Issue 4 Stories

A Minimally Invasive Way to Replace Faulty Heart Valves

TAVR: The Benefits of Open-Heart Surgery Without the Open-Heart Surgery

Jessie Gooden felt like she was always tired. Normally active around her house and at her church, all she wanted to do was rest.

“My legs and feet were swelling,” says Gooden, of Elkton, then 84. “I couldn’t stand on my feet for long.”

Then in early January 2017, Gooden saw her primary care physician, who sent her to Sentara RMH cardiothoracic surgeon Jerome McDonald, MD. Dr. McDonald in turn referred her to the hospital’s interventional cardiologist, Salman Allana, MD.

After conducting a series of tests, Dr. Allana diagnosed Gooden with severe aortic stenosis, a condition in which the aortic valve in the heart narrows and does not open properly.

On Jan. 23, just a few weeks after seeing her primary care physician, Gooden became the first patient at Sentara RMH to receive a new type of surgery known as transcatheter aortic valve replacement, or TAVR.

“They told me I was a celebrity,” says Gooden, who came through the procedure, recovery and rehabilitation with flying colors.

During the TAVR procedure, Dr. Allana worked with Dr. McDonald to access Gooden’s heart through a blood vessel in her groin. Using guidance from X-ray and echocardiography, Dr. Allana guided the new valve through her blood vessels to her heart. Remarkably, the only incision the surgeon had to make was about 1 centimeter (less than a half-inch) long.

“It was an extremely satisfying experience,” says Dr. Allana, who began work with Sentara RMH in summer 2016. “Mrs. Gooden had an excellent recovery and outcome.”

Smooth Recovery

Later in the day after Gooden’s surgery, nurses had her out of bed and walking. The following day, she was walking around the hospital’s halls. Already, she says, she could feel a difference in her energy levels. After two nights in the hospital, Gooden was released to go home.

Prior to the advent of TAVR, patients with severe aortic stenosis had to undergo an open-heart surgery procedure to replace a faulty aortic valve. This more invasive surgery involves a sternotomy, an incision across the full length of the breastbone, or sternum. The open-heart procedure also requires the use of a heart-lung machine, which temporarily takes over the function of the patient’s heart during the surgery.

“Use of a heart-lung machine is not trivial—especially in elderly patients,” says Dr. Allana.

TAVR can be performed without the use of a heart-lung machine and without the need for sternotomy in a majority of cases. The innovative technique is an excellent option for patients who cannot have traditional aortic valve surgery, or for whom open-heart surgery would present a high or intermediate risk due to age, frailty or other health issues.

According to Dr. Allana, recent data suggests that TAVR is associated with less bleeding and atrial fibrillation than open-heart surgery, and a similar (if not lower) risk of stroke. TAVR also is associated with less pain after surgery, shorter recovery times and shorter stays in intensive care.

“Now with TAVR, outcomes are continually improving as the technology advances,” Dr. Allana notes.

With TAVR’s shorter recovery time, Gooden was ready to build up her strength again with physical therapy after just a few weeks of rest. Her cardiac rehab took place three times a week for six weeks at the Sentara RMH Heart and Vascular Center. Part of her rehab involved using a step-type machine that monitored her heart rate. She also lifted light weights and did other light exercise.

“I was a little hesitant about going to rehabilitation, but after I started I could tell it was helping,” recalls Gooden. “It even helped my bad knee. The physical therapy team took such good care of me, that I regretted having to say goodbye to them at the end of my rehab.”

Getting Back up to Speed

Betty McGahey, 85, of Harrisonburg, has always been an active woman. She worked for Merck for 35 years, helped out with Meals on Wheels, and served on the boards of the Elkton Area United Services and Weekday Religious Education. In 1992 she started a senior bowling league that continues to meet weekly at Valley Lanes in Harrisonburg, although she had to stop bowling three years ago when she broke her leg. She lives alone, takes care of herself and is active in her church in Elkton.

Before she had TAVR surgery in March, McGahey had been feeling more and more fatigued. She couldn’t even walk through her home without stopping to rest.

“I thought it was age,” McGahey says. “But I was going downhill fast.”

She saw her primary care physician in January 2017 to address the issue, and tests revealed that she had a severe heart valve problem. Within days, she was talking with Dr. Allana about TAVR.

“Dr. Allana and Dr. McDonald explained the procedure thoroughly, including some alternatives they could do if the procedure didn’t go as planned,” she says. “I knew something had to be done, but when Dr. Allana told me, ‘I will treat you like my mother,’ that settled the matter for me.”

After several weeks of tests and consultations, McGahey had the TAVR procedure on March 3. Like Gooden, she spent just a few days in the hospital and a few weeks resting before beginning cardiac rehab.

TAVR Becoming a Popular Option

Since Gooden’s groundbreaking TAVR surgery, Dr. Allana has performed several additional TAVR procedures, including one case on a patient in his 90s. The decision to perform TAVR versus open-heart surgery is made in a collaborative, multidisciplinary manner among cardiologists and cardiothoracic surgeons on the heart team.

“Anyone with symptomatic severe aortic stenosis can be a candidate for TAVR,” Dr. Allana says. “Aortic stenosis is a disease of the elderly, so advanced age is not a contraindication of the procedure.”

Dr. Allana and the rest of the heart team deliberate carefully before deciding whether or not TAVR is a patient’s best option. As with any medical procedure, TAVR carries risks of complications, so candidate patients undergo thorough testing before having the surgery to minimize the potential for problems.

TAVR Yields Impressive Outcomes

Gooden and McGahey can’t say enough good things about TAVR and the care they have received at Sentara RMH.

“It’s unbelievable, the difference in how I feel,” McGahey says. “TAVR is a fantastic thing for older people. Just think of going up through an old lady’s blood vessels to put in a new heart valve!”

She says the cardiac team at Sentara RMH is “blessed with superpowers.”

Like Gooden, McGahey also appreciates the cardiac rehabilitation team. “They know how to take it slow and keep an eye on you,” she says. “Now I can do almost anything I want.”

Gooden is now back to baking cakes and preparing dishes for her church’s fundraising events. On Sunday mornings she picks up her 91-year-old sister for lunch, and she attends services regularly on Sunday and Wednesday evenings.

After evening church services, she sometimes goes out with friends for coffee, where they sit and talk for hours, she says. Before her TAVR procedure, she had stopped making those outings due to lack of energy.

“It’s great to have my life back,” Gooden says. “I just go out and enjoy myself. Life is good again!”

Aortic Stenosis

Located in the left ventricle (chamber) of the heart, the aortic valve controls the flow of oxygenated blood from the heart into the aorta, the large artery leading from the heart and branching off to other parts of the body, explains interventional cardiologist Salman Allana, MD. Over time, the aortic valve can become calcified, leading to a condition called aortic stenosis, which is a narrowing in the valve opening. This narrowing reduces the amount of blood that can flow into the aorta.

Age, high blood pressure, high cholesterol, smoking, a birth defect in the valve, rheumatic fever or family history may all contribute to aortic stenosis.

Symptoms include shortness of breath, fatigue, difficulty walking short distances, lightheadedness, swollen ankles and rapid heartbeat. In some people, however, there may be no outward symptoms.

Aortic stenosis affects millions of Americans, with estimates that the condition may affect up to 12.4 percent of people over age 75. Without treatment, average survival is two to five years—worse than the survival times associated with many types of advanced cancer. If you have any of these symptoms, see your doctor.


Hybrid Operating Room Enhances Safety for TAVR and Other Heart and Vascular Patients

Transcatheter aortic valve replacement, or TAVR, is one of the many procedures performed in the new hybrid operating room (OR) at Sentara RMH Medical Center. This state-of-the-art facility is called a hybrid OR because it combines the capabilities of a traditional OR with the advanced imaging features of a cardiac catheterization lab.

The hybrid OR allows cardiothoracic surgeons to transition seamlessly from a minimally invasive heart surgery like TAVR to an open-heart surgery, when needed, without having to move the patient to another OR. Vascular surgeons use the hybrid OR to treat aortic aneurysm and other complex endovascular (inside the blood vessel) procedures.

Constructed in late 2016 at a cost of $4.5 million, the hybrid OR was built on the roof of a one-story extension of the hospital. Sentara Healthcare provided $4 million of the cost, and the RMH Foundation contributed $500,000 out of donations from the local community.

“The hybrid OR is yet another example of how generous charitable support makes it possible for our community to have access to top-flight medical care,” says Cory Davies, RMH Foundation executive director. “Donors indeed bring new levels of care through their generous giving.”

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