Surgeons perform aortic valve replacement through catheter on 94-year patient

Vivian Valentine, a 94-year-old Santa Monica resident, has much to be thankful for this Thanksgiving. A new lifesaving heart-valve procedure, performed without traditional open heart surgery at UCLA, has given her a new lease on life. 
 
Her holiday wish: to live to be 100 and to continue to sing in her church choir. Her doctors say she may just do that, given the success of the procedure, which is known as transcatheter aortic valve replacement, or TAVR.
 
Like many older patients, Valentine was too frail to undergo conventional surgery to replace her main heart valve, which was so clogged with calcium deposits that it couldn't open wide enough to adequately pump blood through her body. As a result of this condition, called aortic stenosis, she was chronically tired, couldn't perform everyday tasks, suffered from heart palpitations and swelling in her legs, and was at a much higher risk of heart failure and death.
 
Luckily, doctors at UCLA were able to help her using the new, minimally invasive TAVR procedure, which was approved last year by the U.S. Food and Drug Administration. Although other minimally invasive surgical procedures have been used on the aortic valve in the past, they relied on incisions in the chest wall and required cardiopulmonary bypass.
 
With the new procedure, far fewer surgical risks are involved. TAVR allows doctors for the first time to replace the aortic valve without a chest incision, and it only rarely utilizes a bypass machine, helping to prolong the lives of patients who aren't candidates for traditional surgery. The new valve is deployed using a catheter - a long tube that travels through an artery in the groin up to the heart. Once in place, the valve is opened and starts working immediately.
 
Procedures like TAVR offer new options for patients who are inoperable or excessively high-risk candidates for conventional open aortic-valve replacement surgery. Previously, these patients, who are often in their 80s and even 90s, had no choice but to accept a diminished quality of life or a shortened life.
 
"This new procedure can give older patients a new lease on life and a chance to live better, longer," said Dr. Jonathan Tobis, a clinical professor of cardiology at the David Geffen School of Medicine at UCLA and director of interventional cardiology for the UCLA Health System.
 
Tobis noted that older patients with aortic stenosis who couldn't undergo traditional heart surgery previously had only a 50 percent chance of living two years after their symptoms were diagnosed.
 
Valentine is UCLA's oldest TAVR patient to date.
 
"These new, minimally invasive surgical techniques can really help extend and improve the quality of life for older patients who previously had few options," said Dr. Richard J. Shemin, chief of cardiothoracic surgery for the Geffen School of Medicine and the UCLA Health System. "It is our goal to provide the best valve replacement device and the least invasive technology, which allows our patients to resume a more normal life."
 
As for Valentine, she left the hospital just three days after her Nov. 14 TAVR procedure at Ronald Reagan UCLA Medical Center. Her doctors say her prognosis is good and that she can soon resume her regular activities.
 
Her son, Lynn Lawrence, who owns a beauty salon in Altadena, was concerned at the prospect of his mother having a heart procedure at such an advanced age. "However," he said, "I was just amazed at how well she's doing - even the first day after the procedure."
 
Valentine, who said her damaged heart used to pound so loudly it sounded like Louis Armstrong playing trumpet in her chest, now says walking and breathing are much easier. And since the procedure, she noted, her heart is much quieter. Dr. Shemin said that is due to her heart murmur stabilizing with better blood flow through the valve.
 
Valentine is eager to get back to singing soprano in both the Santa Monica Emeritus College Gospel Choir and the Redeemer Baptist Church choir. She's been performing since 1957 and says it really keeps her going. She even sang a medley of her favorite songs - "Love Lifted Me," "Amazing Grace" and "God Has Smiled on Me" - to her doctors from her hospital bed.
 
A Santa Monica resident since 1944, the family matriarch is also looking forward to enjoying the upcoming holidays with her seven grandchildren, seven great-grandchildren and three great-great-grandchildren.
 
TAVR is the latest in a trend of major surgical procedures now being performed without invasive surgery at UCLA.

With this unique technology, cardiologists and heart surgeons work closely together in performing the procedure. Valentine's team included heart surgeons Dr. Shemin and Dr. Murray Kwon and cardiologists Dr. Tobis, Dr. William Suh and Dr. Gabe Vorobiof. Valentine's longtime cardiologist is Dr. Lawrence Lazar.
 
The cardiac team also relies on key anesthesiologists, nurses and technologists who help address the needs of each individual patient.