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Thursday, August 20, 2015

Frank Perrone wasn’t eligible for open-heart surgery to replace his failing heart valve. Luckily for him, a cutting-edge alternative procedurewas available at WMC

Posted By: Advancing Care

Frank Perrone, 65, of Mohegan Lake, is a former boxer and race car driver and an active public servant. But his fast-paced lifestyle slowed in February 2015 when he experienced difficulty breathing. He knew something was wrong, and a trip to the ER at a local hospital confirmed it: He was told he had pneumonia. Though he was admitted to the hospital and discharged with a clean bill of health seven days later, he still felt like he couldn’t breathe. Further medical investigation revealed that pneumonia was in fact a misdiagnosis. Instead, his aortic valve was operating at 25 percent capacity, causing fluid to back up into his lungs.

We expect our bodies to slow down as we age. But how can we tell if we, or older loved ones, are not experiencing normal aging, but instead, like Perrone, showing symptoms of a life-threatening illness? Shortness of breath, fatigue, appetite loss, lightheadedness, weight loss or even mild depression warrant a trip to the doctor. These subtle signs could be symptoms of aortic valve stenosis (AS), a condition that can become problematic for seniors.

At issue is the heart’s aortic valve, the last valve through which blood passes out of the left ventricle to circulate the body. It becomes progressively stiffer from calcium deposits, which prevent the valve from opening and closing properly. This interferes with blood flow not only out of the heart, but inside the heart as well. The symptoms can be innocuous, but the consequences can be life threatening.

“I was told I’d need open-heart surgery,” says Perrone. Eventually, his cardiologist referred him to Westchester Medical Center (WMC), where he was told that the severe calcification of his aorta actually indicated open-heart surgery was not an option.

At WMC, Perrone met Gilbert Tang, MD, MSc, MBA, who is the Director of the Valve Disease Center and a cardiothoracic surgeon at WMC and an Associate Professor of Surgery at New York Medical College. Dr. Tang was not surprised by Perrone’s initial misdiagnosis. “Aortic stenosis is a serious medical condition that is under-diagnosed and undertreated, especially among older patients,” he says. “Patients say, ‘I’m just feeling old.’ There are many, many people who have AS, but they just think maybe their arthritis is getting worse, and that’s why they’re tired. Then they get diagnosed with a heart murmur.” Left untreated, 50 percent of people with AS die within two years of their diagnosis.

As in Perrone’s case, the diagnosis is critical—and simple. If a doctor puts a stethoscope to the chest of a patient 65 or older and detects a heart murmur, he or she needs to be examined to make sure that AS is not at play. Once diagnosed, the patient is evaluated for options to replace the aortic valve. Fortunately for Perrone, since open-heart surgery was ruled out, Dr. Tang was able to utilize a new technology known as TAVR, or transcatheter aortic valve replacement.

Dr. Tang, along with a team of specialists including  interventional cardiologists, a cardiac anesthesiologist, an echo cardiologist, a radiologist, and nurses and technicians, use a catheter (usually through an artery in the groin) to thread a tiny replacement valve inside the heart. Dr. Tang literally pushes the old, stiff valve out of the way and replaces it with a new artificial valve.

“We’ve performed many difficult cases, including a few first done at our hospital and one of the first in the country, with excellent results.” – Dr. Tang

Paradoxically, the calcification that had interfered with the valve opening becomes the firm “foundation” that holds the new valve in place inside the heart. If there’s not enough calcification to hold the new valve in place, then TAVR may not be an ideal option, and open-heart surgery is recommended.

“There are now about 400 facilities in the country offering TAVR,” says Dr. Tang. “We’re one of only a handful of programs to offer the latest cutting-edge practices, including TAVR, routinely performed with only local anesthesia. We’ve performed many very difficult cases, including a few first done at our hospital and one of the first in the country, with excellent results.”

Perrone is happy. Not only did he avoid major open-heart surgery, but he also cut short his recovery time. His doctors expected to keep an eye on him for two to three days, but Perrone insisted that he was well enough to go home the following day. After running some tests, they concurred. “The Devil’s afraid of me, and heaven’s full right now,” he jokes. A week after the procedure, he’s feeling better than he has in a long time. “I could step into the ring right now,” says the former boxer. “Dr. Tang saved my life.”