TAVR procedure saves mail carrier’s life

Dyke-Foster-TAVR-blogDyke Foster, 55, a longtime mail carrier from Assumption, Illinois, has had a problematic heart his entire life. Afflicted with a congenital heart condition, he had his first surgery at age six. In 2000, at age 41, a failing heart valve was replaced with a harvested human one. By 2014, this replacement valve was failing, and he needed an artificial valve to save his life.

“I’ve been working mail routes for close to 30 years; when I was getting really tired and winded, I knew something was wrong,” recalled Foster. “It turns out that over the last 14 years, my replacement valve had calcified and turned to rock.”

Foster’s health continued to decline. In April, he was airlifted to the Washington University and Barnes-Jewish Heart & Vascular Center because his local hospital wasn’t equipped to help him; traditional open-heart surgery was just too dangerous. At Barnes-Jewish, Foster’s best option was a minimally invasive approach called transcatheter aortic valve replacement (TAVR), a treatment not available at many hospitals.

Alan Zajarias, MD, Washington University interventional cardiologist at Barnes Jewish-Hospital, is part of the highly specialized team, which was the first in the region to offer TAVR. Since then, the team has performed nearly 500 of these innovative procedures, in which a small incision is made in the groin, chest or under the ribs, and a catheter is threaded through a vein to the heart. Once it reaches the diseased valve, the catheter deploys a stent-type replacement valve that, when opened, pushes aside the old valve and immediately begins to function.

“It’s rare we have a patient as young as Mr. Foster,” said Zajarias. “His was a difficult case for many reasons. Because of his previous surgeries, he was not a candidate for a traditional valve replacement. He needed a special valve that was being evaluated for a clinical trial he was not a candidate for. We had to be careful in how we approached his surgery.”

Foster was born with a bicuspid aortic valve, a condition in which the aortic valve has two flaps instead of the normal three. His heart defect caused aortic valve stenosis, which over time severely weakened and narrowed his heart valves, making it difficult for his heart to effectively pump blood to the body.

Foster’s multidisciplinary cardiovascular team, which included Zajarias and Hersh Maniar, MD, Washington University cardiac surgeon at Barnes-Jewish Hospital, determined Foster needed a 29 millimeter artificial TAVR valve to replace the calcified valve, a size being looked at in clinical trials but not commercially available.

“Mr. Foster simply didn’t have time to wait; we had to act fast,” said Marci Damiano, RN, MSN, clinical nurse coordinator for the center. The team appealed to the U.S. Food and Drug Administration, the hospital board and the device manufacturer for permission to use the new valve. “We filed for ‘compassionate use,’ which allows medical teams to use investigational methods to treat seriously ill patients,” Damiano said.

Foster and his wife, Cheryl, returned home to wait for approval. Weeks passed without word. By early May, Foster’s condition was worsening. “It was really scary. I was watching him get sicker and sicker and had no way to help,” said Cheryl. “That was the worst part. We had no doubt that Dr. Maniar could perform the surgery. But his hands were tied.”

Too sick to remain at home, Foster needed to return to the hospital, where he finally received his good news. “Our team put in long hours to secure approval,” said Maniar. “It was an incredible moment to walk in and tell Mr. and Mrs. Foster the valve was on its way.”

The next day, the team successfully performed the TAVR procedure with the experimental valve, and Foster’s blood started to flow normally again. “This case is a perfect example of how you have to fit the treatment to the patient, not the other way around,” said Maniar. “Mr. Foster has a long life ahead of him.”

“I don’t really have the words to thank Dr. Maniar, Dr. Zajarias and their team,” said Foster. “We are so blessed that Barnes-Jewish Hospital is near our home. It offered us an incredible group of people who went above and beyond to save my life.”

Just three months after surgery, Foster returned to his mail route, which requires that he walk up to eight miles a day. “A lot of people are surprised I’m back at work. And sometimes I think I should slow down after everything,” said Foster. “But you know what? Why should I? I feel great.”

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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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