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Aortic valve procedure alternative for elderly

Ben Schmitt
| Monday, Jan. 25, 2016, 9:00 p.m.

After a second fainting episode in a month, William Tatrai and his doctor knew medicine alone wouldn't treat his heart condition.

“I was in the bathroom and, the next thing I knew, I was on the floor,” Tatrai, of Munhall, recalled. “A month later, in late November, I was in my bedroom putting on a pair of socks and I fainted again, falling right off my chair. My doctor put me right in the hospital.”

At 92, the physical trauma of open heart surgery wasn't a realistic option for Tatrai.

For several years, he suffered from a condition known as aortic stenosis, which affects a half-million Americans, many of them elderly.

The narrowing of the heart's aortic valve can lead to dizziness, fatigue, breathlessness and chest pain, among other symptoms.

Previously, a patient's only option other than medicine and a doctor's observation was to have open heart surgery to replace the aortic valve. However, in many cases, surgery is too risky for elderly patients.

“My doctor told me about this fairly new procedure that he thought might help,” said Tatrai, a retired U.S. Steel worker. “I knew I didn't want to risk open heart surgery.”

The procedure, known as transcatheter aortic valve replacement, or TAVR, is gaining momentum as an established alternative to surgery for elderly patients or high-risk surgery patients. In the procedure, doctors implant an artificial valve through a catheter, or thin tube, inserted through a large artery in the leg or chest.

In Tatrai's case, Dr. Thomas Gleason, chief of UPMC's cardiac surgery division, performed the TAVR at UPMC Shadyside in December.

“I feel great,” Tatrai said Monday. “I recovered in a nursing home, and now I'm back home feeling fine.”

Health systems UPMC and Allegheny Health Network perform TAVR procedures. UPMC cardiologists recently performed their 500th TAVR operation.

“People are enthusiastic because it is less invasive,” Gleason told the Tribune-Review. “The stress on the system is not as high, and we can avoid putting patients on the heart-lung machine.”

He said long-term results of TAVR compared to surgery need to be monitored.

“We'll know more at the 10-year mark,” Gleason said. “But I can say with confidence in the early and mid-term, it appears equivalent to surgery.”

Studies and randomized trials are underway to determine if the procedure would benefit aortic stenosis patients at lower risk for surgical complications.

“The tide is turning toward studying this technology in intermediate risk patients,” Gleason said. “Eventually those classified as low-risk may also be studied.”

Tatrai, who lives with his son, Joel, 63, is pleased that his doctors recognized he could benefit from TAVR.

“For a few years, they were waiting to see if something serious happened, and something happened,” he said of the fainting. “So far, so good.”

Ben Schmitt is a Tribune-Review staff writer. Reach him at 412-320-7991 or bschmitt@tribweb.com.

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