Cathie Rowand | The Journal Gazette Dr. Roy Robertson, president of Parkview Heart Institute, is glad to see more heart valve replacements done with a minimally invasive surgery.
Thursday, June 22, 2017 1:00 am
Heart valve replacement 'changes lives'
Recovery fast when catheter method used
STEVE WARDEN | The Journal Gazette
At a glance
Transcatheter aortic valve replacement is a minimally invasive procedure for patients with severe aortic stenosis. Traditional heart valve surgery would require months of recovery, whereas the TAVR procedure requires only a few days of hospitalization and recovery.
In his 30 years as a cardiologist, Dr. Roy Robertson, president of the Parkview Heart Institute, has strong feelings on the several transcatheter aortic valve replacement procedures he has performed.
“It's probably one of the most gratifying things I've ever done in a sense that it just changes people's lives,” he said.
The minimally invasive surgical procedure repairs a heart valve without removing the old, damaged valve; while the heart is still beating; and without opening the chest cavity, Robertson said.
A valve in need of replacement “gets calcification, like a rusty hinge on a door,” he said. “It all blocks up and … you're getting a cocktail straw's worth of blood out of every beat rather than a hose worth. The heart can only push so much through a small space in a given period of time.
“When that occurs, there are a couple things that happen: One is patients begin to have symptoms where they have congestive heart failure, they pass out or they start to have chest pains. Those are the three big things we think about.
“On top of that,” Robertson added, “aortic stenosis, in its own isolated state, reduces the patient's life expectancy.”
Untreated conditions can develop into severe aortic stenosis, which is determined by an echocardiogram, Robertson said.
“Once they get there, they have a significant mortality associated with that, meaning that about 40 percent of people with severe aortic stenosis would still be alive in two years.”
Robertson said while traditional valve replacement required open heart surgery, the TAVR can be done with a minimal incision.
“Patients are able to have a one-inch incision in the groin or a poke hole in the groin, and have a new heart valve without any thoracic surgery,” he said.
The procedure, he explained, is similar to that of a stent being placed in an artery, and the TAVR surgery delivers a fully collapsible replacement valve through a catheter.
“We then restrict that old valve, using the calcification and the degenerative nature of the old valve kind of as a plaster,” Robertson said. “We don't suture it in; we actually imbed it into that old valve, and that old calcium that's there acts almost like a little bit of plaster and holds the new valve in place.”
Not only does the patient feel better afterward, Robertson said, the patient's recovery time is significantly reduced.
“Those patients tend to recovery very quickly because obviously they haven't had any major influx of their thoracic chest region and no major surgery, so they don't have any tubes or anything,” Robertson said.
“Essentially what happens is we bring patients in, and they'll have that procedure done in the morning or that afternoon, and they're usually sitting up, going for a walk that evening, and either going home the following day or the day after that. So typically they're in the hospital for about two days.”
It was four days – admitted on Monday, released on Thursday – for Betty Kyler, whose surgery was last December.
“I had absolutely no energy at all,” said Kyler, 87. “I sat in a chair and I did nothing. I had no energy. After I had this done, in about a week I was feeling much better. In about two weeks, I was driving and going to breakfast with my friends and getting out and enjoying life again.”
Adds Robertson, who performed the surgery on Kyler: “The wonderful thing of that whole scenario is that because recovery from the surgical portion of it is so straightforward, people get a dramatic improvement almost instantaneously.
“A patient could come in and say, 'I can walk maybe 20 feet – 30 feet at the most – and I have to stop because I'm short of breath.' They have an aortic valve put in that manner the next day, and maybe they'll be able to walk a mile. It's literally that dramatic.”
Kyler says her life has changed since surgery. “Now I can do my own laundry. I can drive. I can do anything. I have a lot of energy and I enjoy life.”
Robertson said recovery time after a thorachotomy, or a surgical incision in the chest, is about six weeks for the wounds to heal, several months before a patient is free to drive, and even longer before a patient becomes fully active. But the significant difference is long term.
“It turns the mortality curve back to a normal curve,” Robertson said. “So you go from severe aortic stenosis and have a TAVR, you're going from a 40 to 60 percent two-year mortality rate to a dramatic lesser mortality rate, depending on what category you fall into. The survival curve goes back to a more normal curve.”
The procedure was once reserved for high-risk patients only, but Robertson says it has been approved for intermediate-risk patients.
“Now we can offer it to many, many patients,” Robertson said. “I would say we do one surgical valve for every six catheter valves that we do, just roughly guessing.”