Minimally Invasive Heart Valve Replacement Now Performed At Penn Highlands DuBois

There have been many medical firsts during Richard Kirsch’s lifetime, which spans 75 years, but he never imagined that he would participate in one. On December 6, Mr. Kirsch was the first person to have transcatheter aortic valve replacement (TAVR), a minimally invasive alternative to open heart surgery, at Penn Highlands DuBois.

“I was experiencing shortness of breath when I was doing things I like to do such as golfing,” the DuBois resident explained. “I met with my primary care physician who didn’t like what he heard when listening to my heart, so he sent me to see Dr. Brent Barnes, at Penn Highlands DuBois.”

Dr. Barnes, who specializes in interventional cardiology at Penn Highlands Healthcare, performed a series of diagnostic tests ranging from cardiac catheterization and echocardiography to a special CT scan of the chest. The tests revealed severe aortic stenosis which occurs when the heart’s aortic valve becomes stiff and narrows. The valve does not open fully which ultimately reduces or blocks flow from the heart into the aorta and the rest of the body. In order for Mr. Kirsch to resume normal activities, it was necessary to replace the valve.

“Once reserved only for people too high risk for open-heart surgery, TAVR is now considered a safe, effective tool for those at intermediate or even low risk too — such as Mr. Kirsch,” Dr. Barnes explained.

“Being a golfer, I did not want my chest opened. I didn’t want anything to interfere with my game,” Mr. Kirsch said with a smile. “I liked Dr. Barnes the first time I met him, and when he recommended TAVR, I immediately knew that I was ready to be the first person to have this procedure performed at Penn Highlands DuBois.”

The minimally invasive TAVR procedure is performed under either general anesthesia or conscious sedation which keeps the patient awake but very drowsy while the valve is replaced. The procedure begins by placing small flexible tubes in the femoral arteries in the groin. These tubes are carefully inserted under ultrasound guidance without the need for an incision. The valve prosthesis is collapsed around a balloon which is inserted in the tubes and delivered to the heart through the femoral artery. Throughout the procedure the physician is viewing x-ray and ultrasound images of the patient’s heart in order to guide and place the new valve in the correct position. Once the new valve is precisely positioned within the old valve, the balloon is inflated and the new valve expands into its final position. The small tubes are then removed from the groin and the arteries are sealed with invisible sutures under the skin.

Dr. Barnes, along with Dr. Prasad Gupta and Dr. Siyamek Neragi-Miandoab, performed the TAVR procedure in a new state-of-the-art operating room, which features a catheterization lab inside an OR. This “hybrid OR” was specifically designed for this procedure in Penn Highlands DuBois.

“TAVR is not nearly as invasive as open-heart surgery. Typically, the procedure can be performed in under an hour compared to the three to five hours that is the norm with open-heart surgery. In addition, people who have TAVR usually have a much shorter hospital stay than those who have surgical aortic valve replacement,” Dr. Barnes explained.

Mr. Kirsch only required one overnight stay in Penn Highlands DuBois. Following discharge he was not permitted to lift heavy objects or drive. One week from his surgery, he resumed normal activities.

Dr. Barnes and Dr. Gupta, who also specializes in interventional cardiology at Penn Highlands Healthcare, trained in this procedure for more than six months before the first TAVR was performed on Mr. Kirsch. Dr. Siyamek Neragi-Miandoab, a cardiothoracic surgeon, brings extensive experience with the TAVR procedure to Penn Highlands Healthcare and not only assists during the procedure, but provides surgical backup should an unforeseen complication arise.

“The whole experience was fantastic. My care was unbelievable; in fact, they treated me like a celebrity,” Mr. Kirsch said. “I am especially thankful that I was able to have the TAVR five minutes from my home and I didn’t have to travel to Pittsburgh or Cleveland for this procedure. The only thing that would make this even better is if it could help me shave a few strokes off my golf game.”

Dr. Barnes is board-certified in internal medicine, cardiovascular medicine, interventional cardiology, nuclear cardiology, echocardiography and cardiovascular CT. From his practice, DuBois Regional Cardiology Associates, he sees patients in DuBois and St. Mary’s. For more information visit phhealthcare.org or call 814-375-3722.