Small incision makes a big difference
Just a couple of years ago, the future may have looked bleak for heart valve patients like 72-year-old Stuart Peterson of Chaseburg, Wis. Now a procedure known as TAVR has changed the future to one of hope.
"I had a lung removed in 1989 and triple heart bypass in 1995," Stuart explains. "Despite that, I remained active. But in 2014, I struggled to take a deep breath and do the things I liked to do."
Stuart first visited Gundersen cardiologist Michael Witcik, MD, FACC, at the Gundersen Viroqua Clinic because he was having problems breathing and doing everyday activities. Further workup at Gundersen in La Crosse revealed he had severe symptomatic aortic stenosis—a narrowing of the valve in the main heart artery. Due to a build-up of plaque and calcium, the valve was unable to work properly. The only treatment for this condition was to replace the faulty valve.
"Traditionally, valve replacement surgery is done using open heart surgery. But for some patients, open heart surgery is very high risk for various reasons and therefore not an option," reports cardiologist Hjalti Gudmundsson, MD. "Mr. Peterson is one of those patients for whom we had no good medical treatment to offer prior to TAVR. It's clear that TAVR is having a significant impact on survival of these patients."
TAVR, or transcatheter aortic valve replacement, is a minimally invasive technique. "The primary approach uses a catheter threaded into the femoral artery with a direct puncture or a small incision in the groin," Dr. Gudmundsson explains. "Using imaging techniques to guide the catheter, the catheter carries a collapsed stent valve to the aortic 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."
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 with severe aortic stenosis," states Dr. Gudmundsson.
Though TAVR is less invasive, there are still risks involved. The FDA has approved the procedure but, so far, only for patients who are a high surgical risk or inoperable including those with:
- additional severe health conditions
- anatomic and surgical hurdles such as scarring from previous bypass surgeries or radiation, like Stuart
- severe hardening or calcification of the main heart artery
After more than 25 TAVR procedures at Gundersen over the first year, the TAVR team is confident in its effectiveness in improving survival and quality of life for patients who once had few options. And as a minimally invasive procedure, it usually means shorter hospital stays and faster recovery than with traditional open-heart surgery, especially among this group with extreme risk.
Stuart agrees: "I spent just four days in the hospital before going home. Now it is much easier for me to walk and climb stairs. I feel much better, I have a good appetite and I've been able to cut back on some of my medications."
At Gundersen, the TAVR procedure is a collaborative effort between a team of cardiologists and heart surgeons. In addition to Dr. Gudmundsson, the team includes heart surgeons Venki Paramesh, MD, FACS and Sajjad Rizvi, MD; and cardiologists Raju Ailiani, MD; Sampoornima Setty, MD, FACC; and Michael Witcik, MD, FACC.
If you think you may be a candidate for TAVR, talk with your primary care provider about a referral to the Gundersen Valve Clinic, call (608) 960-8906.