

Stanford University Medical Center

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