Cleveland Clinic Surgeons Pioneer a New Minimally Invasive Heart Valve Surgery

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Edward Liebler, a 78-year-old retired veterinarian, perfectly understood his predicament: His quality of life had greatly decreased because he needed a heart valve replacement, but he was considered “high risk,” limiting his surgical options.

Cleveland-Clinic-Jugular-Stented-Heart-Valve — Cleveland Clinic surgeons were the first in the nation to perform this innovative heart valve surgery through the jugular vein in the neck.

Previous open-heart surgical procedures in recent years for a leaky heart valve only brought temporary relief, and now Edward could barely walk and found it extremely difficult to breathe. He was in no condition for another major operation to treat his life-threatening condition — tricuspid valve regurgitation, which causes blood that should flow out of the heart and into the lungs to flow backwards, spilling back into the heart.

Luckily, Edward was the perfect candidate for a new, minimally invasive procedure using a special kind of self-expanding valved stent that was pioneered by a team of Cleveland Clinic surgeons and researchers, led by surgeon José L. Navia, MD.

“This is a step forward in the treatment of tricuspid regurgitation,” Dr. Navia said.

From OR to wood shop
Edward, who traveled to Cleveland Clinic from Lansing, Mich., for the surgery, said he felt it was his only hope. “I decided we’d better try it,” he said.

And he’s glad he did. More than seven months after Dr. Navia made a tiny incision in Edward’s neck and used his jugular vein as the passageway to implant the tricuspid atrioventricular valved stent (AVS) into his heart, Edward feels better than he has in years.

“I have a wood shop where I build short wave radios, and now I can work in the shop all day,” Edward said. “The procedure is a terrific advancement in science. It’s made a tremendous improvement in my life.”

A nationwide first
Cleveland Clinic surgeons successfully performed the nation’s first implantation of the AVS in November 2016 in a 64-year-old woman with a long history of severe tricuspid regurgitation. Edward was the second patient at Cleveland Clinic to receive the surgery, which has now been performed in about a dozen patients. FDA approved the AVS in 2016 for expanded access (sometimes called “compassionate use”), which is use outside of a clinical trial of an investigational medical product.

The distinctive aspect of the procedure is that the AVS can easily be threaded through the jugular — a vein collecting blood from the brain, parts of the face, and the neck — to reach the tricuspid valve, which was the faulty valve causing a back flow of blood into the right side of Edward’s heart instead of it going to the lungs. The AVS is “strapped” into place and restores normal function.

Tricuspid valve regurgitation is a very serious condition, Dr. Navia explained. Over time, all major organs suffer from the low blood flow condition, and the heart ultimately fails.

“The ideal candidate is a patient like Edward, with a high risk of complications or death from open-heart surgery,” Dr. Navia said. “Now, he has almost normal heart function. I’m extremely happy with the result.”

Future plans
Currently, the AVS procedure is only approved for high-risk patients, but Dr. Navia believes it has potential use for patients who aren’t as sick but would nevertheless benefit from less invasive surgery. He said plans are under way for a clinical trial of low-risk AVS use in the future.

As for Edward’s future, he has plans to supplement his hobbies by adopting a puppy sometime soon. His previous dog had been his steady companion since his wife, Constance, passed away in 2009.

“I feel like I can take care of a puppy now,” Edward said.

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About Cleveland Clinic

Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. Cleveland Clinic is consistently recognized in the U.S. and throughout the world for its expertise and care. Among Cleveland Clinic’s 81,000 employees worldwide are more than 5,743 salaried physicians and researchers, and 20,160 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties. Cleveland Clinic is a 6,690-bed health system that includes a 173-acre main campus near downtown Cleveland, 23 hospitals, 276 outpatient facilities, including locations in northeast Ohio; Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2023, there were 13.7 million outpatient encounters, 323,000 hospital admissions and observations, and 301,000 surgeries and procedures throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 132 countries. Visit us at clevelandclinic.org. Follow us at twitter.com/CleClinicNews. News and resources available at newsroom.clevelandclinic.org.

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