Minimizing the risk of repairing a broken heart

Aortic valve disease threatened to undo all the effort Beverly Gorham put into getting healthy. The 79-year-old Genoa, Ill. resident has been working hard to keep off the 100 pounds she lost in her early 70s.

However, slowly over time she noticed she couldn't complete her goal of 10,000 steps. Then she couldn't even make it down the block without getting winded, lightheaded and extremely tired.

Gorham's aortic valve had thickened, resulting in a narrowing of the opening and restricted blood flow from the heart. Her heart had to work much harder and her body was getting less oxygen. Due to Gorham's age, traditional open heart surgery to replace the faulty valve could be risky.

She elected to undergo a Transcatheter Aortic Valve Replacement (TAVR) procedure at Northwestern Medicine Central DuPage Hospital in Winfield, Ill.

"With TAVR the aortic valve is replaced using a catheter-based technique, avoiding a major open heart surgery," said Imran Ahmad, MD, medical director of interventional cardiology at Northwestern Medicine Central DuPage Hospital.

Ahmad performed the procedure with Gyu Gang, M.D., surgical director of the Northwestern Medicine Bluhm Cardiovascular Institute at Central DuPage and Delnor hospitals.

In a Cardiac Cath Lab, interventional cardiologists and cardiac surgeons thread the new TAVR valve to the heart via a catheter, or tube, inserted in the patient's groin.

The new valve is securely placed within the diseased valve. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the replacement valve takes over the job of regulating blood flow.

"It is wonderful and marvelous to no longer feel the tightness in my chest or get winded when just walking," Gorham said. "I've got lots of life to live and I feel blessed to have not needed the open heart surgery."

Transcatheter techniques like those used in TAVR are performed while the patient's heart is still beating, eliminating the need for a "bypass" machine and its associated risks during open heart surgery.

Northwestern Medicine Central DuPage Hospital now offers the two valve systems currently available in the United States - Medtronic CoreValve and the Edwards SAPIEN Valve.

"For each individual patient, one may offer a slight benefit over the other," said Dr. Ahmad. "We review tests and analyze the patient's anatomy to determine if one of the two valves may have an advantage."

Due to the number of tests performed and specialty consultations, the work-up for patients with aortic stenosis typically can take a long time. The Valve Clinic at Northwestern Medicine Central DuPage Hospital consolidates the resources needed to help facilitate a more timely evaluation. Patients can complete testing and evaluations in the least number of visits under the guidance of a valve coordinator who shepherds patients through the whole process.

The TAVR team at Northwestern Medicine Central DuPage Hospital is composed of an interventional cardiologist, cardiac surgeon, a cardiac imaging specialist, valve clinic coordinator, structural heart nurse and a structural heart nurse practitioner. The team meets on a weekly basis to review patient cases to decide the best plan for that patient and to provide updates on other TAVR patients.

"We are working together as one team and not in separate silos. We are integrated and we are truly using a collaborative team approach," Dr. Gang said. "We don't consider these 'their' patients or 'my' patients, these are 'our' patients that we try to find the best solution for together."

Following the expansion of the Bluhm Cardiovascular Institute to the western suburbs in late 2016, specialists have completed more than 70 TAVR procedures at Northwestern Medicine Central DuPage Hospital.

"The turnaround in the quality of life is outstanding," said Dr. Ahmad. "People that weren't able to get out of their homes are now enjoying everyday activities."

Now, Gorham is planning a trip with her husband to make up for a 60th anniversary vacation that had to be canceled last year due to her aortic valve disease.

"Now my husband has trouble keeping up with me," jokes Gorham.

TAVR is available for patients at high and intermediate risk for surgery. Northwestern Memorial Hospital is participating in studies to determine how the valves perform for patients at low-risk for surgery.

Bluhm Cardiovascular Institute at Northwestern Memorial Hospital is one of the top 10 national programs for cardiology and heart surgery, according to U.S. News & World Report, and consistently ranked the top cardiovascular program in Illinois and the surrounding states.

To learn more about the Northwestern Medicine Bluhm Cardiovascular Institute at Central DuPage Hospital, visit heart.nm.org or call (630) 232-0280.