Too sick for surgery? Memorial introduces an easier way to replace a heart valve

James Valdivia of Modesto was one of the first patients in Stanislaus County to undergo a heart procedure that’s now offered at Memorial Medical Center.

The retired welding instructor returned home 48 hours after doctors replaced the aortic valve in his heart by inserting a catheter in his groin and threading it through arteries to his heart.

The doctors activated a balloon to put the new valve in place.

Valdivia, 83, said he had an easier time than his brother, who had open-heart surgery to replace a coronary valve. “My brother had the open-heart and it took him three months to get back to normal,” Valdivia said.

“I have no pain at all. I feel a lot better. I can breathe better,” Valdivia said.

The newer procedure, called transcatheter aortic valve replacement, or TAVR, was introduced at Memorial last month as an option for older patients who suffer from a common heart condition.

Aortic valve stenosis occurs when one of the four valves in the heart becomes calcified with age and narrows. It usually occurs in seniors who are 75 years or older, giving them shortness of breath, chest pain, fatigue and early signs of heart failure.

People with severe symptoms are said to have a 50 percent chance of surviving for two years – if they are not treated.

The less invasive TAVR procedure was approved in the United States in 2011, creating an option for patients who are taking a gamble if they have open-heart surgery.

Doctors Amar Pohwani and Hassan Hussain conducted the first two TAVR procedures at Memorial on March 30 and expect to perform one or two every week. The first two patients were sitting up in chairs and walking the day after the procedure.

Both were discharged home after 48 hours.

The Modesto cardiologists traveled to Germany for one week of training in TAVR. Back home, they took their initial cases to Sacramento last year to hone their skills under supervision.

Pohwani said last week he has done more than 40 cases.

“It is a big achievement for the community, for patients in the Central Valley,” Pohwani said. “Patient’s don’t want to travel outside of Modesto. This condition is common in many patients.”

A doctor can often hear the murmur of aortic valve stenosis through a stethoscope. Tests are run to confirm if patients with symptoms have the condition. Patients also are checked for blocked coronary arteries, the doctors said.

A CT scan is done to size the artificial valves, which range from 20 to 29 millimeters in diameter. During the TAVR procedure, the artificial valve mounted on a stent is put in place by inflating a balloon.

To make sure the valve is the proper size, the cardiologists inject a dye and watch a video screen to see if blood moves around it.

The entire TAVR procedure takes 60 to 80 minutes.

Upon returning home, Valdivia was instructed to walk for 15 minutes in the morning and 15 minutes in the evening, and then gradually increase his exercise. Patients take aspirin and Plavix for three to six months to guard against blood clots.

Valdivia’s wife, Adeline, said her husband is eager to get back to his gardening. He raises tomatoes and chili peppers at their east Modesto home.

“I have to tie him down because he can’t be going out,” Adeline said this week. “He likes being outdoors.”

The FDA’s approval of TAVR five years ago was considered a lifesaver for patients who were not healthy enough for surgery.

Studies have since weighed the benefits for seniors who are a moderate risk for open-heart surgery.

According to the American College of Cardiology, moderate-risk patients in a clinical trial had about the same mortality rate two years after TAVR as surgery patients. The latest data, reported last month, showed a slightly less incidence of death and disabling stroke with TAVR. The rate was 12.6 percent with TAVR against 14 percent with surgery.

The TAVR procedure has been associated with a risk of stroke, though studies have been inconclusive. It’s thought that fragments of calcified material might break loose when doctors place the new valve over the natural one.

A possible complication is leakage around the new valve and the need for a second procedure. A small percentage of TAVR patients will need a pacemaker.

Studies continue on whether TAVR should be offered for low-risk patients.

Hussain said that Memorial, with its high-tech operating rooms, has facilities to expand into more complex interventions so local patients don’t have to travel to Sacramento or the Bay Area.

“It opens the door for a gamut of newer procedures,” Hussain said. “Our goal is to have a heart and vascular institute that is treating patients in Modesto as much as possible.”

This story was originally published April 11, 2017 at 2:01 PM with the headline "Too sick for surgery? Memorial introduces an easier way to replace a heart valve."