Best Doctors 2014: Path Finder

With a new treatment for faulty heart valves, University Hospitals' Dr. Marco Costa helps a patient avoid open-heart surgery.

Ten trips down the hallway and back — that's how 92-year-old Hilda Blatt marks each mile of the two to four she walks daily in her Mayfield Heights condo development.

Such exercise has been part of Blatt's routine for years, so it troubled her when she started experiencing shortness of breath during her walks about a year ago.

Blatt's doctor referred her to University Hospitals cardiologist Dr. Marco Costa. "That's when they found that my heart valve was blocked," she recalls.

Blatt was experiencing aortic valve stenosis, a narrowing of the aortic valve that restricts the amount of blood flowing through the heart. It's common in aging hearts like Blatt's, but is also the most serious of heart valve problems leading to heart failure.

"If you went to the gym and started lifting weights and kept repeating that over time, what's going to happen? You get big, bulky muscles," says Costa, director of UH's Center for Research and Innovation and Interventional Cardiovascular Center. "It's the same with the heart. It never gets a chance to relax and becomes a thick, muscular heart."

This causes it to become stiff and its valves become ineffective. Until recently, the only option for treating aortic stenosis was open-heart surgery to repair or replace the faulty valve.

But today, Costa is leading the way in a new approach to treating aortic valve stenosis that allows patients to avoid open-heart surgery and general anesthetic through transcatheter aortic valve replacement, or TAVR.

This treatment gives Costa access to the heart through a catheter fed into the patient's groin. That catheter guides a mesh-encased artificial valve to the heart. It is then expanded by a balloon to take the place of the faulty valve. Whenever possible, Costa performs this procedure while the patient is still awake — usually under mild sedation known as twilight — avoiding the complications that can accompany general anesthesia. Some have even gone home the same day.

"This is revolutionary," Costa says. "If you had asked me five years ago if we could be treating these patients the way we are, I would have said definitely not."

While the Food and Drug Administration didn't approve the device used in TAVR procedures until 2012, Costa already has four years of experience thanks to a network of innovators in Europe.

"This is part of our strategy to be on the forefront of cardiovascular medicine," he says. "I go constantly to Europe to evolve my skills and gain access to new technologies. By the time they come here, we are either leading those services or are early adopters."

Blatt, who underwent the procedure at 2 p.m. on a Tuesday and received her TAVR without general anesthesia, was back in her condo by 5 p.m. Wednesday evening.

Just two weeks later, Blatt was working her way back to her pre-stenosis activities. "To have no pain and no complications," she says, "it's the most wonderful surgery I've ever heard of."

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