Steven Filby, M.D.
|Peter I. Ellman, M.D.|
PINEHURST – When Dennis Morgan awoke with a heart attack the morning of Dec. 30, 2016, he had no way of knowing that he was about to enter FirstHealth of the Carolinas medical history.
Although FirstHealth interventional cardiologist Steven Filby, M.D., was able to place stents that re-opened two blockages in the same artery of the Tramway resident’s heart, Morgan’s unusual cardiology experience didn’t end that day. A few days later, Dr. Filby told him that testing had revealed severe aortic stenosis, which made him a candidate for another procedure.
The morning of Thursday, Feb. 16, 2017, Morgan became FirstHealth’s 100th successful transcatheter aortic valve replacement (TAVR) patient. He went home the next day.
“I came home Friday afternoon and felt fine,” says Morgan. “I had almost zero pain, but was told no lifting, no driving. After two weeks, they lifted all that and told me I could go back to doing whatever I wanted to do.”
At 66, Dennis Morgan represents a new generation of TAVR patients. When a multidisciplinary team of specialists from interventional cardiology, cardiac surgery, radiology and anesthesiology started the TAVR program in FirstHealth’s Reid Heart Center four years ago, patients were typically in their 80s – some in their 90s – and had chronic medical conditions that made them high-risk or totally inappropriate for traditional open-heart valve replacement.
Nowadays, many TAVR patients are younger and patient eligibility has been reduced from high-risk or inoperable to intermediate-risk. Studies are ongoing to determine if the procedure would also be appropriate for low-risk patients.
Despite his location on the low end of the age spectrum, Morgan was considered an “intermediate-risk” candidate because of his diagnosis of chronic obstructive pulmonary disease (COPD), his recent heart attack and his use of the blood-thinning medication clopidogrel.
“With the evolution of the procedure, the TAVR technique has become more advanced,” Dr. Filby says. “As the equipment has become smaller, the procedure has become less invasive. The incisions are smaller, and we’re using less anesthesia. Recovery is faster, and the risk of complications is lower. There’s been a definite frame shift and a lot of excitement in terms of what we have seen so far.”
Dr. Filby describes Morgan’s recovery, especially his overnight hospital stay, as “pretty impressive.” The usual length of stay for a TAVR procedure at FirstHealth is three days; the national average is five days.
“We’re observing a trend toward select patients having early discharge,” Dr. Filby says. “When a patient does very well and has no issues, then we feel comfortable.”
Approved in 2011 by the U.S. Food and Drug Administration, TAVR is a lifesaver for patients with severe aortic stenosis, a valve condition that affects about 3 percent of the American population over age 65. Caused by a thickening of tissue in the aortic valve that restricts arterial blood flow from the heart to the rest of the body, the condition can cause chest pain, shortness of breath, dizziness, fatigue, even death.
During a TAVR procedure, the faulty aortic valve is replaced by a tiny balloon-expandable device that is inserted by catheter through a small surgical incision in the groin area of the leg or through a small incision in the chest wall at the tip of the heart. Since moderate sedation without a breathing tube is required, patients are usually easily roused and up and walking within a few hours.
Unlike anything else in the specialty of cardiovascular medicine, TAVR requires the collaboration of a large team that at Reid Heart Center also includes the imaging support of radiologist Michael Edwards, M.D.; and anesthesiology provided by specialists from Pinehurst Anesthesia Associates. Cardiac surgeons Peter I. Ellman, M.D., and Art Edgerton, M.D., not only help determine the eligibility of TAVR patients but also take the lead on certain procedures.
Dr. Ellman calls TAVR one of the most important innovations in cardiovascular treatment of the past 10 or 20 years. From the 20 TAVRs of the FirstHealth program’s first year, the Reid Heart Center team has since more than doubled that number to the 44 procedures of 2016.
“TAVR offers patients an alternative to fix their valve that is much less invasive and can give them a longer and better quality of life,” Dr. Ellman says.
Morgan has unquestionably found that to be so, and he is grateful for the FirstHealth experience that made his much-improved life possible.
“I would like to thank Dr. Filby and Dr. Ellman and their team and all the hospital staff, which was unreal,” he says. “From nurses to food service, they almost made having a heart attack enjoyable … almost.”