Artists on the Fly
As a professor of surgery and the director of a mitral valve clinic that performs 300 to 400 valve repairs each year (the average for most clinics is 10), all while planning a major departmental move, it’s a wonder how Steven Bolling, M.D., has time to sleep at night.
Yet amidst seminars, surgeries and moving boxes he was able to co-invent a groundbreaking device that treats mitral valve leakage, improving the left ventricle and helping congestive heart failure patients regain lost heart function.
The GeoForm annuloplasty ring, invented by Dr. Bolling and Ottavio Alfieri of St. Raffaele Hospital in Milan, was launched by Edwards Lifesciences Corp. in September and will be for sale in the U.S. in January.
The surgery is just one of the new heart-shaping techniques being studied and tested at the University of Michigan Cardiovascular Center, which is in line for a new $212 million heart hospital next year.
Dr. Bolling said the GeoForm ring forces the heart into a healthy football shape, as opposed to an enlarged basketball shape caused by heart failure. Once it’s positioned, the device eliminates the backflow of blood caused by a leaky valve.
“This ring’s special three-dimensional shape makes it easier for the surgeon to pull the heart muscle up in a way that forces the left ventricle to remodel...and returns the heart to a pointy, or ellipsoid, shape from a rounded shape,” he said.
The heart muscle has to work twice as hard with a valve that leaks, which in turn causes weakness, shortness of breath and eventually death.
Dr. Bolling said there have been 200 implants so far and in Europe, where it became available in October, the devices are “flying off the shelves.”
“The patients are doing well and we are getting rid of the mitral regurgitation for good, as opposed to older ways of treating it with medication and having it come back,” he said.
He stressed that valve repair is a much better treatment than medication or heart replacement.
“Today, replacement is really a far worse second choice,” he said. “If at all possible, repair is the preferred method of treatment for patients.”
Dr. Bolling said he hopes the productivity brought by the new hospital will increase the number of valve repairs his clinic performs to an even higher number.
“In the U.S. right now, only 40 percent of the mitral valves that should be repaired are repaired,” Dr. Bolling said. “That’s because it is a very complex, technical surgery. You have to be an artist — an artist on the fly.”
Pioneering a Heart Wrap
Another surgical option being tested at the clinic is the insertion of an Acorn CorCap cardiovascular device, which is a biocompatible, mesh-like jacket that’s slipped around the heart. Dr. Bolling calls it a “jock strap for the heart.”
“It doesn’t squish the heart down or anything, but it sort of stops it from growing any larger,” he said. “It is not really an active way of changing the heart, but it allows the heart to change itself.”
He said his surgeons have performed around 30 CorCap installations and have seen semi-positive results so far. The main problem with the device is that it’s difficult to figure out how tight to make it.
“You don’t want it too tight, and if you make it too loose it won’t be effective at all,” he said. “You sort of just make a good guess and that’s it — it’s still very unfamiliar to most surgeons.”
But charting unfamiliar territory is nothing new for U-M’s cardiovascular department — after all, it was the first in Michigan to implant heart-assist devices and the new center is going to be absolutely state-of-the-art, according to Dr. Bolling.
“We are doubling our capacity — not only in cardiac surgery, but also in cardiology services,” he said.
The six-story hospital will include 48 inpatient beds — half of them for intensive care — 36 outpatient clinic areas, 12 suites for minimally invasive procedures and eight operating rooms.
It will also have a heavy emphasis on patient comfort, with indoor and outdoor healing gardens, rooms for quiet reflection, a patient education center, a heart-healthy café and art-filled hallways.