Minimally Invasive TAVR Procedure Helped Ruby Feel Like Herself Again

Ruby Morgan-Dermody, a feisty 89-year-old who exercises daily, thought she was pretty healthy. At a visit to her primary-care physician, Ruby told the doctor she “felt a bit tired, but I’m an old lady!” While listening to Ruby’s heart, her physician told her things weren’t working the way they should. “Sure they are,” she remembers responding.

“Actually, we’d been watching her heart for a while,” said Michele Johnson, Ruby’s daughter. “She did go to the YMCA to exercise and for the social aspect, but she seemed exhausted by travel and didn’t want to do much outside of the house.”

Ruby’s primary-care physician referred her to the Washington University and Barnes-Jewish Heart & Vascular Center. The specialist who examined her told her she had aortic stenosis—her aortic valve wasn’t functioning properly, resulting in insufficient blood flow through her heart.

“She may not remember this now, but she had shortness of breath for two years that she felt was due to getting old. And she wasn’t able to sleep in her bed without a lot of pillows behind her back because of it,” said Alan Zajarias, MD, the interventional cardiologist who treated Ruby. “It is not uncommon that patients confuse symptoms of aortic stenosis with symptoms of aging. People tend to avoid activities or modify them to prevent them from being symptomatic or feeling ill.”

Ruby was surprised by the diagnosis but, true to her character, determined to get better. When given the choice of valve replacement or swift deterioration of her health, she said it was obvious what she had to do.

After considering Ruby’s serious condition and high surgical risk, her medical team recommended transcatheter aortic valve replacement (TAVR). During this minimally invasive procedure, a specialist replaces the aortic valve via a small tube, called a catheter that is threaded into the heart through an artery in the groin or the chest wall. The procedure is done through a single, tiny incision.

Although aortic stenosis tends to effect older adults, age is not the only factor used to determine whether TAVR is an effective approach. Anyone who is considered a high or intermediate risk for traditional open-heart surgery and meets other medical criteria may qualify for TAVR. An experienced, multidisciplinary team of specialists can make the determination.

Within a few weeks of her diagnosis, Ruby had a new valve. Following their standard process, Zajarias and cardiothoracic surgeon Hersh Maniar, MD, worked together during the procedure, and both specialists provided follow-up care afterward. “The TAVR heart team is probably the best example of multidisciplinary care in cardiovascular medicine today,” Maniar says. “It leverages the skill sets of both heart surgeons and cardiologists, resulting in the best care possible. We see this model expanding, and it’s my hope that the success of TAVR and the heart team will pave the way for further multidisciplinary care in other areas of cardiac health.”

Zajarias said that patients who undergo TAVR tend to recover well and return to their daily activities faster than those who have open-heart surgery. This proved true for Ruby. She was released from the hospital four days after her new valve was put into place.Ruby Morgan-Dermody and Family

“It was very different from other surgeries I’ve had,” Ruby said, noting that she had very little postoperative pain. “I feel like a million dollars now!” Daughter Michele noted that her mother obviously improved after the procedure. “Her whole demeanor is different,” she said. “She’s brighter and more engaging, and willing to do more things with the family.”

With her aortic stenosis behind her, Ruby, an avid baseball fan, attended her first St. Louis Cardinals game in person, and continues her exercise and hobbies. “If the grim reaper’s going to come for me, he’s just going to have to wait a while longer,” she said.

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Category: Heart & Vascular, Patient Stories

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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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