Published on November 30, 2012

Heart Surgery Close To Home

Minimally invasive aortic valve replacement at Genesis

Dale Long of Sterling, Ill., has more energy for farming after receiving minimally invasive aortic valve replacement surgery at Genesis Medical Center, Davenport.

Dale Long of Sterling, Ill., has more energy for
farming after receiving minimally invasive aortic
valve replacement surgery at Genesis Medical
Center, Davenport.

Dale Long always knew that one day his heart would pay for the childhood bout with rheumatic fever he had as a boy. A reoccurrence of the fever hospitalized him for two months as a young adult.

One day, doctors told him, he could suffer heart valve problems as a result.

After living a normal life for eight decades, working hard labor as a farmer and having his heart checked regularly, Dale Long learned that day had finally come. The aortic valve in his heart was narrowing, and it was beginning to affect his stamina. He would become short of breath when he mowed or exerted himself.

“Last spring, I had an echocardiogram and was told my aortic valve was closing up and would damage my heart irreversibly if I didn’t fix it,” says

Mr. Long, 82, a retired farmer from Sterling, Ill. “My local cardiologist said it was time to consider surgery, and he recommended some hospitals in Chicago. I wanted a second opinion, and he thought it was a good idea.” Mr. Long already had a strong connection to the Genesis Heart Institute in Davenport because his wife, Joyce, and a son had both received stents to open blockages in their hearts during procedures performed by cardiologist Peter Sharis, M.D. The Long family was glad to be referred to Genesis heart surgeon Dr. Nicholas Augelli, M.D.

Treatment would involve surgically replacing Mr. Long’s damaged aortic valve with a prosthetic one.

“We had a consultation with Dr. Augelli and were really impressed,” Joyce Long says. “Dr. Augelli was such a positive, understanding surgeon and knew it was important to Dale to be able to help our son harvest the corn.“

Mrs. Long adds, “A week later, Dale and I were eating in a Clinton, Iowa restaurant and picked up some reading material. I opened a page, and there was a photo of Dr. Augelli. It was as if God was answering our prayers and telling us where to go; it was an affirmation that Dr. Augelli would be a great doctor.”

On Oct. 29, 2012, Dale Long had minimally invasive aortic valve surgery at Genesis Medical Center’s East Rusholme Street campus in Davenport.

The hospital has been named a Top 50 Heart Hospital by Thomson Reuters in 2011. In addition, Genesis Cardiac Surgeons has received two national awards for high patient satisfaction.

Valve replacement surgery

Mr. Long had aortic stenosis, or a narrowing of the aortic valve caused when the valve’s leaflets become abnormally rigid and do not fully open.

The narrowing causes significant resistance against the main pumping action of the left ventricle as it tries to eject blood throughout the body.

Depending on the severity of the narrowing, this can lead to progressive lung congestion and heart failure.

About 20-25 percent of valve surgery at Genesis is done with a minimally invasive approach, provided the patient meets certain criteria, including the ability to tolerate one-lung ventilation.

“The minimally invasive procedure is done in the same way we would do an open procedure, except the incision is placed laterally on the side vs. a midline incision,” Dr. Augelli says. “Either procedure requires the use of cardiopulmonary bypass, or the heart-lung machine.”

Stopping the heart from beating allows the surgeon to safely open the aorta and access the aortic valve in a bloodless field.

Dr. Augelli adds, “A minimally invasive approach has many benefits, including less pain and blood loss and a quicker recovery due to the fact the sternum is not opened. You don’t have to wait three months for full recovery...instead, the recovery is more like 4-6 weeks.”

There are two major types of aortic valve prostheses: mechanical and tissue.

  • Mechanical valves last a lifetime, however, the blood-thinning drug coumadin must be taken for the rest of the patient’s life to prevent clots from forming on the hinges of the valve. More often, these valves are used on younger patients.
  • Tissue valves have a lifespan of 25-30 years and usually are made of either cow (bovine) or pig (porcine) tissue. No blood-thinning drugs must be taken.

“The choice of valve depends on the patient’s needs and preferences and the amount of calcification around where the surgeon must cinch down the valve to the tissues,” Dr. Augelli says.

“I’ve had patients say they don’t want a pig valve. One patient, a cow farmer, wanted only a cow valve. I try to make the decision based on the actual anatomy I find inside. For example, if there’s not a lot of calcium around the patient’s valve, then I use the bovine valve because it’s more compliant for people with softer tissues.”

After caring for pigs when he was younger, going into dairying and then raising beef cattle in the last years of his farming career, Mr. Long’s own aortic valve was replaced with a pig valve. He went home from the hospital five days after surgery.

“He received exceptionally good care -- from Dr. Augelli and Denise Antle, ARNP, to the hospital staff who treated Dale on the Intensive Care Unit and Cardiac Care Unit. We never dreamed he would be home so soon,” Mrs. Long concludes. “We had a lot of people praying and a lot of confidence and reassurance from the people at Genesis. It turns out it was a good experience.”

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1227 E. Rusholme Street Davenport, IA 52803 563-421-1000