Heart Valve Replacement without Open Heart Surgery

Bonnie Morris of Bettendorf learned a lesson from her courageous mother, who endured cancer for four years before her death: Don’t sit around and complain when you don’t feel well. Get up and get on with your life.

That’s exactly what the ever-positive Bonnie Morris did over the years as she faced lung cancer, the removal of her left lung, a heart attack, heart-bypass surgery, a pacemaker, chronic obstructive pulmonary disease and other health challenges.

She even remained upbeat despite her latest foe -- severe aortic stenosis, a progressive narrowing of the aortic valve opening that restricts normal blood flow to the entire body. Increasingly, overwhelming fatigue restricted her daily activities.

“Some days, I hardly had the energy to walk across my apartment to the bathroom,” said Mrs. Morris, 81, who has five children, nine grandchildren and 12 great-grandchildren. “I knew I wasn’t in good shape, but I didn’t realize how close I was to meeting my Maker.”

Life-saving chance

Her life-saving chance came July 15, 2014 at Genesis Medical Center, Davenport, where a minimally-invasive procedure replaced her aortic valve without using traditional open-chest surgery. Transcatheter Aortic Valve Replacement or TAVR, is for patients with severe aortic stenosis who are at high risk or too sick for standard valve replacement surgery.

Genesis was the first hospital in the Quad Cities to offer TAVR.

“Transcatheter Aortic Valve Replacement is the most significant event in cardiology in the last 35 years,” said cardiologist Nidal Harb, M.D., Chief Executive Medical Director of the Genesis Heart Program. “Genesis, as one of the nation’s Top 50 Heart Hospitals, is excited to bring this cutting-edge procedure to the Quad Cities area.”

If untreated, about 50 percent of patients with severe, symptomatic aortic stenosis will not survive more than two years.

“With TAVR, we can change life expectancy, and we can change quality of life,” said interventional cardiologist Jon Robken, M.D., a member of the TAVR team at Genesis. “This procedure is transformational and has taken on worldwide significance, allowing treatment for very elderly and very sick patients who otherwise would not have received care.”

A valve within a valve

TAVR repairs the valve without removing the old, damaged valve. Somewhat similar to a stent placed in an artery, TAVR delivers a replacement valve to the valve site through a catheter. Once the new valve is expanded, it pushes the old valve leaflets out of the way, and the replacement valve takes over the job of regulating blood flow.

Typically, valve replacement requires open-heart surgery, where the chest bone is surgically separated to access the heart. However, TAVR patients are not candidates for traditional surgery. They’re often so frail that the overwhelming likelihood is that they would not survive conventional heart surgery. Because of that risk, they're left with no treatment for their aortic valve disease.

The narrowing in the aortic valve that restricts blood flow to the body is progressive. Eventually patients slip into heart failure; blood backs up into the lungs; the lungs become congested; and patients become more short of breath and uncomfortable. It's a problem that’s very difficult to manage with medicine.

The artificial heart valve is made of the heart tissue of a cow and a fabric skirt, attached to a strong metal frame.

A second chance

Bonnie Morris credits Rafat Padaria, M.D., her cardiologist and a Genesis TAVR team member, with recommending her for the procedure.

“Dr. Padaria said, ‘I think we can help you.’ She immediately got on the phone with her colleague Dr. Jon Robken and said, ‘You need to meet this patient. I think she’s a good candidate.’”

Dr. Padaria continued to advocate for her patient during the weeks before the procedure as Mrs. Morris’ health deteriorated. “Dr. Padaria insisted, ‘You’re going to get this procedure. I’m not giving up,’” Mrs. Morris said.

In the eight months leading up to her TAVR, Mrs. Morris estimates she had more than 25 blood transfusions due to her leaky heart valve. “My veins had started collapsing, and the blood transfusions and needles became very, very painful for me,” she recalls.

During TAVR, the catheter that delivers the prosthetic aortic heart valve can be inserted through an incision in the femoral artery in the groin, through an incision between the ribs, or through a small incision in the front of the chest.

A team approach

Whatever approach is used, it takes a care team of about 25 health care specialists working together during the procedure to bring about the best outcomes for the patient. A partnership between the cardiac surgeon, interventional cardiologists, and cardiac anesthesiologists establishes the core of the TAVR Heart Team.

Valve Clinic Coordinator Tami Gumpert guides patients through the many tests and physician office visits they must undergo before doctors decide if the TAVR procedure is appropriate for them.

“Our patients go through the myriad of testing and do everything we ask so we can make the best decisions in their care,” Gumpert said. “Over time, our patients are like family. It’s very rewarding to see how their quality of life improves after the TAVR procedure.”

It was the team approach that made Mrs. Morris more confident in having the procedure.

“It’s the most fantastic team,” she said. “The Genesis TAVR team gave it everything, plus more. Not only are they doctors, but they’re very human…respectful, kind, funny and great at explaining things. The nurses are wonderful, too. Once you meet the TAVR team at Genesis, you know you’re going to be fine.”

--- By Linda Barlow, Genesis