New Minimally Invasive Aortic Valve Replacement Procedure Gives 80-year-old Grandmother More Quality Time with Her Family

Published Date: 
Tuesday, October 23, 2012 - 10:48am
Wynema Schwarz of Tucson may have had numerous health challenges thrown at her this past summer, but undoubtedly this 80-year-old wife, mother, grandmother and gardener has a strong will to live. That’s why she and her family are grateful for a new procedure at The University of Arizona Medical Center (UAMC) – University Campus that has given her the strength and energy she needs to heal from a broken hip and overcome congestive heart failure.
The recently formed Transcatheter Aortic Valve Replacement (TAVR) Team at UAMC conducted two procedures on Mrs. Schwarz to repair a calcified aortic valve that was causing her heart to fail. In such cases, the aging process causes calcium and scar tissue build up that leads to blockage of the aortic valve.
New to southern Arizona, the TAVR procedure is a minimally invasive catheter-based treatment option for patients who are considered too ill to survive open-heart surgery to replace severely blocked aortic valves.
UAMC’s TAVR team is led by Kapil Lotun, MD, associate professor of medicine in the UA College of Medicine, Department of Medicine, Section of Cardiology and associate director of the Cardiac Catheterization Laboratories at UAMC, who serves as medical director, and Robert Poston, MD, professor and chief of the Division of Cardiothoracic Surgery in the UA College of Medicine, Department of Surgery, who serves as surgical director.
The procedure takes place in UAMC’s hybrid catheterization lab that is equipped to perform less invasive procedures such as this, but is capable of converting to an open-heart procedure in case of an emergency. Dr. Lotun is supported by Sreekumar Subramanian, MD, assistant professor of surgery in the Division of Cardiothoracic Surgery and the TAVR team, comprised of cardiologists, cardiothoracic surgeons, vascular surgeons, anesthesiologists and supporting staff.
 “TAVR offers a good alternative for patients who are too frail and considered high risk for open-heart surgery. The hybrid lab provides the necessary environment to switch the procedure from catheterization to open-heart surgery in the event the valve placement doesn’t work with the catheter,” explained Dr. Subramanian.
In Mrs. Schwarz’s case, she fell while watering her garden and was transported to St. Joseph’s Hospital. Physicians admitted her for a broken hip, but discovered the next morning that she had had a heart attack within the last 24 hours and was also in congestive heart failure. Her cardiologist did a diagnostic cardiac catheterization and found that her coronary arteries were normal, but she had a severe blockage of the aortic valve. She was admitted to the ICU to try to improve her condition before undergoing hip surgery. Three days later she underwent the hip repair even though she was still in heart failure. Her family was given little hope of her surviving through the surgery, but Mrs. Schwarz believed that God would see her through it, said Heidi Figueroa, her daughter. Surgeons did a successful hip “nailing,” but she went into worse heart failure and the next day slipped into a coma-like state, Figueroa said.
 “Our cardiologist started to prepare our family to say our goodbyes,” said Heidi. “But several hours later he approached the family and told us that UAMC was doing a new procedure that we might want to consider. I tried to explain it to my mother in her ear and expected no response when I asked her if she wanted to do it. She shouted with all the strength she had left, ‘Yes!’”
 “The doctors weren’t sure that she would survive the ambulance ride between St. Joseph’s and UAMC, but we knew she had a strong will to live, and an even stronger faith in God,” said Heidi.
The cardiologist first referred Mrs. Schwarz to Dr. Lotun for a balloon valvuloplasty, a procedure that stretched open with a balloon the narrowed heart valve that was calcified. She also had a pacemaker implanted.
Afterward, Dr. Lotun said Mrs. Schwarz was an excellent candidate for a TAVR procedure in which the team inserts a catheter through the artery near the groin area. It contains a pliable valve that is opened and implanted into the damaged valve.
Following the balloon angioplasty and pacemaker procedures, Mrs. Schwarz was discharged from UAMC. However, she was rushed again to St. Joseph’s Hospital for emergency surgery to drain fluid from around the heart. She was on a ventilator for five days and required her lungs to be flushed because she contracted pneumonia. 
Dr. Lotun and the family then went on to battle the insurance plan that wanted to send Mrs. Schwarz to Phoenix or California for the procedure. “Dr. Lotun even called the insurance plan while he was on vacation,” said Heidi. “My mother was on death’s door and he literally saved her life twice!”
If the TAVR procedure works, why do surgeons continue to replace valves with open heart surgery? “While the TAVR results are very good and appear to be comparable to open-heart surgery for these very high-risk patients, more data need to be gathered before TAVR can be recommended as the standard of care,” said Dr. Lotun. “The valves used will not last for decades and presently are only indicated for elderly patients at very high risk of not surviving open-heart surgery.”
At her follow-up appointment 11 days after the procedure, Mrs. Schwarz said, “I feel great. There’s no soreness in my chest. Sometimes I wonder if he even did the procedure! I just feel some discomfort by the incisions.”
Mrs. Schwarz, who is recovering at her daughter’s home, expects to resume her normal lifestyle which includes gardening, shopping and driving. She lives independently with her husband. “Age shouldn’t keep you from living a better life with your family and grandchildren,” said Mrs. Schwarz. 

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