New FDA guidelines have opened the door for low-risk patients like Gladys Musselman, 71, of Silverdale, Pennsylvania, to have Transcatheter Aortic Valve Replacement (TAVR), a minimally invasive alternative to open heart surgery.
Strolling the boardwalk at the shore with her grandchildren, Gladys was struggling to catch her breath. "I grabbed my daughter's arm and said, 'We need to slow down,'" she recalls. "I couldn't keep up."
With a zest for life and a bucket list a mile long, Gladys didn't like missing out.
Talking to Her Doctor
Her breathing problems were interfering with daily activities and walking up inclines had become impossible. She discussed her symptoms with her physician, who checked her heart and heard a swishing sound called a heart murmur—a red flag for aortic valve disease.
Aortic Valve Stenosis
Aortic valve disease can be caused by a birth defect or illness, but usually occurs in people age 65 and older due to a buildup of calcium over time.
A healthy aortic valve has three leaflets that open and close when the heart beats. The leaflets keep blood flowing one way—from the heart into the aorta, the main artery that carries oxygen-rich blood throughout the body.
In Gladys' case, calcium deposits made her valve narrow and stiff (stenosis), and her leaflets were not closing properly, allowing blood to leak backwards (regurgitation). Her heart was working hard to compensate, causing shortness of breath and making exercise difficult. Stenosis may also cause chest pain, fatigue, lightheadedness or fainting.
Seeking a Solution
Gladys' stenosis was advanced, so aortic valve replacement surgery was recommended. She consulted with Doylestown Health cardiothoracic surgeon James B. McClurken, MD, chief of thoracic surgery, who told her about TAVR.
Initially only for sicker patients who could not tolerate open heart surgery, TAVR had recently been approved for low-risk patients. Studies have shown that while both involve risk, TAVR is as safe and effective as open-heart valve replacement, according to Dr. McClurken. Open-heart surgery involves a chest incision, heart-lung machine and weeks of recovery.
"TAVR is usually accomplished through small punctures in the femoral arteries and vein in the groin," says Dr. McClurken. "Most of the time we use conscious sedation, as done for colonoscopy where the patient is breathing on their own but deeply asleep and unaware; patients usually spend a night or two in the hospital, resuming normal activities in about five days."
The TAVR Team: Planning for Optimal Outcomes
"Our multidisciplinary team reviews each patient's health and anatomy to determine if TAVR is an appropriate option," explains Dr. McClurken. "Imaging guides us as we plan each procedure and consider which tissue replacement valve offers the best fit."
All TAVR patients are followed in a confidential, national data registry, and studies assessing valve longevity are ongoing.
Experience and Innovation
TAVR is performed in a sophisticated hybrid operating room by a team which includes an interventional cardiologist, cardiothoracic surgeon, cardiac anesthesiologist, TAVR coordinator and cardiac surgical and cath lab nurses and technicians. The echocardiographic team assesses the new valve function immediately after deployment in the room.
The new valve travels through a thin, flexible tube (catheter) inside the blood vessels up the aorta.
"State-of-the-art imaging, and a tilting operating table and imaging system provide a precisely measured view as we place the new valve inside of the existing aortic valve," says Dr. McClurken.
Designed with a wire mesh stent, TAVR valves collapse to fit through the straw-sized sheath catheter and reopen when in place.
"My care before, during and after TAVR was excellent. I always had someone to call, and the day after my procedure, I felt ready to rock 'n' roll!" says Gladys.
Cardiothoracic transitional care nurses, who round with surgeons during a patient's stay, also visit the patient at home after they are discharged to ensure the patient is recovering well. "The transitional care nurse visited me at home, and I was doing so well she didn't have to come back," adds Gladys, who also participated in Doylestown Health's Cardiac Rehabilitation Program.
Back to Life
Happily keeping up with family without "huffing and puffing," Gladys is making travel and bucket list plans, "There's a zipline waiting for me somewhere!"
Doylestown Health Valve Clinic
Doylestown Health's Valve Clinic combines the expertise of cardiologists, interventionalists, surgeons and a valve clinic coordinator, providing physicians and patients with prompt assessments and advanced treatment options.
A dedicated nurse practitioner collaborates with physicians and staff to evaluate patients, coordinate diagnostic studies and arrange all necessary sub-specialist appointments.
Markers in Quality
In 2019, Doylestown Health achieved the following milestones:
- First 300 TAVR procedures with zero, 30-day mortality
- Lowest mortality in the tri-state area for aortic valve replacement
- U.S. News & World Report Best Hospitals for aortic valve surgery – high performer
About Doylestown Health's Heart & Vascular Services
Expert cardiologists and cardiac surgeons assist patients and physicians with managing risk factors for heart disease, offer advanced treatment options and provide outstanding emergency cardiac care. Doylestown Hospital’s accredited Chest Pain Center is fully prepared to treat cardiac emergencies around the clock, focusing on rapid diagnosis and effective treatment. The multidisciplinary team at the Woodall Center for Heart and Vascular Care is dedicated to providing the highest level of quality care and patient safety.