Clearing the Way
Innovative surgery replaces blocked heart valve with only a minor incision
Good luck keeping up with Janet Piger. When she’s not swimming laps, lifting weights or pedaling a stationary bike, she’s attending a library board meeting or volunteering at her church.
“I try to keep as busy as I can, and exercise properly,” says the 83-year-old, who has always watched her diet and remained active. So she didn’t waste any time getting back to her condo complex’s pool and fitness center—just two months after her heart surgery.
Heart surgery might bring to mind a huge incision or a crackediopen chest. Neither of these happen with TAVR, or transcatheter aortic valve replacement, Piger’s surgery. This minimally invasive procedure treats aortic valve stenosis, a narrowing of the aortic valve opening that affects mostly people in their 70s and 80s.
Piger joins more than 400 others since 2011 who have had TAVR at Providence Spokane Heart Institute, which has one of the largest and most experienced teams of surgeons and cardiologists in the region.
TAVR, performed under general anesthesia, requires only the smallest incision, through the groin or chest. At Providence, a cardiologist and a cardiac surgeon work together to insert an animal-tissue valve into the large artery using a catheter, or thin tube. Using X-ray views, they ease the replacement valve up to the heart, then gently push the damaged valve aside and implant the new one.
“It’s a highly regulated procedure,” says Matthew Forrester, M.D., Providence cardiac surgeon, and not everyone can have it. “Based on the latest clinical trials, the U.S. Food and Drug Administration and Medicare allow only patients at a moderate to high risk for conventional, open-heart surgery to be candidates for TAVR.” Patients also have to have at least two chronic health conditions at once, be elderly or have difficulty traveling.
Providence specialists in radiology, anesthesiology and other areas team up with a cardiologist and a cardiac surgeon. “We look at the patient’s images, lab work and medical history, relative to various studies and research databases, to predict the person’s risks with TAVR,” Dr. Forrester says.
Michael Ring, M.D., Providence cardiologist, adds, “We consider all the surgical options, in addition to TAVR. Two heart surgeons must concur that conventional surgery is too risky before we perform the TAVR procedure.” Doctors also need to know whether it’s technically feasible, so they require a specialized CT scan.
Support Through the Process
Piger was relieved when her cardiologist gave her the go-ahead for TAVR. “It’s an attractive procedure in appropriate patients because it’s less invasive and improves symptoms and quality of life,” Dr. Ring says. Along with saving lives, TAVR results in less postoperative pain, shorter hospital stays, faster recovery and smaller scars.
“All of the staff at Providence were so great,” Piger says. “They explained things in detail to me. And the surgeons, they were very kind to me and my son and daughter-in-law.”
“We provide a lot of help to the patient before surgery, so they can do better afterward,” Dr. Forrester adds. “Our social workers, case managers and palliative care specialists make sure patients have the most appropriate recovery plan.”
On the Move Again
After only a couple of days in the hospital, Piger returned to her condo, where a home-health provider helped her readjust to everyday responsibilities, such as taking a shower and fixing meals. A physical therapist got her going.
“There were exercises while in a chair and standing, for balance, and walking,” Piger says. “I progressed by doing. You can’t just sit.”
Before she knew it, she was back in the pool and working with her fitness trainer. “I have lots more energy now and can do everything I did before,” adds Piger, who also has taken a few trips since her surgery.
“It’s hard to catch me at home.”
TAVR keeps moving, too. “Even better methods are quickly coming,” Dr. Forrester says. “It’s humbling to know that the procedures I do now might be replaced with completely different technology that I don’t even know yet. And that’s exciting.”