For people with certain heart valve problems, years can pass before the problem needs to be addressed. But once the heart’s ability to work is affected, the valve must be fixed, and that usually means open-heart surgery.
That is, until recently.
A trial at UCHealth is giving patients who would otherwise need open-heart surgery the chance to have their heart valves repaired with a less-invasive procedure.
Lee Steele, an interior trim carpenter from Cheyenne, Wyoming, got that chance.
Steele and his UCHealth cardiologist, Dr. Todd Whitsitt, had been monitoring Steele’s heart for more than four years. Each year, Steele would get an echocardiogram, a type of ultrasound of the heart, to monitor Steele’s condition, called aortic stenosis, which prevents the heart’s aortic valve from opening properly.
As one ages, basic wear and tear can cause the flaps of a valve to thicken. As a result, the heart has to work harder to pump blood through the valve, and the body can suffer from a reduced supply of oxygen.
“A lot of times the issue is found because a doctor will identify a heart murmur,” said Dr. Brad Oldemeyer, a UCHealth interventional cardiologist. “Then it’s discovered there is a thickening of the aortic valve. Until it becomes severe and a person develops symptoms, we don’t need to fix it.”
It’s usually not until blood flow is significantly restricted that people experience symptoms such as breathlessness, chest pains or pressure, noticeable heartbeats, decline in physical ability or fainting.
After close monitoring — and a failed stress test at UCHealth Heart Center in Loveland — doctors decided it was time for Steele, 79, to have his valve fixed.
Open-heart surgery was the only option until the less-invasive TAVR, or transcatheter aortic valve replacement, procedure came along.
During open-heart surgery, the damaged valve is removed and replaced with an artificial valve while the patient is under anesthesia. Typical recovery is eight to 12 weeks and requires months of cardiac rehabilitation to help the patient regain energy and overall health. What’s more, a person with a mechanical valve will most likely take medication the rest of his or her life to help prevent blood clots.
TAVR is a minimally invasive surgical procedure that repairs a damaged valve without removing it. A team of heart surgeons and interventional cardiologists works together to place a collapsible artificial valve into the heart. When in position, it expands and pushes the old valve leaflets out of the way, and the tissue in the replacement valve takes over the job of regulating blood flow.
The procedure was approved by the FDA in 2011 but only for patients who were too high risk for open-heart surgery. The FDA later approved the procedure for moderate-risk patients.
“Before, we’ve had to tell people that they were too healthy for TAVR,” Oldemeyer said. “But the data is showing that it’s equivalent, if not superior, to surgery with the outcomes we want, and therefore it’s being offered to a broader range of patients.”
Patients like Steele — who are otherwise healthy and a low risk for surgery — still are not guaranteed the TAVR option. That’s why Steele decided to participate in UCHealth’s low-risk TAVR trial, which is being offered at UCHealth Heart Center at Medical Center of the Rockies in Loveland as well as at UCHealth University of Colorado Hospital in Aurora.
Because TAVR is a less invasive surgical procedure, patients usually experience a quicker recovery. Oldemeyer said it’s common for low-risk patients to go home the next day.
“I’m an interior trim carpenter by trade,” Steele said. “Given the work that I do and the needs of my family, I wouldn’t have been able to handle the long recovery involved in open-heart surgery.”
Steele said he enrolled in the trial because it gave him a 50-50 chance of getting TAVR, a procedure he’s learned from friends was the way to go.
“We [Steele and his wife] have close friends here in Cheyenne and family in California that are very familiar with TAVR, and all of them said that it’s the way to go,” he said. “It’s the new way of doing things.”
With reassurance from his friends and family — and previous experience with Medical Center of the Rockies for a spinal fusion — Steele said he wasn’t too concerned about his procedure.
“We were so impressed with the quality of care before that it lessened the normal apprehensions we may have had about the surgery,” he said. “The doctors and nurses were just extraordinary.”
Just a few days after his August 2016 heart surgery, Steele began to do minimal work in his small workshop while also attending cardiac rehab at Cheyenne Regional Medical Center. In the next month or so, he plans to reconnect with a custom cabinet manufacturing company to continue doing installations and interior trim carpentry.
“I feel very good,” he said. “Since the surgery, I’ve met a number of people in rehab that have had the different procedures, and those who have had TAVR don’t seem to have any hesitation recommending it. Their quality of life afterwards is excellent. And I know the program for which I’ve been exposed has been an A-plus program.
“A significant part of recovery is participation in cardiac rehab and a commitment to exercising regularly and following a heart healthy diet. These are all part of the recovery program. I am very fortunate to have had the opportunity for TAVR and to have added a significant number of years to my life.”