Replacing a Valve Without Opening the Heart
By Delia O'Hara
George Kilburg had quadruple bypass surgery — a major operation that requires weeks of recovery — more than 20 years ago, and he was not interested in ever going through that ordeal again.
But in early 2019, the 76-year-old electrical contractor started suffering from aortic stenosis, a common but serious cardiac condition for someone his age.
The aorta, the largest artery in the human body, begins at the top of the left ventricle, which is the part of the heart that pumps oxygenated blood out to begin its journey through the body. Between the left ventricle and the aorta is situated a one way valve: the aortic valve. Stenosis is a narrowing of this valve, which can get worse over time, impeding the flow of blood from the heart to the aorta. Symptoms of aortic stenosis may include breathlessness; chest pain, pressure or tightness; fainting; or fatigue following even mild exertion. Progressive stenosis is fatal.
Kilburg, a resident of Park Ridge, Illinois, learned he would likely die if he didn’t seek treatment; but this time, he had a choice. A friend of Kilburg’s had a transcatheter aortic valve replacement (TAVR) procedure at Rush University Medical Center, and Kilburg was impressed with the ease and speed of her recovery. So when his longtime doctor warned him his condition was rapidly becoming life-threatening, Kilburg called the Rush Center for Adult Structural Heart Disease and scheduled a consultation.
A life-changing choice
Given his age and overall health, Kilburg was actually a good candidate to have open-heart surgery. But when Kilburg expressed his desire to have TAVR rather than go through another grueling open procedure, the Rush team listened.
TAVR is FDA-approved to treat aortic stenosis in older patients, usually those over the age of 80, and for patients with health conditions that make open-heart surgery risky. Even though Kilburg's previous cardiac surgery opened the door to him having TAVR under the current protocols, his treatment was a good example of the kind of shared decision-making that is becoming increasingly common in medicine.
"That means we include the patient's perspective in deciding how to proceed,” says interventional cardiologist Neeraj Jolly, MD, who performed Kilburg’s TAVR. "Our job as physicians is to guide the patient in the right direction, but we have to take into account their concerns and desires as well — assuming, of course, that they are a good candidate for the procedure, as Mr. Kilburg was."
Valve repair made simpler
Kilburg had his TAVR in February 2019. Jolly — one of three physicians at Rush who offer TAVR — inserted a catheter carrying a new synthetic valve into the femoral artery in Kilburg's groin, and ran the catheter up through his torso. At the spot where the aorta meets the heart, the new valve was placed and made to expand out, displacing Kilburg's diseased valve and taking over the work of regulating blood flow to the aorta. A cardiac surgeon was part of the team during the procedure, Jolly says.
Kilburg stayed overnight at Rush but was able to go home the next day. He returned to normal activities within a week, including work, though these days he handles office duties rather than going out in the field to do electrical work himself. Jolly prescribed several cardiac rehabilitation sessions at Rush Oak Park Hospital after discharge, which Kilburg completed with flying colors. He has also returned to brisk walking, and playing tennis and golf.
"Rush surpassed any expectations I had," Kilburg says. "I can't say enough good things about the staff and the facility." Kilburg called the nurses "fantastic," and in particular praised Jolly. "On a scale of one to 10, I'd give Rush a 12."
Expanding the use of TAVR
That level of enthusiasm is not surprising given that Rush’s TAVR team has a wealth of experience with the procedure, having performed about 150 in 2018; Jolly, himself, did roughly 30 that year. "We are very good at this. We get excellent results,” says Jolly, who earlier in his career worked in Rouen, France, with Alain Cribier MD, the interventional cardiologist who performed the first TAVR in 2002.
Jolly and his Rush colleagues are also leaders in TAVR research, including participating in clinical trials of the valves used for TAVR.
Results from the PARTNER3 and EVOLUT trials, conducted at Rush and other centers nationwide and published in The New England Journal of Medicine, showed that TAVR can be safe for low-risk patients. Based on these findings, the federal Centers for Medicare and Medicaid Services (CMS) have begun to lay the groundwork to expand the use of TAVR in U.S. hospitals. The fact that Rush already has a seasoned program in place means it will be able to quickly ramp up in the event of FDA approval for lower-risk patients.
"TAVR is less traumatic for patients; the body likes it more," Jolly says. “While TAVR is newer, it can be as good as or even better than open heart surgery."
Kilburg could not agree more. "It’s unbelievable. I feel better, and I’m breathing better," he says. “For me, it was definitely a game-changer."