93-year-old is back on beat
...thanks to new minimally invasive procedure for heart valve replacement
Her dangling earrings, sheer scarf and pink lipstick may fool you into thinking Evelyn Zirk is a dainty lady. But, the 93-year-old won't mince words telling you she is a "TOFB or tough old farm broad." Evelyn has lived more than 65 years on the family farm in Elroy, Wis.
Few things scare Evelyn like the shortness of breath she experienced as a result of aortic valve stenosis—a narrowing of the valve in the main heart artery due to calcium deposits. The condition, affecting nearly 1.5 million people in the United States, causes the valve to not work properly so the heart must work harder to pump blood through the valve.
Evelyn recalls, "When I would lie down at night, I noticed how difficult it was to breathe. It was scary." Evelyn's symptoms are common in people with severe aortic stenosis, as are chest pain, fatigue, lightheadedness and fainting.
Treatment for aortic valve stenosis is usually valve replacement done as an open heart procedure. But many patients like Evelyn are not candidates for this traditional surgery. For them, Gundersen Health System now offers an alternative: transcatheter aortic valve replacement or TAVR.
"Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure that's FDA-approved for patients with severe aortic valve stenosis who are not candidates or are high risk for traditional open-heart surgery," states Gundersen interventional cardiologist Hjalti Gudmundsson, MD, who manages Evelyn's heart care.
Evelyn became the first patient to undergo TAVR at Gundersen on May 1, 2014. Heart surgeon Venki Paramesh, MD, FACS, says Evelyn was an ideal candidate. "Her age put her at high risk for conventional aortic valve replacement. She continues to be fairly active and independent for someone her age. Plus, she was more than enthusiastic about the possibility of a minimally invasive approach."
At Gundersen, TAVR can be performed with three different approaches. The preferred approach (which Evelyn was a candidate for) is the transfemoral approach with access through an artery in the groin to the heart. The catheter delivers a collapsed heart valve on a stent to the site of the native, diseased valve under fluoroscopic and echo guidance. Once precisely placed in the aortic position, the new stent valve is expanded and locked in place. The old valve leaflets are crushed against the aortic wall, and the new valve takes over the valve function.
If a patient does not have suitable arteries or too small arteries to deliver the valve, the procedure can be performed in one of two more direct routes using a slightly more invasive surgical procedure. With any of the approaches, the procedure is done on a beating heart and there's usually no need for cardiopulmonary bypass.
Though the procedure is minimally invasive, it comes with risks and requires the expertise of the entire valve team, including non-invasive cardiologist and cardiac imaging expert Raju Ailiani, MD; heart surgeons Venki Paramesh, MD, and Sajjad Rizvi, MD; interventional cardiologists Hjalti Gudmundsson, MD, and Sampoornima Setty, MD, FACC; an imaging technologist and anesthesiologist.
"We work together, combining all of our skills to do what is right for the patient," states Dr. Gudmundsson. Evelyn didn't think twice about being the first patient. The collaboration of these specialists was reassuring, as was the fact that "God was holding my hand," she says.
Evelyn spent just five days in the hospital, one week in a nursing home and has been back on the farm ever since. She goes to cardiac rehabilitation three times a week and has no problem staying busy in her spare time. "I plant a garden and have many flowers and vegetables. I've seen improvement [following the surgery] and there will be more," says Evelyn.