“I take the garbage out every week, and it’s quite a long walk on our back driveway,” recalls Mr. Wrigley about his condition in the spring of 2014. “Coming back, I always had to stop two or three times because of shortage of breath.”
Aortic stenosis is typically found in older adults and prevents the aortic valve from fully opening. “As a person ages, just like any other part of the body, the body tissue becomes harder, calcified,” explains Royal Columbian Hospital interventional cardiologist Dr. Albert Chan. “For the aortic valve, the leaflet becomes less mobile.”
The usual treatment is open heart surgery to replace the valve with an artificial one. Mr. Wrigley wasn’t keen on the solution. “I didn’t like the sound of that and the recovery involved,” he notes.
Dr. Chan is among the physicians who have begun a new approach to valve replacement that avoids the need for a large incision. The minimally-invasive procedure, done at Royal Columbian and a small number of other hospitals in British Columbia, is known as TAVI or transcatheter aortic valve implantation.
“In the last dozen years, TAVI has increasingly become common,” says Dr. Chan. “During the procedure, we put in a new valve by threading a catheter up from the groin artery to the heart.”
Generally, TAVI is reserved for older patients who are high-risk surgically. Younger patients would typically still be offered surgery, since we do not yet know how long a stent valve will last when compared to the surgical valve.
But improvements have come with newer generation valves.
“The first generation did not allow any repositioning,” says Dr. Chan. “So you had one shot to deploy the valve. Now with the newer generation, if it’s not perfectly placed in the first try, we can always retrieve it, reposition it, and redeploy it until we are perfectly happy with the position.”
As knowledge about TAVI grows, technology improves and some of the shortcomings with the early generation devices are overcome, Dr. Chan believes more patients may be considered for the procedure.
“It’s less invasive, there’s a much quicker recovery and with a very acceptable complication rate that is comparable to surgery or sometimes even better than surgery,” says Dr. Chan.
Mr. Wrigley first had three stents implanted, followed by TAVI at a later date. He and another man from Kelowna shared a piece of Royal Columbian history by becoming the first two patients at the hospital to receive the newer generation Lotus valve.
Mr. Wrigley says the results were dramatic. “It was like night and day,” he says. “As a result of the TAVI procedure, I am basically back to normal to what I used to do in the garden.”
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