Advanced Valve Procedure Gives FHC Patient New Lease on Life

PINEHURST – Rockingham resident Thomas Butler left the Baptist ministry two years ago aware that his failing heart had limited both his quality of life and his life expectancy and convinced that he would never preach again.

A sophisticated heart procedure at FirstHealth Moore Regional Hospital has since made such a difference in his health that he has reason to believe that he might someday return to the pulpit. He says he has the physicians and staff of FirstHealth’s Reid Heart Center to thank for the change.

“I think they have given me the opportunity to do what God has called me to do,” says Butler, “and I couldn’t ask for any more than that.”

By the time Butler came to Reid Heart Center with severe chest pain last fall, his condition was so impaired that physicians at three major hospitals had said he would never tolerate another open-heart surgery – the fifth in a series that began when he was 8 years old and dealing with the effects of a congenital heart defect.

As an adult, Butler had a triple bypass and then another surgery to correct an enlarged membrane below the aortic valve. He almost died from a fourth surgery, performed in 2003 to replace his aortic valve with an artificial pig valve. His kidneys stopped functioning, and he was in a medically induced coma for three weeks.

Butler’s condition began to change for the better, however, on Dec. 12, 2014, when Dr. Steven Filby and Dr. Peter Ellman of the FirstHealth Valve Clinic adapted the minimally invasive TAVR (transcatheter aortic valve replacement) procedure to replace the root structure of the failing artificial valve.

During the procedure, Dr. Ellman, a cardiothoracic surgeon, made an incision between two of Butler’s ribs to create an access point near the tip of his heart. Dr. Filby, an interventional cardiologist, then inserted a balloon-tipped catheter to transport the new valve to the site of the failing one, pushing the old valve aside and expanding the new one into place before Dr. Ellman closed the incision.

The measured pressures in Butler’s heart and lungs immediately started to improve.

According to Dr. Filby, Butler’s procedure went extremely well, especially considering that previous surgeries had removed the usual physical “landmarks” for valve replacement.

“He’s doing great,” Dr. Filby says. “His kidney function has improved, and he’s no longer short of breath.”

Most often used in high-risk patients to correct aortic stenosis, a narrowing of the main valve that carries blood from the heart to the rest of the body, TAVR usually begins through access either in the groin or the left side of the chest. Drs. Filby and Ellman decided to use the small-incision chest approach for Butler because of thenarrowing of his aorta caused by previous surgery.

Placing an artificial valve within another artificial valve or “valve-in-valve” TAVR, as it is known, is not commonly performed even at large academic medical centers.  According to the company that produces the valves, it has been done only a handful of times in the United States and Canada in patients who, like Butler, have both an artificial aortic root and valve.

“We’re still learning how to adapt and use this technology,” says Dr. Filby.

The procedure results in fewer complications and a quicker recovery, because its minimally invasive nature allows it to be performed on a beating heart, eliminating the need for a heart-lung machine.

“It was an option that we wouldn’t have had even three or four years ago,” says Dr. Ellman.

After the Reid Heart Center procedure, Butler immediately felt better, so much so that he had to be careful not to overdo himself.

“Overall, I feel so much better,” he says. “I can’t say enough about Pinehurst Moore Regional and what they have done for me.It was quite a successful surgery, and I feel like Dr. Filby and Dr. Ellman saved my life.”

Rockingham resident Thomas Butler (second from right) had undergone four traditional open-heart surgeries to correct various problems and had been told that he needed another but would never be able to tolerate it. Then he found the Valve Clinic at FirstHealth Moore Regional Hospital, where he had a minimally invasive valve-in-valve procedure that has greatly improved his quality of life and prospects for the future. Butler is pictured with Valve Clinic coordinator Kimberly LeGrand, R.N.; interventional cardiologist Steve Filby, M.D.; and cardiothoracic surgeon Peter Ellman following a recent checkup.