Without a procedure to replace the faulty valve in her heart, Maria, already painfully immobilized by her symptoms, had very little time ahead of her.

“It’s a deadly condition,” says Dr. Eric Horlick, Cardiologist, Peter Munk Cardiac Centre. “Once you develop symptoms of aortic stenosis and are found to be inoperable, you have about a 50 percent 12-month mortality rate. And those 12 months will be miserable.”

Ten years ago, the only treatment available for aortic stenosis was open heart surgery. For young and healthy patients the success rate of this surgery is high, but for older patients, or patients with additional conditions such as lung disease, the risk of the surgery is prohibitive and the recovery very difficult. Maria had seen the toll surgery can take first hand. “My husband had to have an open heart bypass surgery,” Maria says, “so I know what it is like. It took him three months to recover. And the other thing is that it is horribly painful. It made me so unhappy to see how he suffered.”

This video showcases the technology and procedure involved in Maria’s procedure, performed by Dr. Horlick of the Peter Munk Cardiac Centre

 

The new world of TAVI

Fortunately, a new treatment known as transcatheter aortic valve implantation (TAVI) meant that there was an option for Maria other than open heart surgery. “TAVI is a way to take a person who is too high risk for conventional surgery, go into the artery in their leg, go up through the aorta, and position a stent with a valve sewn into it,” explains Dr. Horlick. “The whole procedure takes 35 minutes. The patient is up and ambulating later in the day. They go home the next day. It’s incredible.”

“It’s a deadly condition,” says Dr. Eric Horlick, Cardiologist, Peter Munk Cardiac Centre. “Once you develop symptoms of aortic stenosis and are found to be inoperable, you have about a 50 percent 12-month mortality rate. And those 12 months will be miserable.”

When TAVI was first proposed there was concern that it might be dangerous or ineffective, and so it was used only on the highest risk patients: those who could neither survive surgery nor survive without it. The results were impressive. A large increase in overall survival was seen among these high-risk patients and, as the technology has improved, making the procedure less and less invasive, TAVI is now being explored as an alternative for moderate risk patients as well.

“I couldn’t walk because of my heart”

Surgery was considered very risky for Maria due to her age and scarring from previous surgeries, so TAVI was put forward as the treatment of choice for her. Dr. Horlick performed the procedure on her in December of 2014, and the effect on her quality of life was immediate and profound. “Before the procedure, I was short of breath. I had irregular heart beats and skipped beats. I couldn’t walk because of my heart,” says Maria. “After the procedure, I recovered very quickly and now I can do everything that I did before. In three weeks I was swimming again. I can exercise. I can cook and bake by myself.”

Joy and gratitude are evident in the voices of Maria and her husband Victor as I speak with them. “Dr. Horlick was so kind,” says Maria. “I would recommend this procedure 100% to anyone who is a candidate for it. Especially with Dr. Horlick.”

Dr. Horlick says that the most important thing is to be aware that there are safe and effective alternatives to open heart surgery for many patients. “There are options if you have aortic stenosis. And the people best able to advise you about these options are the people who actually use all the technologies.” He urges anyone with this condition to seek advice from a doctor who is part of a multidisciplinary team, and who is familiar with both surgical treatments and TAVI.

Which therapy is best for an individual patient can depend on many factors. Only by talking to a doctor with a deep understanding of all the options can a patient ensure they get the best treatment.