For Rosalie Youngerman, the chance to get a new aortic valve without open-heart surgery was literally a lifesaver. In July, Youngerman became the 100th person at the University of Florida Health Shands Hospital to undergo a transcatheter aortic valve replacement, a procedure that allows surgeons to replace valves in patients who are not good candidates for open-heart surgery.
Youngerman, an 89-year-old from Fort White, Fla., learned in April that the valve allowing her heart to pump oxygenated blood to the aorta — the large artery that delivers blood to the rest of the body — was not functioning well and had been narrowed by plaque and calcium buildup. As a result, blood flow throughout her body was diminished.
“I felt like I wanted to pass out all the time,” Youngerman said.
Her advanced age and a slew of other recent health problems made open-heart surgery, the traditional method for replacing aortic valves, a dangerous option. But she was a candidate for transcatheter aortic valve replacement. The procedure, called TAVR for short, allows a team of collaborating surgeons and cardiologists to replace a dysfunctional aortic valve with an artificial one through a small incision in the groin or side of the chest. They use a catheter to insert the new valve and maneuver it to the right place inside the body. The old valve remains in place, but the new one pushes it harmlessly against the wall of the aorta.
Before the TAVR procedure, patients who could not endure open surgery had to rely on medications for treatment.
Youngerman said she could tell immediately after the procedure that the new valve was doing its job. After four days of recovery, she left UF Health Shands Hospital to stay in a rehabilitation facility and regain strength she’d lost due to her myriad health problems. In August, Youngerman returned home, and she recently resumed one of her favorite activities: visiting residents at a nursing home in the area.
“Our patient outcomes have been good, and this milestone really just represents how well our team functions,” said R. David Anderson, M.D., an associate professor in the UF College of Medicine department of medicine’s division of cardiovascular medicine. “It makes us one of the busiest centers in the southeastern United States.”
Anderson and Anthony Bavry, M.D., M.P.H., an assistant professor of medicine in the division, perform TAVR procedures in collaboration with two UF Health cardiothoracic surgeons: Thomas Beaver, M.D., a professor and interim chief of thoracic and cardiovascular surgery; and Charles Klodell, M.D., an associate professor of thoracic and cardiovascular surgery.
The team began offering TAVR in early 2012 after the manufacturer of the valve and catheter used in the procedure approved the hospital to use the products. UF Health Shands Hospital was one of several in the United States initially selected. The FDA approved TAVR in November 2011 for use only in patients with severe aortic valve narrowing who were unable to have open-heart surgery but has since expanded its guidelines.
High-risk surgical patients suffering from severe valve narrowing also are now eligible to undergo TAVR. Such patients include those with liver disease, lung disease, too much plaque buildup in the heart or anatomical features that can prevent open-heart surgery — such as an abnormally shaped sternum, Anderson said. People of advanced age or those who are especially frail also may qualify as high-risk patients.
“You can save them the risk of complications associated with open valve surgery, such as being on a respirator a long time, prolonged hospitalization, possibly inpatient rehab or time in a nursing home,” he said. “If your 89-year-old patient is less functional than you’d like her to be but you can get her through the catheter procedure, she can still go home in four or five days.”
Starting this fall, UF Health’s TAVR team will participate in a clinical trial to test an upgraded version of the valve, which will be used with a smaller catheter. The new catheter may allow more patients to be eligible for the procedure. They also plan to start using a larger valve that will better suit some patients.
In the meantime TAVR is already changing the lives of patients such as Youngerman.
“It’s revolutionary technology, being able to treat patients who could not previously be treated, and in an entirely new way,” Klodell said. “It represents a completely new way of thinking about aortic stenosis patients.”