Heart valve replacement as easy as a trip to the dentist

MORRISTOWN – Until last December, Ruth Zitt had a loud heart murmur caused by a faulty valve.

“The doctors said you could hear it from the other side of the room,” quipped the vivacious 86-year-old, who last May traveled to Florida by herself after nine years of not being able to travel.

After a mini-stroke in 1988, Zitt, who lives in Verona, received a few interventions—two stents in 2001, quadruple bypass surgery a year later, and a pacemaker in 2011. But in 2014 no hospital would treat that heart murmur: they said she was too high risk for an invasive procedure at that point in her life.

Enter the Gagnon Cardiovascular Institute at Morristown Medical Center, where Zitt was deemed a suitable candidate for a non-invasive procedure called Transcatheter Aortic Valve Replacement (TAVR), covered by Medicare.

“Astonishing,” she said. “It was a piece of cake.”

On Dec. 17, six days after getting her new CoreValve, a transcatheter aortic valve manufactured by Medtronic, she was up and walking and, soon after, driving and once again self-sufficient.

Drs. John Brown, a cardiac surgeon, and Robert Kipperman, an interventional cardiologist, are two of the main physicians behind The Heart Valve Program at Morristown Medical Center, one of 20 hospitals in the nation to provide all available options to repair and replace damaged valves. Working together, on an average day, they perform four TAVR procedures. Gagnon, which has done more than 500 TAVRs in five years, was one of the first sites on the East Coast to offer the procedure.

There are four different types of valves—SAPIEN, CoreValve, EvoluteR, and Lotus, the doctors explained. A fifth, Direct Flow, is now in clinical trials. All perform the same task but are made by different companies.

“We’re about to open a new clinical trial, making us one of the only hospitals in the region that offer four different types of transcatheter aortic valves,” said Elaine Andrecovich, hospital spokesperson.

A variety of valve-related trials are available, according to Donna Marie Watridge, nurse manager of cardiac research at Morristown Medical Center. A heart team determines which valve is best for each patient.

“Some of the options we offer have already been approved by the U.S. Food and Drug Administration,” she said, “but by participating in our clinical trials, we can offer our patient population some of the latest technology not yet available.”

How TAVR works

“All the roads lead to the heart,” Kipperman explained. “The easiest for us, and for the patient, is to go through the femoral artery.”

The surgeon, he said, inserts the new, 26- to 31-millimeter valve through a catheter into this large artery, which is located in the thigh and is the primary circulatory route in the legs. The new valve pushes aside the old one, which is not removed, and opens to allow proper blood flow.

Until TAVR, which takes one to two hours, the only option for patients with aortic stenosis—narrowing of the aortic valve—was a six- to eight-hour open heart surgical aortic valve replacement in which the surgeon opens the chest, stops the beating heart, removes the faulty valve, and sews in a new one, according to Medical Device and Diagnostic Industry News. But one-third of the 300,000 people who suffer with the condition worldwide are too high risk to even qualify for the surgery, which has a grueling aftermath.

Recovery from surgery can take months, according to WebMD. Normal activities are very limited for patients and, more often than not, they take weeks off work.

There are risks to TAVR, however, and stroke is one of them, according to Brown.

“It still is a procedure, so you can imagine that the calcium that is on the native valve can be pushed aside, be liberated, and go to the head,” he explained, adding that the calcium debris that is pushed aside also can create a risk for leakage around the new valve.

“TAVR is not without risk,” he said, “but the risks are much lower than with open heart surgery.”

Patients who didn’t need rehab before the procedure, Kipperman added, probably won’t need it afterwards, either. Even those in their late 80s and 90s are usually in and out of the hospital within a week.

Eleanor Breslow, 91, of West Orange, had a TAVR procedure last September and, like Zitt, was driving within two weeks. She had been suffering from critical aortic stenosis. Both women said they now consider going to the dentist a more stressful ordeal than getting a new heart valve.

Patients need to get a checkup 10 months after TAVR, Kipperman said. They also should see a cardiologist regularly.

Learn more

•The Heart Valve Program, Gagnon Cardiovascular Institute at Morristown Medical Center, 973-971-7001, www.atlantichealth.org/landing-pages/cardiac-heart-valve-program

•Atlantic Center for Research, a directory of all clinical trials at Morristown Medical Center, atlantichealth.org/research . For valve trials, search “heart.”