Minimally Invasive Heart Valve Procedure Offers New Hope
Ruth Hoberman, 82, is on the move again, travelling between her Manhattan apartment and her Connecticut home just weeks after doctors at Danbury Hospital used a minimally invasive technique to replace the aortic valve in her heart. "I will never be perfect," she said. "But I have a full life again."
Joseph Muscatello, 85, feels so much better less than a month after getting a new aortic valve with the same treatment that he keeps forgetting doctors told him to take it easy. "I never thought I would recover so quickly," said the Brookfield, Connecticut resident.
The two octogenarians are among the growing number of people turning to Danbury Hospital's multidisciplinary cardiac team for transcatheter aortic valve replacement or TAVR - a minimally invasive surgical procedure that spares patients from some of the trauma of traditional open-heart surgery.
"This procedure offers elderly patients who previously had few options the opportunity to feel better and potentially live longer," said Hal Wasserman, M.D., Director of Interventional Cardiology at Danbury Hospital. "We've gone from a four-hour procedure and a four or five - day hospitalization with standard open-heart surgery to a 90 - minute TAVR procedure and a three - day hospitalization with a much quicker recovery."
"The availability of TAVR builds upon the advanced care that Danbury Hospital already provides to area patients," said Mark Warshofsky, M.D., Chief of Cardiology and Director of the Cardiac Catheterization Laboratory. "We provide the best of both worlds by offering innovative technology and excellent medical care close to home with the community hospital feeling that patients and families appreciate."
The U.S. Food and Drug Administration has approved TAVR for patients with symptomatic severe aortic stenosis deemed too risky to undergo standard aortic valve replacement because of their advanced age and multiple medical conditions.
"The aortic stenosis that we are treating is a disease of the elderly. As we age, some people's aortic valve get calcium deposits which causes the leaflets to become rigid and stick together so the valve doesn't open properly," said Dr. Wasserman, who treated Mr. Muscatello. "It's like any other clogged pipe. The heart has to work harder to push the blood through the blocked valve."
Symptoms include shortness of breath, fainting, and chest discomfort. A physician may detect a heart murmur during a physical examination that warrants further testing such as an echocardiogram. "There is no medication to treat aortic stenosis. It's a mechanical problem that requires a mechanical solution," said Marc Krichavsky, M.D., an interventional cardiologist with Cardiac Specialists who treated Mrs. Hoberman.
Standard aortic valve replacement involve surgically opening the chest and placing patients on the heart-lung machine, explained Cary Passik, M.D., Chief of Cardiothoracic Surgery at Danbury Hospital, who treated both Mrs. Hoberman and Mr. Muscatello.
"With TAVR, there is much less surgical trauma because we're able to access the aortic valve through a cut in the groin or alternatively a very small opening in the upper chest. There is no need for the heart-lung machine," said Dr. Passik. "One of the greatest benefits to patients is the faster recovery time. They are back on their feet much sooner than if they had undergone open-heart surgery."
Patients who come to Danbury Hospital can easily access all the cardiac specialists they need at one convenient location. "They come to one place for a comprehensive evaluation by a team of interventional cardiologists and cardiac surgeons who work together to determine which approach is best for each patient. Having everything under one roof is particularly important for elderly patients who can't make multiple trips to the doctor because they have difficulty getting out of the house," said Dr. Krichavsky.
As the valve program coordinator, Eileen Hurley, APRN, serves as a liaison between patients and the clinical team, making sure the process goes as smoothly as possible.
"I really get to know the patients, their spouses and families," said Hurley. "We're in constant communication before, during and after surgery." Hurley helps patients complete the prerequisite tests and keeps them abreast of developments. "It's not unusual for patients who are in their eighties to be accompanied by spouses who are also seriously ill or by children who are in their sixties. These patients need a big support system, not just from their families, but also from the hospital."
Maintaining an active lifestyle was important to both Mrs. Hoberman and Mr. Muscatello when it came time to make a decision about undergoing TAVR.
Mrs. Hoberman wanted to stay active with her husband as they split their time between Manhattan and Connecticut. Her heart problems began manifesting years ago with complaints about heartburn and feeling as though she "had an elephant on my chest." She had already undergone two cardiac operations. Now she had two faulty valves in her heart - the aortic valve and the mitral valve - that needed repair.
"She was facing a difficult third operation," said Dr. Passik. Mrs. Hoberman was a perfect candidate for TAVR. "We used a small incision under the breast and replaced the aortic and repaired the mitral valve problem at once without using the heart-lung machine," he said. "She came through the surgery beautifully."
Although she "could have easily chosen a hospital in New York," Mrs. Hoberman selected Danbury Hospital on the guidance of her longtime cardiologist, Lawrence Fisher, M.D., of Cardiac Specialists. "He's a compassionate doctor who kept me going until I was ready to have the operation," she said. "I give him a lot of credit." The hospital stay went smoothly, too. "The care I received from the doctors and nurses at Danbury Hospital was excellent. They were all wonderful."
"What is incredible about this technology is that it can help people significantly improve their quality of life. It's not just about living longer, but living better," said Dr. Krichavsky. "Mrs. Hoberman is a vigorous and extremely active woman who had seen her ability to get around New York City decline. Since this operation, she is feeling much better and has gotten back to doing all the things she loves."
Mr. Muscatello, who has congestive heart failure and other ailments, quickly dismissed the thought of traveling to New York for TAVR once he met the Danbury Hospital team.
"Having someone poke around your heart is a very scary thing. But the doctors and nurses were so good to me. They were so upfront with me about the pros and the cons of the procedure that they got my complete trust," he said.
The entire experience - from his three-day hospital stay to his rapid recovery at home - has exceeded his expectation. "Everyone at the hospital was always looking to help me. They have a wonderful crew out there," he said. "They did a great job with me."
For more information regarding TAVR, the minimally invasive technique to replace the aortic valve, call 1-800-516-4743, or visit the section of Cardiology at DanburyHospital.org.
About Western Connecticut Health Network
Western Connecticut Health Network is the region's premier, patient-centered health care organization serving residents of Western Connecticut and adjacent New York. With this recent affiliation, the organization is now anchored by three nationally recognized hospitals, Danbury Hospital, New Milford Hospital and Norwalk Hospital, as well as their affiliated organizations. In addition to the three hospitals, the continuum of care offered includes numerous medical practices and sub-specialties across the region, home health care services, a nationally renowned biomedical research institute, the Western Connecticut Health Network Foundation, the Norwalk Hospital Foundation and other affiliates. For more information, visit TheNewWCHN.org. Share your comments with us at Facebook.com/DanburyHospital; Facebook.com/NewMilfordHospital and/or Facebook.com/NorwalkHospital.