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Open heart procedure offers renewed hope for high-risk patients

By Stephanie Earls Published: April 30, 2013 0

Virginia and Stanton Daries fell in love and courted for 10 months before marrying in 1944. They traveled the world with the military, had kids and settled in Colorado Springs. Soon enough, there were grandchildren and great-grandchildren - 42 of them.

The Daries were in their late 80s but healthy and ready to 'live a full-term life, ' as Stanton put it.

Then, Virginia started to feel ill. Her chest ached, and she was unable to catch her breath after mild exertion.

'If I went to the grocery store and I took a basket and wheeled it in, I wouldn't go 10 feet before I had a pain in the front and the back of my heart, ' said Virginia, 88.

Virginia was diagnosed with aortic stenosis, a 'disease of aging ' characterized by severe narrowing of the main heart valve - and a deeply grim prognosis.

'Half of patients are going to die within two years if they don't have their valve treated. So, in that respect, it's worse than many cancers, ' said Dr. John R. Mehall, director of cardiothoracic surgery at Penrose-St. Francis Health Services. 'With Americans living longer and longer, more people are having that problem. '

Virginia's age and physical condition made the traditional treatment for aortic stenosis - open heart surgery - too risky. Even a minimally invasive valve surgery would require a chest incision and the use of a heart-lung machine, since the heart would have to be stopped and the blood rerouted while surgeons replaced the unhealthy valve. That, doctors feared, would be too much for the ailing octogenarian.

'She would be considered high risk for a surgical procedure, (at) risk of death, stroke and slow recovery, ' said Dr. Christian Simpfendorfer, an interventional cardiologist with Penrose-St. Francis.

There was another option, though - transcatheter aortic valve replacement.

TAVR is a relatively new procedure in which doctors replace the diseased heart valve with the Edwards Sapien transcatheter heart valve, a prosthetic made of stainless steel and bovine pericardium, using a special balloon device attached to a catheter and inserted through the femoral artery in the leg. With TAVR, Virginia could expect to live another five years or more.

If she decided to proceed, she would be the first person at Penrose to receive the life-saving surgery.

For Stanton, 89, there was never a question.

'I don't want to lose her for any reason, especially when there's something to do about it. So we did it, ' he said.

The aortic valve is between the main pumping station of the heart and the body. Over time, due to calcium buildup, the valve can become blocked.

'When the blockage is severe, the opening is usually less than a square centimeter, so it's really hard to get the blood out to the body, ' Mehall said. 'By replacing the aortic valve, you essentially put those people back on the normal life expectancy curve. '

With TAVR, a stent with a balloon-expandable replacement heart valve at its tip is inserted into a large artery in the thigh. In the heart, the stent is used to pierce and widen the damaged heart valve; the balloon is engaged, the new valve uncrimps and expands to roughly an inch in diameter, wedging firmly in place.

'All of that calcium buildup that was the enemy of the valve is helping hold the new valve in place, ' Mehall said.

Though the safest alternative for high-risk patients, there are post-surgical dangers associated with TAVR, Mehall said.

'You're taking this old calcified valve, and pieces of that valve can break off, ' he said. The risk of a patient suffering a stroke after undergoing open heart surgery is about 1 percent; with TAVR, it's 5 percent.

'That's still relatively low, but significantly higher, ' Mehall said.

Open heart surgery is the norm for most people with aortic stenosis, Mehall stressed. TAVR has only been approved for patients for whom other procedures aren't an option because of age, frailty and other medical problems.

However, 'we're expanding the patient pool of people who can be treated with this surgery, ' Mehall said. 'People who previously had no option, other than take your medicine and die, can now get valve replacement. '

On March 21, Virginia underwent TAVR surgery, performed by a team of doctors at Penrose that included Mehall and Simpfendorfer. Within days, she was back home, pain-free and growing stronger.

'I'm so thrilled that I have more years than two to live, ' she said. 'Now, I can breathe and, oh, I just can't tell you how wonderful I feel. I'm alive. '

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Contact Stephanie Earls: 636-0364

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