VA Ann Arbor Healthcare System
New State-of-the-Art TAVR Procedure a Success
The VA Ann Arbor Healthcare System (VAAAHS) discharged its first Transcatheter Aortic Valve Replacement (TAVR) patient only 48 hours after surgery.
Marine Corps Veteran, Paul Lehr, underwent a successful TAVR procedure on Wed, Jan 7, 2015, at the Ann Arbor VA’s Hybrid Open Heart Surgical Suite/Catheterization Laboratory.
“I feel great,” said Lehr. “I have no pain.”
The healthcare system’s Chief of Staff, Dr. Eric Young, said TAVR is a minimally invasive, state-of-the-art surgical procedure that replaces a diseased heart valve without removing the old, damaged valve.
According to Dr. Young, a multi-disciplinary team of cardiologists, cardiac surgeons, operating room nurses, anesthesiologists, imaging experts and a host of other specialists manipulate catheters to insert a replacement valve into the old valve’s place.
VAAAHS is one of only six VA facilities in the nation chosen to perform this procedure. Dr. Young said making TAVR available is about improving the quality of life for patients like Lehr.
“As a system, we are responsible for providing a comprehensive benefits package of healthcare – we should be able to offer anything that’s considered important and available,” said Dr. Young. “We look at TAVR in that way. It’s all part of progress – the continual improvement of the scope of services that we offer.”
TAVR Lead Surgeon Dr. Paul M. Grossman, chief of the catheterization laboratory at the Ann Arbor VA, and associate professor at the University of Michigan Cardiovascular Center, said TAVR is a safe alternative for many Veterans.
Intended for older patients, or those with underlying medical conditions that make it too risky for open-heart surgery, TAVR treats a condition called aortic stenosis which is when the area of the valve is restricted due to an abnormality of the valve and the heart has a difficult time circulating blood throughout the body.
Over a period of time, an individual will typically experience shortness of breath, pain, and arrhythmia, among other symptoms, and a significantly reduced quality of life and even lifespan.
According to Dr. Grossman, that can all change with TAVR. Unlike traditional aortic valve replacement surgery, there is no surgical incision, the chest is not opened, and the patient is not put on heart-lung bypass – the stress of TAVR is minimized and recovery times are dramatically reduced.
“TAVR team has been the pinnacle of my career. The opportunity to work closely with so many talented physicians to bring together a true team of professionals who are dedicated to caring for these patients has been fantastic,” said Dr. Grossman. “Hospital leadership at both the University of Michigan and VA Ann Arbor Healthcare System have been wonderful partners in this journey. We all recognize the responsibility that we have as one of the few institutions in Michigan and only VA Healthcare System in the Midwest to offer this procedure.”
Lehr’s wife, Darlene, said her husband’s condition was getting progressively worse, so they’ve had to postpone their seasonal move to Arizona for the past several years.
She said the only hope they had to travel this year was to utilize a less invasive, low maintenance cardiac intervention with a fast recovery, so when they learned about TAVR they were eager but skeptical.
“He has color in his face for the first time in years,” said Darlene. “His energy and mental clarity has already improved. I can’t believe how great he looks.”
Lehr said the Ann Arbor VA was his obvious choice. He said he went to other hospitals for care in the past, but those doctors missed the lymphoma ravaging his system.
He said VAAAHS not only diagnosed the cancer, but treated it very quickly, so when TAVR became available he jumped at the opportunity to get his treatment at the VA.
“TAVR was the best option for me,” said Lehr. “I like it here, the [Ann Arbor] VA saved my life twice.”
Cardiac Nurse Manager Barbara Clarke, the TAVR project manager who helped design the hybrid lab, said Lehr’s procedure could not have gone any better.
She said coordinating a TAVR can be a difficult undertaking. Pre-procedure testing and planning is more extensive for TAVR than for most other cardiovascular procedures, and coordinating highly skilled teams of physicians, nurses, and other specialists can be a challenge.
Clarke said despite the logistical complexities, the VAAAHS TAVR team is quite experienced. She said they are “manipulating catheters much the same as they’ve always done for many other procedures,” including performing TAVRs across the street at the University of Michigan.
According to Clarke, the expansion of the cath lab was already underway and an upgrade in technology was necessary, so when VA Central Office in D.C. approved the Ann Arbor VA for TAVR everything fell into place. She said it only took two years to plan, initiate, and execute the first TAVR procedure.
“I don’t believe I’ve ever been so excited to get a patient on the table,” said Clarke. “It was so exciting to see that balloon inflate and that valve deploy.”
Just 24 hours after the procedure, Lehr was already talking about the warmer air of the southwest. He was discharged within 48 hours, and his bags were packed the next day.
“I’ll keep my follow up appointment here,” said Lehr. “But I’m ready for Arizona.”