Minimally invasive surgeries at Oakwood improve odds, reduce recovery times

It was near Thanksgiving in 2012 that Jean Gottleber was first concerned about her heart.

The 85-year-old Lincoln Park resident said she had just pulled in her receptacles on garbage day when she felt dizzy and short of breath.

“I thought I was going to die,” she said.

A trip to the emergency room at Oakwood Hospital-Dearborn confirmed her concerns: she had early signs of heart failure caused by an ailing valve. Due to her age, however, she was not a good candidate for surgery.

When her symptoms returned—nearly 11 months later—the diagnosis was the same but her options were much better. By then, Oakwood doctors had adopted a new potentially life-saving procedure known as Trans-Catheter Aortic Valve Replacement (TAVR), a minimally invasive operation in which surgeons can replace cardiac valves through a catheter that is inserted either in the groin or through a small incision at the side of the chest.

“It is no longer necessary to open the chest for this,” said Reza Dabir, MD, an Oakwood-affiliated cardiovascular surgeon and one of the co-leaders of the program. “By avoiding that high-risk surgery, patients get back to their regular activity with minimal restrictions after a short recovery time.”

For Gottleber, that meant being released from the hospital after five days, resuming her normal activities a week later and returning to work—she is a greeter at a Detroit-area Kmart—about six weeks after that. She said the recovery was surprisingly quick and relatively free of discomfort.

“They are miracle workers,” she said of the cardiology team. “I didn’t even know it was over. I am almost back to my old self and I feel great.”

The TAVR procedure has been available for about a decade in Europe and was approved in the U.S. about three years ago. Oakwood is among the first in the region to offer it to high-risk patients, according to program co-leaderSamir Dabbous, MD, FACC, Director, Heart and Vascular Services and Cardiac Cath Lab at OH-D. It is available for high-risk patients who are not eligible for traditional open heart surgery—either due to advanced age, previous surgeries or other complications.

“It is a new, better option that we are now able to offer to the community,” said Dabbous. ““It is an orchestration of the cardiology team and the cardiac surgery team working together during surgery. This is a tremendous advancement that will help our patients live longer, fuller lives.”

Dearborn resident Larry Cotton was one of the first recipients of the TAVR procedure at Oakwood. Considered a high-risk patient due to a four-way bypass he underwent six years ago, Cotton said he was informed by Dabbous that he needed valve replacement surgery during a regular follow up visit two years ago. Then 76, his cardiac care team decided open heart surgery—the only option available at the time—was too risky for him. After screening showed he was eligible, he underwent the TAVR procedure in July, was released from the hospital three days later and given approval to resume his regular lifestyle a week later.

“I’m feeling great,” said Cotton. “I’ve got a lot more energy now. Before, when I walked while out deer hunting, I would get a little short of breath. I feel much better now, like I’m getting more oxygen.”

Dabir said the quick recovery time was one of the main benefits of the procedure. It is also less risky than open heart surgery, and less stressful on patients and their families.

“The average open heart patient is in the hospital for one week. They can drive a car in four weeks and return to normal activity in three months,” said Dabir. “A TAVR patient is home in two to four days and can resume life as normal soon after that. The important thing is that there are minimal restrictions when the patient does return home.”

Dabbous said that the TAVR and other minimally invasive surgical techniques are a boon to patients, surgeons and health systems alike because of their potential to reduce risks, speed recovery times and produce better outcomes.

“Never in my wildest dreams did I ever imagine that we would be coming to a point where we could replace an aortic valve without opening the patient’s chest,” said Dabbous. “This is obviously a major achievement. It’s a change in the paradigm of proactive interventional cardiology.”