New Hope

TAVR procedure offers successful alternative to open-heart surgery.

Mort Stoelton fought rheumatic fever twice before the age of 20, first when he was 12 years old and then again when he was 19. The first battle with the inflammatory disease forced him to miss nearly a year’s worth of school, but neither that bout nor the second caused him to miss much of anything else.
Like most of the friends he made while growing up in a western suburb of Detroit, Michigan, Mort played a lot of football, hockey and basketball, including for his high school team. Like many others, he also began working at the age of 16, eventually settling into a career as a service engineer with the Ford Motor Company.

Photo by Fred Bellet.

Mort relaxes with his dog Riley.

Midway through his 35-year stint as a service rep in the truck division at Ford, Mort was moved into a management-level position that required him to get health check-ups every two years. It was about that time doctors first began to detect some more serious issues stemming from his bouts with rheumatic fever.
“I had a heart murmur,” Mort reveals. “Doctors first detected it when I was 12, but back then it was a really light murmur. Most of the doctors could barely hear it. They had to listen really close or they wouldn’t know it was there. Over time, though, the murmur got worse. After a while, I didn’t have to tell the doctors to look for it anymore. They could hear it without any trouble.”
The heart problems that stemmed from Mort’s two bouts with rheumatic fever increased dramatically over time. He had triple bypass surgery about eight years ago and then, about a year ago, Mort began noticing some other problems that proved to be associated with his heart.
“I only sleep about four or five hours a night, so I usually take a nap in the afternoons,” Mort, 83, explains. “All of a sudden, though, I was taking two naps a day, one in the morning and another one in the afternoon. I was feeling tired all the time. Even when I’d walk, I couldn’t walk one hundred feet without getting tired.”
The onset of increased fatigue prompted Mort to make a visit to his heart doctors in Sebring. When it was discovered that he needed an aortic valve replacement, Mort was referred to S. Jay Mathews, MD, a member of the Bradenton Cardiology Center who specializes in cardiovascular disease.

A New Path

“Mort came to us through an outside referral from one of the noninvasive cardiologists in our community to Dr. Allesandro Golino, a cardiovascular surgeon who is on our structural heart team. He was diagnosed with severe aortic stenosis, which is a narrowing of the aortic valve,” Dr. Mathews explains. “That’s why he was feeling so tired all the time and was struggling even to walk across the room.
“When you have severe aortic stenosis, the blood flow to the rest of the body, including the brain and the other vital organs, is restricted. The most common symptoms are a lack of energy, feeling tired all the time and some people even complain about shortness of breath just walking across the room.”
For years, the most common approach to repairing a damaged aortic valve was to perform open-heart surgery. But for patients such as Mort, who has a long history of progressive heart failure, the risks associated with open-heart surgery are too great. That’s why Dr. Mathews opted to treat Mort by performing a transcatheter aortic valve replacement, or TAVR.
Approved for use in the US by the Food and Drug Administration in 2011, the TAVR procedure is designed to repair an old or damaged aortic valve without removing the existing valve. It is typically achieved by first running a catheter through a small puncture near the groin to the heart.
The replacement valve is then run through the catheter to the damaged area in the existing valve. Similar to a stent, the replacement valve is then wedged into place to create a valve-within-a-valve structure.
Though the procedure has been performed for years, it is still considered to be on the leading-edge of medical technology. So, too, are the replacement valves used in the procedure. Unlike the manufactured bio-prosthetic valves used during open-heart surgery, the valves used in the TAVR procedure are derived from animal donors.

Photo by Fred Bellet.

Since undergoing the TAVR procedure,
Mort is back on his feet.

“There are two varieties – bovine, which is from a cow; and porcine, which is a pig valve,” Dr. Mathews explains. “It’s actual tissue, and because it’s mounted on a stent cage, we literally inflate this balloon that allows us to replace the valve completely.
“One of the advantages of this particular type of valve is that it conforms very well to the original valve. As a result, there are very little gradients, which is the pressure drop-off across the valve. It’s about as close as you can come to replacing the kind of valve you were actually born with, which is critical.
“Sometimes, with the manufactured valves used in open-heart surgeries, there can be a mismatch between the size that’s put in and the one you were born with. We don’t get that mismatch with this type of procedure or this type of valve. That’s one of the technological advances that’s happened in this field.”

Excellent Success Rate

Another advantage of the TAVR procedure is that by employing the catheter, which can also be inserted into the arm or chest, the need to reach the damaged valve by surgically separating the chest is eliminated. As a result, most patients are ready to leave the hospital within 48 hours of having the procedure done.
“That was one of the things about the procedure that Mort was most excited about,” Dr. Mathews says of the minimal recovery time required. “And Mort had a great result. He had the procedure and was up and walking again later that evening and was out of the hospital after three days.
“If he had undergone an open-heart procedure, he would have been sidelined for quite a while, and there could have been a lot of other complications associated with it as well. That’s why, especially with older patients who have other risk factors, this is becoming such a great option.”
“The procedure is really remarkable, and it went just the way Dr. Mathews said it would,” Mort enthuses. “They put this new valve inside of my old valve, and that way, they didn’t have to do any operational work because my old valve held the new valve in place. And it started working right away. I was up and moving around again before the next morning.”
The FDA currently requires patients to have at least a four percent risk of mortality to be considered a candidate for the TAVR procedure. Dr. Mathews says that risk factor is determined through consultation with other cardiologists and surgeons as well as the use of an algorithm the team has developed to determine risk levels.

Graphic courtesy of Medtronic.

By using the Medtronic
CoreValve™ system (shown above), the TAVR procedure allows a failing aortic valve
to be replaced without
open-heart surgery.

Dr. Mathews adds that patients with a lower risk of complications may soon become candidates for the procedure as well and notes that at Manatee Memorial Hospital, the highly skilled team of cardiologists and surgeons performing the procedure has achieved an excellent success rate.
“We’ve been doing some really challenging cases,” Dr. Mathews asserts. “Some of them are patients who, in the past, have been turned down for operative replacement. We are now doing patients like that every day, and our success rate is beating the national average in terms of outcomes [according to the Transcatheter Valve Therapy (TVT) Registry, a partnership of the American College of Cardiology and the Society of Thoracic Surgeons].”
Mort is one of the program’s successes. In addition to being back on his feet and feeling re-energized, he reports that he’s working out three times a week now, doing cardiovascular and weight training. He says he wouldn’t be doing any of that were it not for the care he received from Dr. Mathews, Dr. Golino and the team at Manatee Memorial Hospital.
“The people there at the hospital, they’re all just super people. Dr. Mathews makes you feel so comfortable and confident with everything. I’ve never dealt with doctors who are so confident in themselves and what they’re doing and have had so much confidence in me as they did.
“When they’ve got that kind of confidence, it just makes you feel so much better about everything. And everyone else at the hospital, even the orderlies, they were just excellent. Manatee Memorial Hospital is a great hospital. I love to talk about them because they’re all just so great. I’d recommend it in an instant.”

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