In the past year, 86-year-old Eunice Wunderlich of Velva, North Dakota, noticed that her heart condition was getting worse.
“Steps were hard, and if I would walk down to the end of the block and come back, oh, I couldn’t wait to get in the house to sit down because I was so out of breath and tired,” Wunderlich said.
Her coronary artery disease was progressing, and she had significant blockage of her aortic valve. Wunderlich was referred to Sanford Health in Bismarck, where the heart care team could determine whether she would qualify for a less invasive transcatheter aortic valve replacement, or TAVR, procedure.
Learn more: Download a booklet about TAVR
Examining the options
Because of her age and advanced disease, Wunderlich wasn’t a good candidate for enduring the stresses of a traditional open-heart operation. But Wunderlich’s family hoped the less-invasive TAVR procedure would be the right option for her.
“We knew there would be so many complications with the other way of doing open heart surgery,” said Wunderlich’s daughter Joan Hansen. “So when we found out that my mom did qualify for the TAVR method, it was like winning the lottery.”
During TAVR, a catheter is inserted into a patient’s leg and from there is guided gently to the heart. A collapsible replacement aortic heart valve is then inserted into the catheter, moved up to the heart and opened up, providing the heart with the improved oxygen and blood flow it needs.
Make an appointment: To ask about TAVR in your area, call Sanford Heart (Bismarck, ND) at (701) 323-5202, Sanford Heart Hospital (Sioux Falls, SD) at (605) 312-2200, or Sanford Heart & Vascular Clinic (Fargo, ND) at (701) 234-4800.
A new technology
Wunderlich’s heart care team also used a new technology to further protect her during the TAVR procedure. The Sentinel Cerebral Protection System is the only device in the U.S. to offer protection from the risk of stroke during TAVR.
“It basically works like a fishnet and captures material,” said Timothy Pansegrau, M.D., a cardiovascular surgeon for Sanford Health. “During TAVR, sometimes calcification can break away. If it does, this covers the arteries and protects the pathways to the brain.”
The Sentinel device is deployed at the beginning of the TAVR procedure via a small tube inserted through the wrist. When removed after the procedure, calcium particles often are trapped in the device.
New valve, new life
Overall, Wunderlich’s TAVR procedure went well. After recovering for about a month, she already notices a difference.
“I can tell I have more energy, and I’m ready to do a few things, whereas before I just didn’t feel like it,” Wunderlich said.
Her family is grateful to see her feeling better.
“She looks and acts 10 years younger,” said Hansen. “And to see her energy level, it’s just a 180 from who she was. And that was the whole purpose of this, to give her a better quality of life.”
Another TAVR candidate’s story
Darleen Hoover, an 87-year-old native of Bismarck, was diagnosed with severe aortic valve stenosis. She began experiencing stenosis-related breathing problems and fluid retention, all complicated by the beginnings of congestive heart failure.
“What happens with aortic stenosis is the aortic valve narrows down to the point where blood cannot get out of the heart. If blood can’t get out of the heart, it can’t get to the brain or the rest of the body,” said Sean Russell, M.D., a cardiovascular surgeon at Sanford Health.
These issues began to have a profound impact on Hoover’s quality of life. While keeping her stabilized, the care team at Sanford Heart did testing to identify next steps for her. They determined that the TAVR procedure would be an excellent treatment option.
“I think the team is really focused on making you feel comfortable about this whole procedure so that you have confidence in doing it,” said Hoover, who was 85 at the time of her surgery. “I was impressed with that.”
‘Never did have any pain’
“Heart technology is advancing at an incredibly fast pace,” Dr. Russell said. “We can do these big procedures that were really invasive before, and now they’re easier on the body, they’re easier to do and patients are having better outcomes.”
After the TAVR procedure, Hoover was monitored in the hospital for three days and then continued recovery at home.
“I never did have any pain,” she said. “And coming home seemed like an easy adjustment. I wasn’t having the breathing problems anymore, and certainly my legs were not as swollen as they had been.”
Darleen’s interventional cardiologist Andrew Carter, D.O., is confident that more patients than ever can benefit from TAVR and other advancements.
“I’d like patients with heart disease to know that heart problems are common. They show up in many forms at all ages,” Dr. Carter said. “We have a lot of resources available that can improve quality of life with any number of heart conditions.”
For patients like Hoover, the TAVR procedure offers a meaningful chance for vastly improved quality of life without facing the significant challenges of open heart surgery.
“I would tell patients to consider this procedure and not to be afraid of it because it’s not that difficult. Even somebody like me was able to tolerate it very easily, and I would think anybody would be able to, whatever age,” Hoover said.
Transcatheter aortic valve replacement is a revolutionary procedure safely treating patients with severe aortic stenosis without open heart surgery. A minimally invasive surgical procedure, TAVR repairs the damaged aortic valve. That’s one of two main valves on the left side of the heart regulating blood flow by opening and closing, allowing blood to flow throughout the body.
A condition caused by the heart’s crucial aortic valve narrowing or failing. Aortic stenosis results in reduced or blocked blood flow to the body. About 1.5 million people in the U.S. have aortic stenosis. Without an aortic valve replacement, 50 percent will not survive more than two years once symptoms begin.
A fellowship-trained team of cardiovascular surgeons, interventional cardiologists and anesthesiologists place a collapsible replacement heart valve into the body via a catheter through the femoral artery in the thigh. The catheter is gently threaded up to the heart. The valve is set in place of the old one without removing the damaged valve. Once the collapsible aortic heart valve is in place, the surgeon opens up the device, opening the aortic valve and providing the heart the oxygen and blood needed to pump more efficiently. The procedure is completed while the heart is still beating.
Usually valve replacement requires an open heart procedure with a sternotomy, surgically separating or opening the chest to perform the procedure. With TAVR, very small incisions are made in the femoral artery in the thigh, leaving all the chest bones in place.
For those diagnosed with aortic stenosis, options to mend the weakened heart valve used to be slim. In fact, research shows patients with severe aortic stenosis do not survive more than an average of two years after the onset of symptoms if they do not have surgery. However, some patients with severe aortic stenosis are not candidates for open heart surgery. TAVR provides an opportunity for patients whose condition was previously untreatable to now receive treatment.