LI hospital tackles new heart procedure

Anthony Leto is the kind of heart patient some surgeons might not want to put on the operating table.

The former butcher from West Hempstead is 92 years old, with a long history of heart disease and a newly diagnosed problem - a damaged aortic valve that needed to be replaced.

Doctors diagnosed aortic stenosis, a condition often treated through open-heart surgery, which can prove risky, if not deadly, for someone Leto's age.

Fortunately, they didn't have to resort to it.

His physicians at St. Francis Hospital in Flower Hill had just joined a federal clinical trial in which aortic valves are replaced without cracking open chests. The new procedure puts a pig valve in place without surgery or stitches.

Doctors involved in the research are calling the method revolutionary because it eventually could eliminate open-heart surgery for 100,000 people a year, most of them elderly, in the United States.

"It will change the treatment landscape as we know it," said Dr. Newell Robinson, chairman of cardiothoracic and vascular surgery at St. Francis.

Dr. Marc Ruel, a cardiac surgeon at the University of Ottawa Heart Institute in Canada, calls the minimally invasive approach an advance that can increase quality of life and quantity of years.

"It is a dramatic breakthrough because it allows patients who are not good candidates for surgery to have their aortic stenosis symptoms relieved," Ruel said.

Two days after becoming the first Long Island patient to undergo the experimental procedure, Leto was walking in his hospital room, joking with visitors. "I feel great," he said. "I'm 92 and kicking."

Leto had an instant answer when asked why he chose to participate in the trial: "I want to live."

He has a full agenda, he said, tending his fig trees and preparing meals for his family. Pasta fagioli is a specialty.

Had he undergone conventional surgery, he would have been in intensive care, facing weeks of recuperation.

The procedure borrows from a technique used to implant stents in clogged coronary arteries - threading a catheter through a small incision in the groin, and guiding it from the femoral artery in the thigh to the heart.

Robinson said the porcine valve, carried in a mesh scaffold, fits permanently inside the patient's damaged one and starts functioning immediately. The tube and scaffold are removed. The implantation system called CoreValve has been approved in Europe since 2007.

Leto received his implant free of charge because it's part of a 20-month clinical trial at 40 centers nationwide. The U.S. Food and Drug Administration has conditionally approved CoreValve for study. Full approval depends on the outcome of the research.

For high-risk patients such as Leto, open heart surgery is fatal in about 15 percent of cases, said Dr. George Petrossian, director of interventional cardiology at St. Francis.

He is studying both CoreValve and aortic stenosis, a narrowing of the aortic valve that can be a consequence of aging's wear and tear on the heart.

Calcium builds in the valve, Petrossian said, limiting the amount of blood that can flow through it, leading to shortness of breath, even fainting.

Feeling rejuvenated, Leto is looking forward to the years ahead and sharing them with his wife of 62 years, Annie.Doctors have set a series of appointments for Leto long into the future.

"I have to come back 30 days from now," he said, "then six months and once a year for the next five years."