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Alan Paggi

Thanks to TAVR, logger was not felled by a faulty heart valve

Transcatheter aortic valve replacement, or TAVR, has not only revolutionized heart valve replacement, but has become a life-saving option for those who had few options just a few years ago. Such is the case for 55-year-old Al Paggi of Genoa, Wis.

In his 20s, Al had cancer. While aggressive radiation treatments saved his life, it had residual effects. "They told me I might have heart trouble later in life," recalls Al. "In the early 1990s doctors detected a heart murmur."

A heart murmur can be benign, requiring no treatment, or it may be a symptom of a potential heart problem. So doctors monitored Al's condition over the years until the problem worsened. Al reports, "I'm a logger and work became very difficult. I would get so out of breath."

"Mr. Paggi's case required complex decision making across several departments," explains Gundersen heart surgeon Sajjad Rizvi, MD, who was part of the team who developed and carried out Al's customized treatment plan. "Al's aortic valve (in the main heart artery) wasn't working properly. Traditional open-heart surgery to replace the damaged valve was too risky because of scarring from his earlier radiation treatments."

In 2014, Gundersen Health System began offering TAVR, a minimally invasive procedure. Initially, TAVR was FDA-approved only for use when open heart surgery posed a high risk for patients. This restriction was recently expanded to also include intermediate-risk patients, like Al.

"Prior to TAVR, we had few good treatment options to offer patients like Mr. Paggi. It's clear that TAVR is having a significant impact on survival of these patients," states Dr. Rizvi.

TAVR generally relies on a catheter threaded into the femoral artery in the groin. Imaging techniques guide the catheter carrying a collapsed replacement valve to the site of the faulty valve. The new valve is then expanded, pinning the old valve's leaflets out of the way as it takes over the valve's function.

"But we had another hurdle to overcome," continues Dr. Rizvi. "This procedure requires placement of a temporary pacemaker to keep the heart beating strong during the procedure. The pacemaker wires are placed through a major vein to the heart but in Mr. Paggi's case, there were blockages. Gundersen interventional radiologist Ezana Azene, MD, had to first find and open the blockages in order to place the pacemaker."

"In addition to allowing placement of the pacemaker, fixing Mr. Paggi's veins completely relieved his chronic leg swelling and leg pain," reports Dr. Azene. "As a result, he can breathe and exercise easier and it's made a huge difference in his quality of life."

TAVR relies on a specially trained team of heart specialists including interventional heart doctors, heart surgeons and heart imaging experts. "We work together, using all of our skills to do what we believe is the best treatment option for each patient," states Dr. Rizvi.

"I received absolutely great care. I couldn't believe how fast I improved. Now I feel 100 percent better. It's like I'm a different person," says Al.

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