Heart valve symposium organizers aim for more intimate setting in Missoula

At this meeting, small is beautiful.

Only about 100 cardiac surgeons will spend the next few days talking hearts with each other in Missoula. The faculty taking turns at the front of the room will number fewer than a dozen and a half. The line between speaker and audience will blur, often and on purpose.

By GINNY MERRIAM of the Missoulian

http://missoulian.com/articles/2004/07/21/news/local/news03.txt

The International Heart Institute of Montana’s 14th Rocky Mountain Valve Symposium has stayed small intentionally, Heart Institute leaders said Tuesday.

The big annual cardiac meetings around the country can have faculties of 150 and attendance of thousands, said Carlos Duran, a cardiac surgeon and researcher who is chairman of the board of the International Heart Institute Foundation and a founder of the institute. Attending means choosing among too many interesting programs and running around among them.

"It’s impossible to absorb, and you leave with a sense of powerlessness," he said.

"Here, everybody has the time to meet each other."

At the Missoula meeting, heart specialists present a case each morning to the surgeons, cardiologists and anesthesiologists gathered in the Broadway Building Conference Center at St. Patrick Hospital, home of the Heart Institute. The visitors then watch the surgery as it goes on live in the operating room in the hospital. They discuss it with each other and with those in the operating room. Sometimes they argue.

That’s how medicine advances, Duran said.

"Small faculty, small attendance, intimate discussion," said Tim Descamps, who just began his new job as executive director of the Heart Institute Foundation. "A larger conference would defeat what the conference has gained as its identity."

Descamps began work at the Heart Institute, a partnership between St. Pat’s and the University of Montana, on July 1. The job is a new one; Descamps is the first.

"It’s a sign of the growth of the foundation," Duran said. "The amount of work and projects and ideas has grown to the point where we need someone to unify it and bring it out into the open."

The institute is unique in its marriage of basic scientists and research at UM and practicing doctors at St. Pat’s. Missoula is a small city without a medical school or a teaching hospital, but that’s part of the attraction, Duran said.

"All the cardiac surgeons in the world know what goes on in Missoula," Duran said. "You go to New Zealand or Russia, they know."

Smaller-town life attracted Descamps and his family. His wife, Lauren, grew up in Great Falls and is a member of the Davidson family, known for its financial business. The Descamps have two elementary-school-age sons and had been living in San Rafael, Calif. Descamps (pronounced as it’s spelled) is a certified public accountant who has worked for 15 years as chief executive in technology and financial management companies.

His job will be to increase the foundation’s annual $2 million budget by fund raising, to form partnerships with other research institutions and to promote Heart Institute projects to industry.

"My role is to build on the success the foundation has had," he said.

Reporter Ginny Merriam can be reached at 523-5251 or at [email protected]

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One year later, beat goes on for test-case heart patient

By GINNY MERRIAM of the Missoulian

http://missoulian.com/articles/2004/07/21/news/local/news02.txt

A year ago, it looked like Paul Lackey wasn’t going to make it much longer.

Heart failure had made him sick and weak. He didn’t have the energy to work in his machine shop on Evaro Hill off U.S. Highway 93, making and fixing things.

"What we were talking about last year was having him live a month or two," Missoula cardiac surgeon Stephen Hiro said Tuesday.

Lackey isn’t turning cartwheels. But he does have his life back.

"I’ve been running a big truck, a big front-end loader, doing some welding," he said. "I ain’t got extra energy. But I have some."

Lackey had a heart attack last summer, less than two weeks before the International Heart Institute of Montana’s Rocky Mountain Valve Symposium would bring 200-plus heart surgeons, cardiologists and cardiac anesthesiologists from around the world to Missoula. One of the hallmarks of the annual conference is its daily live surgeries, in which the expert audience watches and discusses the surgery with those in the operating room and each other. One of the conference topics was heart failure, which has drawn the attention of heart surgeons in recent years.

Not long ago, a diagnosis of heart failure – sometimes called congestive heart failure for the fluid buildup it causes – meant a patient was sent home with many drugs and told that a spot on the waiting list for a heart transplant was his destiny, said Carlos Duran, an International Heart Institute cardiac surgeon who is the program director of the symposium. A greater understanding of the heart’s mechanics and the causes of heart failure brought surgical solutions that previously seemed unrelated. For instance, repair of a heart’s mitral valve can head off the development of total failure.

"Then the physicians started sending the patient for surgery much earlier," Duran said. "The results are much better."

Lackey’s heart had three big problems.

First, his coronary arteries were clogged with plaque. He needed four bypasses, in which surgeons use other arteries, usually taken from the patient’s leg, to build new highways for blood around the blockages.

Second, his heart had rhythm troubles. Probably because of damage from a heart attack a decade before, the left and the right halves were no longer synchronized, causing a wobbly beat that made his heart work harder to accomplish less.

Third, two of his heart valves, the mitral and the tricuspid, were damaged. Valves in the heart open and close for the passage of blood. In congestive heart failure, the heart becomes stretched out of shape, and the valves can’t do their jobs well because of the insult to the heart’s geometry.

Lackey, who’s 72 now and once made a gear that fixed the Missoula County Courthouse clock when no one else could, got a quadruple bypass. He got his heart electrically regulated with a fairly new procedure called biventricular pacing that uses an electrical wire implanted in the surface of the heart.

Surgeons at the symposium argued about whether Lackey’s mitral valve could be repaired. Some said it should be replaced with a pig valve. Others, surgeon Hiro included, thought it could be fixed .

They tried it. They sewed up his heart and looked at its function with an echocardiogram. The valve was insufficient. They went back in and took it out, replacing it with a pig valve.

They had promised Lackey – and his wife of now 53 years, Marlene – a competent valve, Hiro said. And he got it.

The Valve Symposium participants got a fascinating case that showed how three approaches worked together.

"It wasn’t until he had all three arms of that that he got better," Hiro said.

Lackey didn’t leave the hospital until October. He took a while to recover from the surgeries and a staph infection.

While he was there, he kept telling the cardiac surgeons about a lump on his hip.

"I’ve known it’s been there two, three years," he said. "The eraser on a lead pencil was all the bigger it was. But when I was in the hospital it grew and grew, like they was fertilizing it."

Eventually, the Lackeys found out it was an unusual cancerous tumor. Lackey had it removed in December and has been fine since.

His heart is much improved.

"They say the valves are doing what they’re supposed to now," said Marlene.

On Wednesday at this year’s symposium, surgeons will take on another complex heart failure case and use skills and knowledge that add to what they knew last year, Hiro said.

"The focus over the past five years has been an evolution," he said. "We’re taking on patients whose hearts are more and more weak."

Reporter Ginny Merriam can be reached at 523-5251 or at [email protected]