Wayne Petty, 79, spends summer weekends at the shore on his sailboat with his wife of almost six decades. Weekdays he spends time with the grandkids, volunteers at St. Mary Medical Center in Langhorne, and goes for long walks with his dog.
Things weren’t always so rosy, however. Around the first of the year, Petty started to experience shortness of breath, aching legs and overall discomfort. The long walks became short ones.
“It was annoying to my dog,” Petty recalls.
Petty had undergone two prior open-heart surgeries, one when he was 47 and another at 71. During one of his volunteering shifts as a Heart Ambassador at St. Mary, he ran into his cardiologist, George Heyrich, M.D., in the hallway and pulled him aside. After a series of tests, Dr. Heyrich told Petty he needed a stent and that he was a good candidate for a new procedure called TAVR, short for transcatheter aortic valve replacement.
TAVR is a minimally invasive procedure that treats severe aortic stenosis, a condition in which the aortic valve narrows or is obstructed, thereby preventing the flow of oxygen-rich blood throughout the body. TAVR uses a catheter to insert an artificial heart valve with a metal stent and enables the blood to flow again. The valve is inserted most commonly via a small incision in the patient’s groin (known as transfemoral access) but has also more recently been approved for insertion through a small incision in the patient’s chest wall between the ribs (known as transapical access).
TAVR was approved by the U.S. Food and Drug Administration in 2011, though it was first performed in 2002 in France. Compare that to open-heart surgery, which was first performed more than 120 years ago. Cardiothoracic surgeon Mehmet Oz, M.D., best known as author and television personality “Dr Oz,” describes TAVR as the cardiology equivalent of landing a man on the moon.
Todd Nixon, M.D., a cardiothoracic surgeon at St. Mary, might have preferred a different analogy but concedes that this new procedure is “a miracle cure for people with severe aortic stenosis who otherwise would not be offered surgery.”
“It’s an amazing intervention,” Dr. Nixon says. “It’s remarkable to be able to do this for patients for whom surgical risk is too high and then see them awake and sitting in a chair and eating lunch. It’s dramatic for me to see.”
Heyrich is the director of Structural Heart Disease at St. Mary. He agrees that the U.S. health care system is in the midst of a major paradigm shift in terms of how it treats patients with aortic stenosis, adding that TAVR serves a unique niche. The majority of patients screened are the elderly, with most patients in their 80s. Sometimes these patients ignore symptoms, thinking open heart is their only option.
“They don’t want their condition evaluated because they don’t want to even consider having their chest cut open,” says Dr. Heyrich, a board-certified interventional cardiologist at St. Mary for the past 20 years. “[TAVR] will improve your quality of life and make you live longer.”
So why not offer TAVR to all patients with aortic stenosis? Dr. Nixon, who performs more than 50 percent of the hospital’s TAVR procedures, says, “The surgical results are so good with open heart and the long-term results with TAVR are not known, especially for low-risk patients.” He adds that TAVR may become an option for a greater range of patients one day, though additional studies need to be done.
The range is expanding, however. According to Dr. Heyrich, TAVR may soon get approval for patients with intermediate risk. But for now, the ideal candidate is someone with severe aortic stenosis and good arterial access (needed for insertion of the valve), who would not be considered for open-heart surgery because of age, frailty, an underlying lung or kidney condition, previous stroke or prior open-heart surgery.
When presented with TAVR as a treatment option, Petty recalls his response: “Let’s get it done … because I love life.” Petty, who had surgery this past April, chose St. Mary for many reasons. “Not all hospitals are doing TAVRs,” he says. And, Petty says he wanted to be close to home in Yardley, near his family.
That’s an important consideration, according to Dr. Heyrich. Staying local ensures the support of family and friends, which tends to keep patients motivated and prevent the onset of depression.
St. Mary was the first hospital in Bucks County to offer TAVR. Today, it is one of 384 hospitals in the country approved for TAVRs, and Dr. Heyrich believes its metrics and quality indicators match up against the country’s best medical centers.
“A critical factor for success is the Heart Team,” Dr. Heyrich says. The team, which includes an interventional cardiologist, cardiac surgeon, nurse practitioner (who acts as coordinator), anesthesiologist and a noninvasive cardiologist, meets weekly to review cases. During the procedure, a team of 12 to 14 people—the above members along with the surgical team (who are ready to handle any complications) and X-ray and other technicians—is present in the operating room.
“It’s an institutional commitment to make the program run,” Dr. Heyrich says, who estimates St. Mary will perform approximately 100 TAVR procedures this year, putting it in the 20th percentile of implanting TAVR sites.
Petty, who is now a couple of months removed from his TAVR procedure, is doing well.
“This was a whole heck of a lot easier,” he says, comparing his recovery from TAVR to that of his open-heart surgery. With open heart, the pain in his chest was terrible. This time around, he was back to driving in a couple of days. In fact, just 23 hours after his TAVR procedure, Petty was resting comfortably in his own living room. It’s important to note, however, that his case was exceptional; the typical hospital stay for TAVR is closer to three to five days.
“I feel pretty good,” Petty says. In fact, he feels so good that those walks with his dog keep getting longer by the day.
St. Mary Medical Center
1201 Langhorne-Newtown Road
Langhorne, PA 19047
215-710-2000
www.stmaryhealthcare.org
Photograph by Jody Robinson
