Vivian Haines is an active 80-year-old who doesn’t shy away from much — until she was faced with the possibility of open-heart surgery.
“I’m no boob, but that one got me,” she said.
This summer, Vivian visited her doctor in Laramie, Wyoming for annual blood work. She wasn’t worried. She’d never had any major health issues, though her husband of 59 years, Elwood “Woody” Haines, had. He’d suffered a heart attack a while back, and he was scheduled to have a pacemaker implanted. Doctors also had been monitoring his mild aortic stenosis.
Aortic stenosis is one of the most common — and serious — heart valve disease problems. When working properly, the aortic valve opens each time the heart pumps and lets a burst of oxygenated blood through and then closes. With aortic stenosis, the valve doesn’t open all the way, causing blood to be held back, increasing the pressure in the heart’s left ventricle and backing up blood into the lungs. In severe cases, the brain and body don’t get enough blood, which causes breathlessness, fatigue and loss of consciousness.
Vivian was walking in Medicine Bow National Forest near the family’s cabin in Centennial, Wyoming, when her doctor called with test results from her blood work. He told her he’d made an appointment for her to see a cardiologist at UCHealth Heart Center at Medical Center of the Rockies in Loveland, Colorado. The doctor said that she, too, had aortic stenosis and it needed to be addressed immediately.
“It was a bizarre situation because I wasn’t feeling sick, and I have never really been sick. He was the one with all the heart problems,” she said, gesturing to her husband.
At the time of the call, Woody was recovering from a pacemaker replacement procedure, and doctors had just told him that his aortic stenosis had become severe.
The common treatment for aortic stenosis is to replace the valve via open-heart surgery. Although it’s a low-risk procedure as far as open-heart surgery goes, the average length of stay in the hospital is six days.
However, UCHealth Heart Centers in Loveland, Aurora and Colorado Springs have specialized heart teams trained and certified to perform transcatheter aortic valve replacements. TAVR is a less-invasive procedure in which a team of cardiologists work together to place a collapsible artificial valve into the heart through a patient’s artery.
This minimalist approach, which benefits patients with generally fewer days in the hospital and faster recoveries, was approved by the Food and Drug Administration several years ago for patients who are too high risk for open-heart surgery. And this summer, TAVR was approved for moderate-risk patients.
Woody qualified for TAVR. But Vivian was healthy, and there was a chance she wouldn’t qualify and would instead have to undergo open-heart surgery.
Now it was Woody’s turn to worry.
“I was so concerned about Viv,” he said. “That [open heart] is a highly invasive surgery with anesthesia. It can take a lot out of you, especially for an older person.”
Vivian, Elwood and their daughter, Carol Lyn Steinberg, sat down with UCHealth cardiologists to discuss Vivian’s options. The mortality rate for those who don’t get surgery is 50 percent after two years, the family learned.
“You see her. She’s healthy,” Carol Lyn said of her mother. “To think she’d only have two years left when she could be kicking our butts for years to come — that was hard to learn.”
Every valve replacement case is discussed at a UCHealth multidisciplinary clinic, comprised of a cardiovascular surgeon, noninterventional and interventional cardiologists, and a valve clinic coordinator.
“Our standard of care is a multidisciplinary clinic and a transcatheter approach when possible,” said UCHealth interventional cardiologist Dr. Brad Oldemeyer. “Every patient is evaluated for a TAVR approach.”
Patients who receive TAVR usually undergo conscious sedation, not general anesthesia. And because doctors only make a small incision in the patient’s thigh or hand through which to guide the device to the heart, the recovery time is much quicker than with open-heart surgery. At MCR, 80 percent of TAVR patients go home the next day.
“The cool thing about TAVR is that the patient is up walking that next day,” Oldemeyer said. “There are not a lot of limitations other than just taking it easy.”
Although TAVR is not yet approved by the FDA for low-risk patients, UCHealth evaluates everyone because patients may qualify for a TAVR study. The studies — at both MCR and UCHealth’s University of Colorado Hospital in Aurora — are evaluating the benefits of TAVR for patients who are considered low risk for open-heart surgery.
“Trials started with the highest-risk patients because they had the most to benefit, and studies showed it was equivalent to surgery,” Oldemeyer said. “Then trials showed it was actually better than surgery for moderate-risk patients because there were fewer strokes and deaths at 30 days [post-surgery]. Now, we are studying those low-risk patients.”
Just as Vivian had decided she would enroll in that study so she’d at least have a 50/50 chance of avoiding open-heart surgery, Woody came rolling down the hall of the Heart Center, pushed in a wheelchair by Oldemeyer.
“Dr. Oldemeyer came to the exam room after my last test,” Woody said. “I had a notion something was going on when he wheeled me out — a doctor never pushes the wheelchair.”
Oldemeyer wheeled Woody to meet his wife and daughter, and then he told them the good news — Vivian qualified for TAVR without having to join the study.
“It turns out I did need it badly,” Vivian said. “I had no idea.”
Vivian had her TAVR procedure at 7 a.m. on Oct. 4; Woody’s followed at 9 a.m. By the time Woody’s surgery was done, Vivian was up walking the halls. Oldemeyer recalls the smiles the couple brought to the staff’s faces when the two crossed paths in the hallway and Vivian leaned down to give Woody a kiss.
The Haines family noticed the smiles as well.
“This place is great,” Vivian said. “We have not seen one unhappy or grouchy face in all our trips here. They really treat you like a special person.”
The couple shared a room during their one night at the hospital, and their kids brought in a few things to keep their spirits up. On the wall of their room was a large picture of Vivian and Woody dancing on their first date. “Heart mates since 1954,” it read, and it included the number of heartbeats the two had shared together: 5,217,523,200, with more to come. That night, Woody ordered the steak and lobster meal from the cafeteria to share with his wife.
Now the two are going to cardiac rehab together and getting their strength back. They have been taking advantage of the warmer temperatures to work in their greenhouse, and Vivian hopes they will get out to a Wyoming football game this year.
“We are darn lucky [UCHealth] has this program,” Woody said. “And we were darn lucky we both got in.”
For more info on TAVR, please visit:
UCHealth Heart Center at Medical Center of the Rockies
University of Colorado Hospital