Structural Heart team saves 74-year-old Redford patient with rare new valve replacement procedure

When Helga Abela of Redford was 60 years old, a faulty aortic valve made it difficult for her to catch her breath and get through daily life.

She was living in Traverse City at the time and her cardiologist recommended a surgical aortic valve replacement using pig tissue. Six months after that procedure, she also underwent open-heart bypass surgery to improve her circulation and overall cardiac health.

Energy restored, Abela was thrilled to get a new lease on life. These significant surgeries brought her considerable relief and the precious gift of time. But that was 13 years ago and unfortunately, artificial valves don’t last forever.

By this time last year, at the age of 73, Abela’s “new” valve was narrowing and leaking. She was experiencing heart failure, but deemed too high risk for yet another open-heart surgery.

That’s when Corewell Health’s Beaumont Farmington Hills cardiologist Dr. David Gowman steered her to the Structural Heart team at Corewell Health William Beaumont University Hospital in Royal Oak, which included cardiac surgeon Dr. Alessandro Vivacqua, Aortic Center director, and structural and interventional cardiologist Dr. Amr Abbas, director of Structural Heart and Cardiovascular Research.

The team determined Abela’s best chance for healing would be via transcatheter aortic valve replacement, or TAVR. An alternative to open-heart surgery, this less invasive technique inserts a new valve mounted on a catheter through a small incision typically in the groin and up to the heart to replace the diseased valve.

But based on information collected through scans and images, Dr. Abbas determined that the path to healing was hampered by not one, but two factors:

• The arteries in Abela’s groin were so blocked and narrowed, it would be impossible to insert a catheter there. Instead, surgeons would have to take the more difficult route of accessing Abela’s arteries through the neck.
• Abela’s faulty valve was too close to the arteries that feed the heart. That meant that if the new valve was placed inside of it, which is typically how the procedure is carried out, arteries to the heart would be blocked and unable to function, possibly leading to heart attack or death.

“Accessing the arteries through the neck to replace a faulty valve is not conventional. But it’s done,” Dr. Abbas explained. “Usually when we go in through the neck, the new valve is simply placed inside the old valve. In this case, however, the tissue of the old valve would first have to be ‘sliced’ with an electric current so it wouldn’t block the arteries of her heart. This technique, in isolation, has been performed several times worldwide. The challenge was to combine the slicing technique of the old valve with the neck access insertion technique to the new valve. This combination has been performed less than a handful of times worldwide. Fortunately, Helga came to the right place.”

Adding to the complexity, Abela was also grappling with severe anemia, which landed her in the hospital several times throughout the first part of 2023.

But when her condition finally stabilized in July 2023, the Structural Heart team was ready.

Abela’s humor helped them all get through the rough spots.

“I told Dr. Abbas, ‘You better be right buddy. I’m not ready to leave this world just yet. I want to find out what happens next.’”

As part of the enormous, multi-disciplinary effort, Dr. Vivacqua’s team was responsible for making the incision to thread the catheter in through Abela’s neck. Once access to the heart and the old valve was established, Dr. Abbas’s team delicately sliced the old valve and carefully replaced it with the new one.

The procedure was successfully completed in just under three hours.

Afterward, Abela and Dr. Abbas celebrated with, not surprisingly, more jokes and laughter.

“I told Dr. Abbas – first I had a pig valve, now I have a cow valve, next time it will be chicken,” Abela said.

She is grateful she is once again able to drive, do her laundry, cook and grocery shop.

“Dr. Abbas ‘gets me’,” Abela said. “He’s there to answer my questions, calm me and talk me down from whatever. Dr. Gowman is the same. He always takes my calls and makes time to ease my fears. Either you’re here, or you’re not. I’m here and I’m celebrating. I feel very fortunate.”

“Helga is the bravest patient I know,” Dr. Abbas said.For more information about Corewell Health’s Structural Heart Program in Southeast Michigan, visit corewellhealth.org/heart-fp.