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TAVR: An Alternative to Open Heart Surgery

So, you’re getting up there in years and you’re dragging, have a little trouble catching your breath. And you figure it’s just because you’re older.

That’s a dangerous assumption. Fatigue and shortness of breath are common symptoms of aortic valve stenosis, which can lead to heart failure if untreated.

“The huge majority of patients are, ‘Oh, I’m just slowing down because I’m getting older,’ ” says Dr. John Mehall, medical director of Cardiac and Thoracic Surgery Associates at Penrose-St. Francis Health Services. “They don’t actually realize that this is limiting them, and then they markedly feel better when its fixed.” And fixing it has never been easier, thanks to a new procedure.

Aortic valve stenosis is a narrowing of the aortic valve that occurs usually as a result of aging. “As the valve narrows, the blood has more difficulty getting out of the heart to the body,” Dr. Mehall says. “It puts an added workload on the heart.”

Aortic valve stenosis typically is discovered during a physical, when the doctor hears a heart murmur. Surgery is the common remedy, but even minimally invasive surgery is too risky for some patients because of their age or condition. TAVR, or transcatheter aortic valve replacement, is for those patients. Penrose Hospital was the first facility in southern Colorado to perform TAVR and just the second in Colorado.

“It’s percutaneous, so just a needle stick; there’s no incision,” Dr. Mehall says. A wire carrying the new valve is threaded through an artery to the heart, then generally a balloon is used to expand the new valve and push the old one out of the way. “The old one basically gets pancaked between the wall of the aorta and the new valve,” Dr. Mehall says.

Patients typically stay in a regular ward rather than the ICU; after a night in the hospital, they go home the next day. “You really can’t overemphasize not just the rapid recovery, but really no recovery,” Dr. Mehall says.

Dr. Mehall also performs MitraClip, another percutaneous catheter technique used to repair mitral valve leakage. “Instead of the valve not opening well, as in aortic stenosis, now the mitral valve is leaking,” he says. As with TAVR, MitraClip is for patients where surgery poses a moderate to high risk.



In counseling heart patients, Dr. John Mehall, a cardiothoracic surgeon, stresses “global awareness” rather than fixating on a specific diet or seeking a magic bullet through, say, chocolate or wine.

“If you’re thinking about what you’re eating and you are thinking about staying active and you have awareness of it, you’re going to make better choices,” he says.

The Ornish Lifestyle Medicine Program at Penrose-St. Francis Health Services is “a great example of a global approach,” Dr. Mehall says; the program designed by Dr. Dean Ornish, creator of the Ornish diet, is aimed at reversing the progression of heart disease through lifestyle changes. “There’s dietary components, there’s physical fitness components, there’s meditation and mental health components,” says Dr. Mehall.   

For more information, go to ornish.com.