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Monday, June 20, 2016

Not Your Ordinary Valve Job

Posted By: Advancing Care

George Valentino’s serious heart problem got fixed with an advanced medical procedure.

By Mary McIver Puthawala, RN, BSN


The only thing George Valentino really wanted to do was to continue his life by working and riding his motorcycle. By age 57, however, he had already exhausted several of his nine lives. The first was at age 31, when he was diagnosed with non-Hodgkin lymphoma, a type of cancer. After rounds of chemo, radiation and two stem-cell transplants, he was given a clean bill of health and was able to reclaim his former life for another decade.

Sickness started to dog him again five years ago, though, when doctors detected fluid in his pericardium, the sac that surrounds the heart. After the fluid was drained, he was referred to a cardiologist, who would monitor his condition. Then, in July of 2015, just prior to his 57th birthday, George got an unwanted gift, in the form of a dangerous blood infection called streptococcus. It was treated successfully but recurred in October. Although grateful to survive, Valentino soon learned that the treatments from radiation left him with a damaged aortic valve, a condition called aortic stenosis (AS).

In a sense, Valentino’s diagnosis was a stroke of good luck, since AS is frequently underdiagnosed, says Gilbert Tang, MD, MS, MBA, who is Director of the Valve Disease Center and a cardiothoracic surgeon at Westchester Medical Center (WMC), the flagship of the Westchester Medical Center Health Network (WMCHealth). The symptoms of AS are subtle: shortness of breath, loss of appetite, weight loss, fatigue, dizziness with exertion, and chest pain. Often, these signs are confused with other illnesses, like arthritis, or are simply attributed to advanced age. But a missed diagnosis carries dire consequences: 50 percent of patients with AS die within two years of the diagnosis if left untreated. Yet, the condition can be so easily detected by a doctor, just by putting a stethoscope on the chest. If a heart murmur is heard, the patient should be checked to make sure they don’t have AS.

“Aortic stenosis can easily be missed,” says Dr. Tang, explaining that it’s tempting to think that as one ages, being out of breath, having a lack of appetite and daily fatigue are a part of a normal aging process. He offers this advice for anyone with these symptoms: “He or she should rule out a heart murmur [a telltale symptom of AS]with their doctor. AS is very treatable.”

Valentino knew how AS used to be treated, with open-heart surgery, in which the diseased heart valve is replaced by one from an animal (usually a cow or pig), something that his own father had endured. “It was the scariest thing,” he said. Luckily, heart-valve replacement technology has come far since then, especially at Westchester Medical Center.

What Is TAVR?

TAVR, or transcatheter aortic valve replacement, is much less traumatic for patients than the open-heart surgery Valentino’s father endured. Once a patient is sedated, a catheter is threaded up to the heart from an artery in the groin. From inside the artery, the new artificial valve is then positioned inside the damaged aortic valve and expanded, pushing aside the damaged valve. Interestingly, it’s the calcium deposits in the old valve that hold the new one in place.

Gilbert Tang, MD, MS, MBA, Director of the Valve Disease Center, in Westchester Medical Center’s Hybrid Operating Room.

Gilbert Tang, MD, MS, MBA, Director of the Valve Disease Center, in Westchester Medical Center’s Hybrid Operating Room.

At WMC, Dr. Tang and his team plan each step of the procedure in consultation with the patient, the patient’s family and the other healthcare professionals involved, consisting of interventional cardiologists, a cardiac anesthesiologist, an echocardiologist, a radiologist, and nurses and technicians. Every patient is different and unique, and Dr. Tang believes this individualized approach is crucial to their exceptional results. “The key is to be able to administer the best therapy in the best possible way,” says Dr. Tang. “Safety is still number one in that decision.”

One reason for the exceptionally high success rate at WMC is because patients are sedated during the procedure and given local anesthesia, a form of sedation technically called conscious sedation, as opposed to general anesthesia, with which the patient is completely unconscious, with a breathing tube in the mouth during the procedure. The advantages to this approach are numerous. First, local anesthesia greatly reduces the risk for complications over general anesthesia. Second, it is much easier and quicker for patients to recover from, especially for those with other health issues. In fact, WMC is unique in that it offers local anesthesia routinely, provided it’s what the patient prefers and that he/she meets the medical criteria.

Dr. Tang and his team are using this already groundbreaking procedure to break even more new ground. They have gained essential expertise in using TAVR to replace all four of the heart’s valves in WMC’s $8 million state-of-the-art Hybrid OR — a 1,000-square-foot operating suite completed in 2013 that combines the sterile environment of a traditional operating room with the advanced imaging capabilities of a modern cardiac catheterization lab.

The industry-leading care at WMC continues, however, well after the patient is sent home, with Dr. Tang and his team going the extra mile as a standard part of their treatment protocol. The patient and his/her family are given access to a mobile hotline that is staffed 24/7 by Dr. Tang and his associate, Joanne Bennett, FNP-BC, Valve Program Coordinator.

“Thank God they had this procedure for me and for Dr. Tang and his team!” says Valentino, who had TAVR done in February. Having always led an active life with his Harleys and Corvettes, he’s once again ready to live to the fullest, especially with that fatigue gone. “I feel fine,” he says. “This weekend I’m going to get in the truck and drive 10-12 hours to buy a new Harley.” •

Top Picture: George Valentino is happy to be on the road again, without feeling fatigued.