Since June 2012, the heart valve team at Edward Heart Hospital has performed nearly 50 transcatheter aortic valve replacements (TAVR) for patients with severe aortic stenosis, making it one of the busiest TAVR programs in Illinois.
Aortic stenosis is a narrowing of the valve opening that leads from the body's main artery, the aorta. This makes it difficult for the heart to pump sufficient blood to the rest of the body. Symptoms might include dizziness, fatigue or fainting on exertion. Valve replacement through open heart surgery is the treatment of choice, but some patients are considered too high risk for this invasive approach.
"Before TAVR, we’d have to say to these patients, 'You'll want to get your affairs in order.' Now patients who would have faced certain death are having treatment that's highly successful," says Bryan Foy, MD, medical director of cardiac surgery at Edward Heart Hospital and cardiothoracic surgeon with Cardiac Surgery Associates.
TAVR patient Leon Lasota, 92, was one of those patients facing a dire prognosis. But this Romeoville resident has a history of surviving close calls. The first was an attempt on his life in the late 1930s arising from political conflicts in his native Poland. During World War II he escaped Buchenwald, a Nazi concentration camp, after a three-year imprisonment. And, he went on to suffer a gunshot wound while serving in the armed forces.
The most recent danger came on September 18, 2013, when Lasota collapsed in his home. His daughter, Sylvia French, was able to cushion his fall, call 9-1-1 and perform CPR.
After a short stay at Edward Hospital, Lasota was released to the care of his primary cardiologist. That October, Lasota consulted with two cardiac specialists at the Edward Valve Clinic: Dr. Foy and Mark Goodwin, MD, medical director of Edward Hospital's Cardiac Catheterization Lab and interventional cardiologist with Midwest Heart-Advocate Medical Group. The Valve Clinic is a multi-disciplinary program to evaluate patients with heart valve problems and recommend the best course of treatment.
After putting Lasota through a series of cardiac tests, Dr. Goodwin diagnosed severe aortic stenosis. Because of Lasota's age and other risk factors, open surgery was ruled out. But, he was a candidate for TAVR, a procedure that Dr. Foy describes as "requiring meticulous planning and execution, despite the fact that it's less invasive."
On November 14, 2013, a group of about 20, including six physicians, a surgery team and a team from Edward's Cardiac Cath Lab came together in Edward's large Hybrid Operating Room to perform Lasota's three-hour TAVR procedure. The interventional cardiologists on the team included Dr. Goodwin and Peter Kerwin, MD, of Midwest Heart-Advocate Medical Group. The cardiac surgeons were Dr. Foy and Frank Lutrin, MD, of Cardiac Surgery Associates. Another Midwest Heart-Advocate Medical Group cardiologist, Stanley Clark, MD, monitored echo images throughout the procedure, and Dr. Kerwin inserted a pacemaker. Also on hand was Edward’s TAVR coordinator, Suzanne Wallace, RN, ACNP-BC.
"Having such a variety of talent and perspective on the team results in the best outcome for the patient,” says Dr. Goodwin. “There are a lot of people in the room but it all goes very smoothly. Everyone knows their role."
To begin the TAVR procedure, Dr. Foy made a small incision in Lasota's chest (in some cases access is through the groin) and inserted a sheath (tube) about the width of a pencil into the heart for transporting instruments. Dr. Goodwin then performed a vulvoplasty, in which Lasota’s narrowed valve was widened by expanding a balloon attached to a catheter that was sent through the sheath. This set the stage for the Edwards Lifesciences SAPIEN prosthetic heart valve to be delivered, in compressed form, to Lasota's existing valve. The new valve was then expanded, pushing the diseased valve aside. Dr. Lutrin removed the sheath and closed the incision in Lasota’s chest.
"That evening our dad had his breathing tube removed and by the next morning he was up and walking around," says Susan Lasota, Leon’s daughter.
"I was very pleased about the less invasive surgery and felt very comfortable and confident with the doctors,” says Leon Lasota. “My recovery was quick and better than I expected. I no longer have trouble breathing, especially when walking."
Dr. Goodwin says, "You would never believe all Mr. Lasota has been through – even concentration camp – when you see what a joyful, kind person he is."
Edward is one of only ten hospitals in Illinois and one of only six in the Chicago area to offer TAVR, which the FDA approved in 2011.
"The demand is on the rise,” says Wallace. “Word has gotten out to patients and doctors that this procedure is available and the outcomes are good."
For more information, call the Edward Hospital Valve Clinic at (630) 416-7796. For information about services provided by Edward Heart Hospital, visit www.edward.org/heart. To learn about Edward’s activities during Heart Month in February, visit www.edward.org/heartmonth.