Naples man one of first to undergo heart surgery with local anesthesia

A Naples man recently underwent a life-saving surgery that might not have been possible if it weren’t for a creative solution by the heart team at NCH. He is like many patients who present a great risk of going under general anesthesia.

Casey Wolff has the lung capacity of a man twice his age born with a genetic condition that causes emphysema, breathing is a challenge.

Wolff said, “And it wasn’t until I was down to oxygen 24 hours a day. And I was still suffocating, that I knew there was something else besides the lungs.”

As it turns out, a heart repair that was done years before was failing. Wolff needed a new mitral valve. Doctors at NCH weighed the risk of surgery with the real possibility that he might not wake up from general anesthesia. Dr. Robert Cubeddu is the president of the NCH heart institute. He came up with a plan to give Wolff the life-saving surgery he needed.

Cubeddu said, “He was at prohibitive risk for an open heart operation, which is traditionally the way we’ve done this. And this was really the only way out for him.”

Wolff said, “He came in one day, and he said, ‘see you Monday, we got this one figured out. We’ll tackle it.'”

Using a minimally invasive approach, surgeons pierced the femoral artery in his leg and threaded a balloon catheter up to his heart. A new mitral valve was delivered through the heart and put in place by inflating the balloon. The procedure is not uncommon. What’s unique is that Wolff is one of the few people in the country to undergo a complex mitral valve repair under local anesthesia.

Cubeddu said, “So it is quite minimal. It’s pretty much what we use when you go to the dentist and have a root canal. Very similar.”

NCH performed the surgery under conscious sedation. Numbing the skin with lidocaine and giving the patient a light sedative, similar to a dental procedure. After one night in the hospital, Wolff went home a new man with a fully functional new heart valve.

Cubeddu said, “It’s good to know that we can count on alternate solutions for that one specific population or subset of patients where general anesthesia represents a high risk.

Wolff said, “Yeah, you should’ve seen me about a week ago. That’s the difference between death and no death.”

Breathing easier now, his one-week follow-up showed the valve doing its job.

Before coming to Naples, Cubeddu was part of the first published case in the world that first replaced a mitral valve under local anesthesia.

This technique is used in other heart repairs, but this one is more complex.