The developments sound like science fiction daydreams rather than actual life-saving medical procedures.
Tiny prosthetic valves can be implanted so that the heart pumps blood properly, greatly extending lifespan. A patch applied inside the heart repairs congenital defects. Delicate cords made of artificial fabric are sewn into the heart, replacing the natural tissue that controls valve leaflets.
For people whose heart valves have been destroyed by disease or other factors, surgeons can implant a cellular matrix into the heart that over time becomes the patient’s own tissue.
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A flurry of innovations have given people with faulty or damaged heart valves hope for living a longer, more normal life. Dr. Marc Gerdisch has been at the forefront of many of those breakthroughs.
“I’ve been doing heart surgery for the past 23 years, and in that time, have invested myself wholly in being part of the advancement of valve reconstruction,” he said. “The acceleration I’ve experienced indicates to me that probably we’re standing on the precipice of some really grand changes.”
Gerdisch, chief of cardiovascular and thoracic surgery at Franciscan Health Indianapolis Heart Center, has dedicated his career to advancing the field of heart valve surgery to make it less invasive and more safe for patients.
In mid-November, Gerdisch became one of the first surgeons in the country to use a new implant to repair the aortic heart valve, providing the life-saving surgery for five Indiana patients.
“We can make the leaflets of the valve meet the way they’re supposed to, and make them perform normally,” he said. “We’re giving these patients in whom their valve has started to leak the opportunity to keep their own tissue and live the rest of their lives with that valve functioning normally.”
On a busy day of appointments, Gerdisch hustled down the halls of the Franciscan Health Indianapolis Heart Center having just finished surgery to repair a patient’s mitral valve.
He had made a small incision just underneath the right nipple, then operated between a small incision the ribs, rather than a large cut in the chest. By minimizing the incision, recovery is drastically improved for the patient.
Franciscan Health Indianapolis has been using this type of incision in surgery for several years, and have refined it to the point where every time patients need surgery on a single heart valve, this is the best approach, Gerdisch said.
“People can go right back to full activity, and have very little discomfort,” he said. “That’s been a marvelous step for us.”
Improvements such as these have transformed how Gerdisch and his colleagues heal patients.
Gerdisch earned his medical degree from Loyola University Stritch School of Medicine, where he also completed his residency and fellowship in cardiovascular and thoracic surgery.
In addition to being the chief of cardiovascular and thoracic surgery at Franciscan Health Indianapolis Heart Center, he is a partner at Cardiac Surgery Associates and the surgical director of the Heart Valve Center and Atrial Fibrillation Center at Franciscan Health.
He is also a clinical assistant professor of thoracic and cardiovascular surgery at the Loyola University Medical Center in Chicago.
With his background in cardiothoracic surgery, Gerdisch has aimed to be an innovator in the field.
One of his most recent projects involved a procedure called the HAART Aortic Annuloplasty. The operation used a fabric-covered frame — about the diameter of your index finger — that strengthens the internal structure of the aortic heart valve, Gerdisch said.
The aortic valve regulates blood from the left ventricle, the primary pumping chamber of the heart, and the body’s main artery called the aorta. The valves have tiny leaflets, which when working properly, keep the blood moving correctly in and out of the heart.
“They behave like pockets, like you’d have on the back of your pants. As the pockets fill, they come together and meet in the middle. When they’re full, they’re round and spherical,” Gerdisch said. “That was what they recognized and used as the foundation for developing these heart rings.”
Patients whose valves have become weakened and don’t line up the right way have blood rushing backwards into the heart, which can lead to heart failure and other potentially deadly conditions.
Often, those patients are younger, so there is increased risk attached to having a valve replacement, Gerdisch said.
“When we replace an aortic valve, even though it’s better than having a diseased valve, the patient assumes a risk for the rest of their lives,” he said. “The more we can do to avoid changing the valve completely, the less risk we leave the patient with. Replacement valves are wonderful, but they carry risk with them.”
The HAART device strengthens the internal structure of the valve, giving it the correct shape so that the surgeon can make tiny repairs to the valve so it opens and closes correctly.
“Imagine that one leaflet is a little bigger and the other is a little smaller. When you put this in, it won’t allow that to happen. You reconfigure the geometry of the valve,” Gerdisch said. “Once that happens, we can work with the bigger leaflet so that opposes the other one perfectly, and that will be permanent.”
The devices are the first commercially available product designed for the repair of the aortic valve. Dr. J. Scott Rankin, the inventor of the device, developed it as a better option for patients with this type of valve disease than what was previously available.
Heart valve repair and reconstruction is preferred to biological and mechanical valve replacement, because patients have better recovery and fewer complications.
Annuloplasty rings are used for most successful valve reconstructions, and the HAART devices are the first internal geometric annuloplasty rings to be developed for the aortic valve, said Rankin, the chief medical officer for BioStable Science & Engineering.
“Availability of an effective annuloplasty device could expand the benefits of valve repair to the majority of patients with aortic valve insufficiency,” he said in a statement.
Rankin directly trained Gerdisch at Franciscan Health Indianapolis over the course of three days, while both surgeons worked on a total of five patients in need of aortic valve repair.
“As much as there is science, there’s art in all of these things,” Gerdisch said. “The science is being able to assign geometry and the architecture to the valve. The art is tweaking the leaflets and reshaping the leaflets and getting them to look normal.”
But his work on the HAART device is just one of many accomplishments throughout his career.
Gerdisch has helped lead research into valve reconstruction using regenerative tissue. He is in the process of developing a procedure that would allow him to rebuild the entirety of the valve’s leaflets to help patients with extremely damaged valves.
He led enrollment in a study demonstrating that a newly designed mechanical valve replacement could be managed with a lower dose of blood thinner. That was vital to reducing the risk of dangerous bleeding from the blood thinners.
Their study convinced the Food and Drug Administration to change the guidelines for use for that particular mechanical blood.
One of his efforts that is expected to be done in early 2018 is a robotic arm that would position the device used to expose the heart valve in surgery. Surgeons can position it on the beside and move it in tiny increments to better see every part of the valve they’re operating on.
“We can move it within millimeters,” Gerdisch said.
He is the foremost surgeon training others in the MAZE procedure, having taught hundreds of other heart surgeons to do it. The procedure uses small incisions, radio waves, freezing or microwave or ultrasound energy to create scar tissue, in order to fix irregular and rapid heartbeats.
But progress keeps marching forward, and Gerdisch is helping to lead those improvements. As new iterations of these devices comes out, and improvements made to combine technologies to address an ever-widening scope of health problems, the potential for progress is fascinating.
“The thing about change is that you don’t know when it’s coming,” Gerdisch said. “What you do know is, usually the immediate past gives us some indication of what the future will be like. And our immediate past is very fast-paced. That means the future will be even more fast-paced.”
Dr. Marc Gerdisch
Occupation: Chief of cardiovascular and thoracic surgery at Franciscan Health Indianapolis Heart Center; also, a partner of Cardiac Surgery Associates and the surgical director of the Heart Valve Center and Atrial Fibrillation Center at Franciscan Health
Education: Received medical degree, residency and fellowship from Loyola University Stritch School of Medicine
Years practicing: 23
2006 to 2017: Named to America’s Top Doctor list by Castle Connelly
2009 to 2017: Named to Indianapolis Monthly’s Top Doctor list for thoracic and cardiac surgery
2016: Was the first in the world to implant a tissue-engineered regenerative CorMatrix ECM Tricuspid Valve in a phase I clinical device trial.
2015: Authored a scientific study leading to FDA approval of the On-X valve allowing patients to substantially lower their blood-thinning medication dose and thereby, reduce the risk of bleeding.
2014: First in the U.S. to enroll patient in a landmark study, performing minimally invasive closure of the left atrial appendage to prevent strokes.
2013: First in the U.S. to implant the only mechanical valve that matches the contour of the heart; recognized by the City of Indianapolis and Marion County City Council with a special resolution for his dedicated service to the healthcare community.
2011: First in the U.S. to use a breakthrough device to replace the aorta in a critically ill patient. He also performed the first surgery in the country using a device that restores the shape of a tricuspid heart valve.
2010: Named a “Health Care Hero” by the Indiana Business Journal for his work; received the Excellence in Health Science Research Award at the annual Tony and Mary Hulman Health Achievement Awards Ceremony.
2008: First in the world to repair heart valves using technology to allow the heart to naturally regrow tissue. He has ongoing research directed at allowing regeneration of an entire heart valve.
2007: First in the world to pioneer a new surgery to repair damaged heart structures while allowing the heart to naturally regrow tissue.
2006: Established Indiana’s first Heart Valve Center.