Facing the prospects of major surgery, Shirley Stevens trusted her heart — and The Iowa Clinic team who prepared her for another valve replacement.
by The Iowa Clinic on Thursday, January 31, 2019
Dr. A. Nasser Khan has a special place in Shirley Stevens' heart — and not just because he placed a new aortic valve in there last April. His care, guidance and expertise helped Stevens through her second heart surgery in three years.
"I will really miss seeing Dr. Khan's smile. I can't explain how he will always have a place in my heart," she says. "Because he is just a magnificent person. He is just kind, loving, considerate, open and honest — and his staff is exactly the same way."
That level of care, from the top down, made the decision-making and the road to heart surgery a whole lot easier for Stevens. A medical advancement since her initial heart valve replacement helped, too.
An Alternative to Open Heart Surgery
The prospect of another open heart surgery made Stevens nervous. At 81, she wasn't sure if another heart surgery was necessary — or even an option for a woman of her age. She was in intensive care for a week and in recovery for months after a heart valve replacement in 2015. The scars — mental and physical — still hadn't healed.
But the symptoms that plagued her the first time around were back. She was tired, out of breath. At an annual physical, her doctor suggested she get that new valve checked out.
"My doctor mentioned they had a new procedure out — the TAVR procedure — which was much less invasive," she recalls. "I said to her, ‘I'm old! Is this going to be okay for me?' She recommended I visit Dr. Khan. So I began my adventure for my TAVR."
Transcatheter aortic valve replacement, or TAVR, is a minimally invasive surgery that replaces a heart valve by inserting a catheter through the groin. Once the new valve expands, it pushes the old one out of the way and takes over regulating blood flow.
"The traditional way to fix a heart valve was to do an open heart surgery where you cut the chest open and they have to stay in the hospital for a few days. The recovery goes up to weeks," says Dr. Khan. "With this newer technology, it's a catheter-based procedure. So all we have is a small puncture in the groin. We get the catheter all the way up to the heart and the valve opens up like an umbrella. Patients are able to get up and walk within a few hours and go home the next day."
The TAVR Adventure
Follow-up tests showed the small bovine valve placed in Stevens' aorta during the initial open heart surgery had curled up and would soon be ineffective.
"The way my heart was with the old valve in it, I would've been okay without having a procedure for probably three to six months. So it wouldn't have lasted very long," Stevens says. "Dr. Khan suggested I go through several tests and visit with some other doctors, and they would decide if I was a candidate or not."
"What we do is called a heart team approach. The decision-making process comes from the heart team, which includes two surgeons," says Dr. Khan. "We are giving this valve only to people who have intermediate or high risk of open heart surgery. So the surgeons have to see the patient and say there is a high or intermediate risk."
The risk cardiologists and surgeons are worried about isn't the risk a patient will have an open heart surgery. It's the risk they won't survive one.
"Patients with a tight valve eventually die. The risk is pretty high," he says. "We prevent death and we also prevent symptoms that affect lifestyle like shortness of breath and tiredness. Those are all gone."
Stevens took Dr. Khan's advice and underwent a battery of tests, including a CAT scan, echocardiogram, angiogram, pulmonary test, ultrasound and blood work. She also met with multiple surgeons to discuss her results and get information on the risks and benefits of the TAVR procedure.
The verdict: Stevens was a candidate for TAVR.
Decision of the Heart
Even after all the appointments, tests and consultations, Stevens was still wrestling with the decision. The TAVR procedure is still relatively new and unknown, which scared her. But the information and preparation she had received on her journey proved vital.
"I hadn't quite made my mind up yet. But I heard someone saying that we're usually afraid of things we don't know, and if we examine the unknown in our lives, it's almost always fine," she says.
"So that's what I told myself. They gave me all the information I needed to know and the chances of me having problems were very minimal. I just felt that all the people on the team were so filled with care and love for me that I had no concerns at all."
So on April 24, 2018, Stevens had her second heart surgery. The first time around, she was in intensive care for a week. This time, Stevens was out of the hospital in two days.
"My care afterwards was just magnificent. It was such a short period of time and it was so different from the open heart surgery. I have gotten a lot more energy. I can go for a longer walk without a walker," she says.
Dr. Khan can't take all the credit though. The TAVR procedure greatly reduces recovery time, getting patients back to their normal activities faster. Another important factor: Stevens' positive attitude.
"One thing that is huge is her positive attitude. She has a very positive attitude towards life," he says. "If someone has a positive attitude and tries to get better — that really helps them to heal. That's something every patient should have, but it's something unique to her. She's an amazing person."
The feeling is mutual, Stevens says. She appreciates Dr. Khan and the entire team that helped her through her "TAVR adventure."
"I really have had some wonderful people. The Iowa Clinic has really been good to me. I cannot explain the peace that I had going into that surgery. I just know that I am extremely grateful."