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LIJ Cardiac Team Performs Aortic Valve Replacement Without Open-Heart Surgery

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Ann Pszybylski, 84, is the first patient on Long Island to receive the only FDA-approved nonsurgical heart valve replacement device. Members of LIJ’s cardiac team wished her well as she prepared to leave the hospital. Ms. Pszybylski is shown, from left, with Jacob Scheinerman, MD; Dorothy Veron, RN, nurse manager of the catheterization lab; Rajiv Jauhar, MD; Annmarie Copertino, RN, nurse manager; and Robert Rodriguez, RN.

Cardiologists and cardiothoracic surgeons at LIJ Medical Center are the first in Queens and Long Island to perform a new nonsurgical heart valve replacement procedure to treat patients with failing heart valves. The device allows patients to be treated without traditional open-heart surgery.

Breakthrough Procedure

Patients with severe aortic stenosis can now be considered for the less invasive procedure with the new device known as the Sapien transcatheter aortic valve replacement (TAVR), manufactured by Edwards Lifesciences in Irvine, CA. These patients are generally older, with multiple medical conditions that may put them at very high risk in traditional surgical procedures.

“TAVR is a breakthrough because it offers some patients who could not withstand the conventional surgery due to age or serious medical conditions a viable treatment option,” said Jacob Scheinerman, MD, associate chair of cardiothoracic surgery at LIJ Medical Center. The US Food and Drug Administration approved TAVR last November; it has been used in Europe since 2002.

Symptoms of Aortic Stenosis

Approximately 250,000 Americans suffer from severe aortic stenosis, often developing debilitating symptoms that can affect normal day-to-day activities, such as walking short distances or climbing stairs. Generally, the condition affects people ages 70 and older. Aortic stenosis occurs when the aortic valve does not properly open and close, usually due to a buildup of calcium. The calcium buildup restricts blood flow from the heart to the rest of the body. This increases pressure within the heart, causing heart muscles to weaken. All these events increase the risk of heart failure. Symptoms of the disease can include extreme fatigue, dizziness, chest pain or pressure, shortness of breath during activity, rapid or irregular heartbeat and fainting.

“Patients who do not receive an aortic valve replacement have no effective, long-term treatment option to prevent or delay the progression of severe aortic stenosis and eventual death,” said Dr. Scheinerman, further noting that approximately 50 percent of patients who are in their 80’s and have symptoms of congestive heart failure with critical aortic stenosis will die within six months to a year without treatment. “For patients who were previously inoperable, the new TAVR gives hope for extending their lives with an improved quality of life.”

New Suite Has Latest Technology

Earlier this year, Dr. Scheinerman, along with interventional cardiologist Barry Kaplan, MD, vice chairman of cardiology at LIJ and North Shore University Hospital; Rajiv Jauhar, MD, chief of cardiology and director of the cardiac catheterization laboratory at LIJ; and cardiothoracic surgeon Robert Palazzo, MD, joined the multidisciplinary team of specialists in performing the procedure on an elderly woman who suffered from severe aortic stenosis. They performed the procedure in LIJ’s new, state-of-theart hybrid operating room. The $5 million surgical suite combines the latest surgical and cardiac catheterization robotic technology and three-dimensional radiologic imaging capabilities with real-time patient monitoring.

“Having all the equipment and members of the cardiac team in one OR saves time and eliminates the need for a patient to be moved from one room to another,” said Dr. Kaplan. “Interventional cardiologists and cardiac surgeons can collaborate closely during the procedure. Working in our new hybrid surgical suite allows us to be ready for any situation or potential emergency.”

Similar to a technique to implant cardiac stents into clogged arteries, the TAVR procedure involves the physician guiding a catheter attached to the Sapien valve through the patient’s femoral artery. The cardiac team uses transesophageal echo and fluoroscopic imaging guidance for proper placement. The Sapien valve is expanded by a balloon, about the diameter of a quarter, in the delivery system, pushing away the calcium to enlarge the opening of the valve. Upon placement at the opening of the valve, it is anchored inside the aorta and blood flow is restored.

First Patient to Receive the TAVR

Ann Pszybylski, an 84-year-old grandmother and great-grandmother of eight from Hauppauge, was the first patient at LIJ to receive the TAVR. Her symptoms increased to the point that she had shortness of breath while doing any type of activity that required movement, even walking. Due to her Parkinson’s disease and frail condition, Ms. Pszybylski was not a candidate for the conventional heart valve procedure.

“After the TAVR procedure, Ms. Pszybylski did remarkably well,” said Dr. Scheinerman. “Within 24 hours after the procedure, she was up and walking around the Intensive Care Unit, and her breathing was easier.”

Ms. Pszybylski, who spent three days in the hospital, said she used to “huff and puff” to keep up with her daughters or residents of the assisted-living facility where she lives. She added, “I’d like to travel to see my nephew in Georgia and daughter in North Carolina, but mostly I’m looking forward to just living longer.”

Elliott Gaberman can resume his volunteer work now that he’s recovered from a procedure to replace his failing heart valve.

Elliott Gaberman, 78, of Oakland Gardens, underwent the TAVR procedure at LIJ. He also suffered from severe aortic stenosis, and TAVR replaced his failing heart valve. Over the past year, Mr. Gaberman, a retired safety quality assurance specialist, struggled with shortness of breath and extreme fatigue while walking and climbing stairs. As his symptoms increased, Mr. Gaberman sought relief from his condition. He was not a candidate for surgical valve replacement because his triple heart bypass in 2007 and other medical conditions closed the door on surgery. “With the TAVR, Mr. Gaberman is breathing easier, is walking more comfortably and is more energetic,” said Dr. Kaplan.

Mr. Gaberman is looking forward to resuming his volunteer work at the St. Albans VA Hospital, where he has transported patients every week for the past eight years. “I’m thankful I was able to receive this new treatment close to my home as opposed to getting the procedure in Manhattan. It’s much easier, especially with presurgical testing and follow-up visits,” he said.

At LIJ, interventional cardiologists, cardiothoracic surgeons and cardiac anesthesiologists evaluate patients for the TAVR procedure. Members of the hospital’s heart team work together to ensure optimal patient outcomes. Specialists include cardiac surgeons, interventional cardiologists, cardiologists, anesthesiologists, echocardiographers, physician assistants, nurses, OR staff and other professionals.

Protect your heart. For information about less invasive heart valve replacement procedures, call LIJ’s Department of Cardiac Services at 718-470-7460.

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