I was home one day after heart surgery. The less invasive TAVR has made it possible.


I am one of those people with an improved heart. In January, I had cow heart tissue inserted into my aorta, which is the main artery that carries blood from the heart to the rest of the body.

This fascinating and relatively new procedure doesn’t attract much public attention but saves – or at least improves – thousands of lives a year. Including mine.

My physical exam last year led me to discover that my aortic valve was seriously narrowed. I’m a two-time winner in this area – a physical exam in 2008 helped my cardiologist at the time discover that one of my coronary arteries was largely blocked, a problem he fixed by putting a stent.

That I’m writing this at 77 is a tribute to preventative screenings — and especially to paying attention to what they show you. It’s also a tribute to the incredible advances medicine has made in creating new ways to treat old problems.

This time the problem was with my aorta. The calcium buildup in my aortic valve had it narrowed significantly, which meant my heart had to work harder to maintain blood flow.

From open heart surgery to transcatheter surgery

In the past — before 2011 — aortic valve replacement in the United States involved open-heart surgery: having your chest cut open, spending about a week in the hospital, and months of rehabilitation. Not very fun. Now, in many cases, including mine, you go home the day after your valve is replaced.

The procedure, called Transcatheter Aortic Valve Replacement – known by its acronym TAVR (pronounced TAH-lock) — is performed by a cardiac surgeon and an interventional cardiologist. A catheter is inserted into an artery through the groin. The catheter carries a replacement valve made of metal and pig heart tissue or cow heart tissue that is laid over your aorta.

I had my valve replaced on a Wednesday morning at Cooperman Barnabas Medical Center in Livingston NJ, which has an established TAVR program, and returned home shortly after lunch Thursday.

It only took a few days to return to my normal, fiery self. I was just amazed, and still am. So did various friends, who bombarded me with cow puns via email.

That most people don’t know about TAVR – which I had never heard of until I found out I might need it – is understandable.

It’s a procedure that was first performed in Rouen, France in 2002 by interventional cardiologist Alain Cribier. The first TAVR in the United States was performed in 2005 at Beaumont Hospital in the Detroit suburb of Royal Oak, Michigan. Beaumont was chosen because of his reputation for working with heart stents, said Amr Abbas, director of cardiovascular research for the hospital. Abbas was part of the team that performed the 2005 TAVR procedure, which also included TAVR pioneer Cribier, who came from France for the occasion.

“People have an aversion to open-heart therapy,” Abbas said. “Being able to offer them the TAVR has allowed us to save several lives.”

The number of TAVRs has increased

It took a while for TAVR to be offered to Americans – the Food and Drug Administration didn’t approve it until 2011. But the number of TAVRs has grown rapidly in recent years, while the number of crack -your-chest-open surgeries – SAVR, for surgical aortic valve replacement – has dropped sharply.

John Carroll, an interventional cardiologist at the University of Colorado Hospital in Aurora, says there were more than 80,000 TAVRs in the United States in 2020, the latest year for which figures are available, compared to around 4,700 in 2011, the first year the procedure was available here. There were about 50,500 SAVRs in 2020, compared to 71,500 in 2011. (Carroll’s figures are from a national registry that is not publicly available.) This means that many patients who should have had surgery with an open heart can now get away with a TAVR.

In addition to spending less time in hospital and rehab, replacing SAVRs with TAVRs saves patients – or more specifically their insurers – a lot of money.

Beaumont Hospital is paid about $56,600 on average for a TAVR from insurers or “cash payers,” a Beaumont Health spokeswoman said. It averages around $62,600 for an SAVR. I’m using these numbers rather than Beaumont’s average “gross expense” numbers of about $235,900 for a TAVR and $261,000 for an SAVR, because few, if any, TAVR and SAVR beneficiaries or insurers pay which equals the current price.

I ended up with a TAVR (for which Medicare paid $50,886.39) because during my annual preventative visit last year, my internist said I needed a cardiac stress test. It was my first stress test in 10 years, which is a typical wait between such procedures for someone like me who has no symptoms of heart trouble.

Much to my dismay, my current cardiologist didn’t like what she saw during the stress test and had me undergo several more tests and scans. They didn’t turn out well either.

I met with cardiac surgeons at Cooperman Barnabas in late December, who told me I needed a TAVR. We had planned it for January 10, but it was postponed to January 12 because Cooperman Barnabas had to deal with many coronavirus patients.

This was the second time my annual checkup helped solve a heart problem I didn’t know I had.

The first time was in 2008, when one of my kids, who is an ER doctor, pestered me to go see my cardiologist because she didn’t like what my wife was telling her — c that is, I looked like I was out of breath while rehearsing out loud for my singing part at an upcoming synagogue service.

I felt fine, but to get my daughter off my case, I went to see my cardiologist and had some tests. To my surprise and dismay, he said that even though my readings were within normal limits, he didn’t like them because they were worse than they were on my last preventative screening. He scheduled an exploratory procedure which showed a major blockage in my circumflex artery which he resolved by inserting the stent.

If I hadn’t had previous readings, which my cardiologist could have seen, who knows what might have happened? Nothing good, I’m sure.

I like to think I learned something from that, which is why I couldn’t resist getting my TAVR in January.

Everything is going well and I have more energy than before my intervention. So maybe I was affected by my messed up aortic valve but I didn’t realize it.

I don’t know, and I don’t think I care. I’m just happy to be where I am.

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