New heart valve procedure an option for older, high-risk patients
Alma enjoys a walk with her daughter, Karen, in April 2012
Alma Olson has relied on faith, family, and fortitude to help her live a long and fulfilling life. At age 90, she’s a model of strength and self-reliance.
So when she started feeling tired on a daily basis in fall 2011—to the point where it took a concerted effort to join group activities at her Iowa City senior living residence—Alma had a simple explanation.
“I figured I just needed to give it a little more ‘oomph,’” she says.
Daughter Karen Arthur and other family members noticed Alma’s constant fatigue.
“Mother was exhausted all the time,” Karen says. “It got to the place where she didn’t have the energy to go visit Dad (Alma’s husband, Arno, 96, lives at a nearby care center) or even go to church. That’s just not her.”
A couple of years earlier, Alma had been diagnosed with aortic stenosis—a narrowing of the heart’s aortic valve through which oxygen-rich blood from the heart’s main pumping chamber flows into the aorta and out to the rest of the body. A poorly functioning aortic valve means the body doesn’t get enough blood, which causes the heart to work even harder. Left untreated, it can lead to heart failure or cardiac arrest.
Alma’s aortic stenosis was due to calcium deposits that had formed around her aortic valve over time. By last winter, it was clear that her condition had worsened. Alma’s primary care provider referred her to University of Iowa Heart and Vascular Center, which recently had become the first and only center in Iowa to offer a new aortic valve procedure that does not require open-heart surgery.
The new approach, called Transcatheter Aortic Valve Replacement (TAVR), uses a prosthetic valve that is compressed onto a balloon. The valve is inserted into a large artery in the patient’s thigh and advanced to the valve site. The new valve is then carefully positioned and expanded with the balloon, making it immediately functional.
Traditionally, replacing a blocked aortic valve caused by aortic stenosis meant major surgery that included opening the chest with a large incision, placing the patient on a heart-lung bypass machine, and then removing and replacing the diseased valve. For some patients, such as those who were in poor general health, this procedure represented a large risk. TAVR is a minimally invasive procedure that offers a viable option for patients who in the past would have had no options.
For elderly and high-risk patients with severe stenosis who are eligible for TAVR, the procedure is a breakthrough, notes Phillip Horwitz, MD, an interventional cardiologist with UI Heart and Vascular Center.
Phillip Horwitz, MD
“This allows us to offer a life-saving treatment for a common disease to patients who would have been considered untreatable in the past,” Horwitz says.
Patients like Alma, for example. Given her age and condition, Alma was considered too high risk for invasive surgery. Before TAVR, she most likely would have had to “live with” her stenosis. The majority of patients like Alma who are untreatable die within one year, Horwitz notes.
The fact that TAVR was a new procedure didn’t faze Alma. She let her faith in God and her trust in the UI heart care team guide her.
“I said, ‘Let’s go,’” Alma says. “I wasn’t worried at all. I figured if they have something that will work, fine.”
“The UI team gave us an overwhelming feeling of total confidence,” recalls daughter Karen. “The caring and expertise shown by the doctors and the nurses was so invaluable. They put us at ease.”
Several days later, Alma returned for her new aortic valve. The procedure went well, and after four days she was able to go home. Remarkably, Alma says she’s had “no pain at all.” She now participates in an outpatient rehab and exercise program through UI Heart and Vascular Center called CHAMPS (Cardiovascular Health, Assessment, Management, and Prevention Service) and is making great progress.
“I feel good,” Alma says. “I would certainly recommend it to others if they are a candidate for this type of surgery.”
“She now has a new lease on life,” marvels Karen. “They told her she has the body of an 80-year-old and the heart of an 18-year-old. How great is that?”
More about TAVR
The Edwards SAPIEN Transcatheter Heart Valve, developed by Edwards Lifesciences, was approved in November 2011 by the U.S. Food and Drug Administration for patients with severe aortic stenosis who are considered too high risk for traditional forms of heart valve replacement surgery or were previously considered inoperable. The Edwards valve is the first transcatheter aortic valve replacement (TAVR) treatment approved for use in the United States.
UI Heart and Vascular Center is one of a select group of centers across the nation—and the only one in Iowa—to offer this procedure to qualified patients.
In October 2011, UI Heart and Vascular Center became the first program in the nation to receive certification for its cardiac valve program from The Joint Commission, the accreditation agency for health care organizations in the United States. In addition to the new transcatheter procedure, the center’s heart valve clinic offers minimally invasive surgery for heart valve repair and replacement.
To learn more, call UI Heart and Vascular Center 319-384-6245.