Over 500 TAVR Procedures, One Man’s Story

In the last six years, James Homire’s heart has caused a lot of health problems.

Beginning in 2010, Homire, 86 and a retired attorney from Eureka, Missouri, has been diagnosed with coronary artery disease, atrial fibrillation and aortic valve stenosis; he also has an abdominal aortic aneurysm. All of these conditions can be life threatening, as they all can dramatically hinder the heart’s ability to perform properly. It was the combination of these conditions that led to Homire’s heart attack in 2013.TAVR Specialists

“My heart just wasn’t working like it should,” says Homire. “I was short of breath all the time and really needed some relief.”

After his heart attack, Homire sought treatment from the multidisciplinary team at the Washington University and Barnes-Jewish Heart & Vascular Center, which was able to provide the level of care and attention his situation required. Homire’s heart specialists recommended bypass surgery and replacement of his aortic valve. Unfortunately, during surgery, it became clear that complications made valve-replacement surgery too risky and only bypass surgery was performed. Homire recovered well. However, two years after his bypass surgery, Homire was once again feeling short of breath. His doctor suspected this was likely the result of a worsening aortic valve. With limited options for traditional valve-replacement surgery, he was referred to a clinic at Barnes-Jewish Hospital that specializes in heart valve disease.

“This was a hard time for my family,” Homire says, “but I knew I was in good hands.”

His multispecialty team at the clinic included Alan Zajarias, MD, a Washington University interventional cardiologist at Barnes Jewish-Hospital, and Hersh Maniar, MD, a Washington University cardiac surgeon at Barnes Jewish-Hospital. They evaluated Homire’s condition and determined his aortic valve disease had indeed worsened and was likely the reason for his worsening shortness of breath.

Drs. Zajarias and Maniar told Homire that the severity of his aortic stenosis had narrowed his heart valve, making it difficult for his heart to effectively pump blood to his body. Homire needed a heart-valve replacement. But his other health problems and surgical history made a repeat attempt of traditional open-heart valve-replacement surgery too dangerous.

The specialists told Homire they could replace his weak valve using a minimally invasive surgery called TAVR, or transcatheter aortic valve replacement. During a TAVR procedure, the surgeon makes a small incision in the patient’s groin or chest, or under the ribs, and then threads a catheter into a vein that leads to the heart. Once the catheter reaches the heart and the unhealthy valve, it deploys a new valve that, when opened, pushes aside the damaged valve and immediately begins to function in its place. The team successfully performed Homire’s TAVR procedure in June 2015.

“When someone Mr. Homire’s age needs a valve replacement, a lot of complicating factors can make open-heart surgery very risky,” says Dr. Zajarias. “Now that we have eight years of experience with TAVR, we can really individualize this minimally invasive approach, which is far less risky than a traditional operation.”

Barnes-Jewish Hospital’s heart and valve specialists were the first in the St. Louis region to offer the advanced procedure. Not long ago, the team reached a significant milestone—its 500th TAVR procedure. Dr. Zajarias says he and his colleagues have learned a lot about TAVR and its potential to help patients along the way.

“TAVR has become a great option for more and more patients,” says Dr. Maniar. “We have multiple types of these devices to choose from now, so we can tailor the treatment to fit the patient. Even though Mr. Homire was older than the average patient who undergoes TAVR, it worked beautifully for him.”

In January 2016, Homire had a third surgery that successfully repaired his abdominal aortic aneurysm―a bulging, weakened area in the wall of the aorta. Aneurysms can be dangerous because they often increase in size and eventually rupture, causing internal bleeding. Repairing an aneurysm can prevent these things from happening.

After multiple surgeries and six years of serious health difficulties, Homire is now doing well. With the help of physical therapy, he has been able to walk up to a mile at a time. “I would tell anyone to go to the doctors and surgeons at Barnes-Jewish Hospital,” says Homire. “They were great all around.”

Both Drs. Zajarias and Maniar say they are excited about the ways in which the TAVR program at Barnes-Jewish Hospital is growing and changing.

“Our 500-TAVR milestone is significant, but we’ll never stop learning,” says Dr. Maniar. “The options for TAVR will continue to improve, which means more people can be treated.” Dr. Zajarias agrees: “We’ll always work to make it better. The TAVR team’s collaboration and commitment is just superb.”

Donor gifts to The Foundation for Barnes-Jewish Hospital supported the PARTNER trial that led to one of the most exciting developments in heart surgery in more than 15 years, according to Dr. Maniar. The procedure has changed the way heart procedures are done around the world.

To learn more about the TAVR procedure, or to schedule an appointment with a Washington University heart or vascular specialist at Barnes-Jewish Hospital, call (314) 867-3627.

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Category: Heart & Vascular

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Barnes-Jewish Hospital at Washington University Medical Center is the largest hospital in Missouri and the largest private employer in the St. Louis region. An affiliated teaching hospital of Washington University School of Medicine, Barnes-Jewish Hospital has a 1,800 member medical staff with many who are recognized as "Best Doctors in America." They are supported by residents, interns and fellows, in addition to nurses, technicians and other health-care professionals.

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