ing to a new beat

Due to her age, doctors recommended that Mary Greene forego traditional open heart surgery and instead undergo a new procedure known as TAVI. Mary heeded their advice and today has renewed hope and renewed health.

WRITER: JAMES COMBS PHOTOGRAPHER: ANTHONY CASTO

Mary Greene of Leesburg is not your typical 87-year-old. She is a bundle of energy who enjoys completing household chores and taking daily thirtyminute bike rides.

Within the past year, though, Mary was forced to slow down considerably when her health took a turn for the worse.

“I wasn’t getting good circulation, and my feet felt like chunks of lead,” she says.

Europe several years ago, is less invasive than traditional open-heart surgery. It was approved by the Food and Drug Administration (FDA) in 2011.

Mary had the surgery in November 2012. Following the operation, she spent several days in the hospital but had the strength and energy to walk three or four times a day down the hallway. When she returned home several days later, she felt “almost normal.”

“I was cooking dinner, they have successfully performed twenty-five TAVI procedures since January 2012. Their facility already serves as a training center where cardiovascular surgeons from around the country come to learn minimally invasive valve surgery.

“TAVI is the biggest development in heart surgery in the last twenty years,” Dr. Moore says. “There is nothing that has revolutionized heart surgery like this. It is wonderful for patients who cannot tolerate open-heart surgery.” as it leaves the heart. When symptoms occur — typically chest pain, shortness of breath, and/or fainting spells — surgical intervention is oftentimes necessary.

With traditional open-heart surgery, a patient’s chest is opened, and a heart-lung machine is used to support the body while the heart and lungs are stopped. The old aortic valve is removed and an artificial valve is sewn into place as a replacement. Many patients are simply too frail to undergo such a rigorous procedure, and for many years there was no alternative.

“My hands would go numb or tingle, and sometimes I would experience shortness of breath.”

After undergoing tests, she learned her aortic valve had severe blockage. Unfortunately for Mary, openheart surgery was not a viable option because of her age and other high-risk conditions.

It was determined by her surgeon and interventional cardiologist that she was a candidate to undergo a transcatheter aortic valve implantation (TAVI). This procedure, which was first studied and developed in cleaning, and doing everything else I normally did before,” she says. “It wasn’t long before I was riding my bicycle again every day. I was very surprised at how well the recovery went. I recovered much faster than my husband, who had open-heart surgery several years ago.”

A change of heart

Cardiovascular surgeons

Drs. Tim Moore and Duane Cook of Leesburg-Ocala Heart Institute were the first physicians in Central Florida to perform the TAVI procedure. As of this writing,

Leesburg Regional Medical Center is one of only four facilities authorized to offer the TAVI procedure, and other cardiology practices such as Florida Heart and Vascular Center and Citrus Cardiology Consultants are also performing the technique locally. Each procedure requires a collaborative team approach between cardiovascular surgeons and cardiologists.

As patients age, many endure narrowing of the aortic valve, which acts as a one-way door, opening and shutting with each beat of the heart to keep blood flowing in one direction. When narrowing occurs, the valve becomes tight and obstructs blood flow

“This innovative procedure has revolutionized care for patients with critical aortic stenosis who were considered surgically inoperable in the past,” says Dr. David Lew, founder of Florida Heart and Vascular Multi-Specialty Group. “Having this option available to them can extend their lives and restore their health.”

How TAVI works

An artificial valve made from a cow’s pericardium, or heart, is mounted on a flexible wire cage. The artificial valve is then compressed onto a catheter, much like the stents in coronary arteries. The catheter is passed across the aortic valve, and a balloon inside is inflated and deploys the valve. This new valve is held in place by the patient’s old calcified valve.

There are two ways to perform a TAVI procedure. The first is called a transfemoral TAVI, which entails inserting the catheter through the femoral artery in the groin and then passing it up and around the aorta until it crosses the valve. This was the first version approved by the FDA.

Unfortunately, this is not an option for patients who have severe blockages in the arteries to the legs. They must is at high risk for standard surgery,” Dr. Moore says. “In addition to age, these patients may have risk factors such as bad lungs and bad kidneys. Some may have a history of strokes, and others are frail and weak. Some may have had a previous surgery, and it may be determined that going back into their chest would be extremely dangerous.”

So, do TAVI patients typically recover faster than open-heart surgery patients?

“A TAVI still requires an incision and still requires anesthesia,” Dr. Moore says. “However, it does appear to average mortality rate for a TAVI is near ten percent. If you only perform TAVIs on people who are too sick to have open-heart surgery, the results are going to be worse.”

Moreover, whether TAVIs will continue being performed in the future remains a dicey issue.

“As it stands right now, a TAVI procedure is very expensive,” says Dr. Moore. “A standard aortic valve used in open-heart surgery costs about $6,500, whereas a valve used in a TAVI procedure cost about $30,000. On average, a TAVI procedure ends up costing undergo a transapical TAVI, which involves making a small incision in the left side of the chest and exposing the apex, or tip of the heart. The catheter is then inserted directly into the apex and out across the aortic valve, where the new valve is deployed.

Both procedures are specifically for patients with aortic stenosis. Several factors determine which patients are eligible for TAVI, including a scoring system by the Society of Thoracic Surgeons (STS) that identifies high-risk patients. The selection process is quite complicated.

“Essentially, patients have to be evaluated by a surgeon and cardiologist who both agree that the patient be less traumatic. In a TAVI, we use a smaller incision and do not stop the heart and lung during surgery, which definitely has some benefits for the patient.”

At this point, though, comparing the results of the two procedures is the classic apples-and-oranges argument, especially since TAVIs are performed on patients who are high-risk, elderly, and frail. Also, since TAVIs are still in their infancy, it is impossible to analyze the long-term outcomes.

“Our results in Leesburg have been perfect; we have had no operative or thirty-day mortality,” he says. “But other places around the country have not done as well. The the hospital $80,000, so the hospital ends up losing money. With everything going on with healthcare and planned cuts, it will be difficult for hospitals to continue this procedure in the future.”

A life changed

That would be a real heartbreaker for patients like Mary, who regained her health and happiness as a result of the procedure.

“I remember waking up in the recovery room, seeing my daughter’s face, and saying to her, ‘I made it,’” she says. “Without this procedure, my quality of life would have been poor, and I probably wouldn’t have been around much longer.”