Peter and Leslie Mastroianni both had the opportunity to try a non-invasive alternative to open-heart surgery to treat their mutual diagnosis of aortic stenosis. Both in their early 70s, they were some of the youngest patients to undergo Transcatheter Aortic Valve Procedure.
Dr. Shikhar Agarwal, Chief of Structural Heart Disease at Geisinger, performs the procedure, also known as TAVR.
Geisinger performed its 1,000th TAVR in June. Dr. Agarwal says it’s becoming an increasingly popular alternative to open-heart surgery.
“We typically put a large tube in the groin, about the size of my pinky,” Dr. Agarwal said. “And through that tube, these valves can be compressed, so these can be folded into tiny structures, we have special devices that do that. After they get folded into tubes, we take these valves up to the aortic valve area.”
Geisinger began offering the TAVR procedure in 2011, but only for patients who were considered high-risk for surgery. Now, Dr. Agarwal says, most patients with aortic stenosis or heart valve disease are evaluated for both.
“You will meet the TAVR people, you will meet the surgery people, and then we all will talk about what is right for the patient, and the patient gets the choice based on their expectations on what is right for them,” Dr. Agarwal said.
“It had a good record of success to that point with people much older than us. So, logically, why wouldn’t it work with us? That was my feeling,” Peter said.
Peter had the procedure in July 2019, when he was 73. The FDA had just approved the TAVR procedure for low surgical risk patients that year.
“Some months, I guess, after Peter was diagnosed I suddenly and very surprisingly was diagnosed with the same thing,” Leslie said. “Just through a routine EKG in my doctor’s office.”
Leslie, who was 69 when she had the procedure, says she immediately knew she wanted to have the TAVR procedure, given her husband’s experience.
“The procedure seemed to make the most sense, the device seemed to be doing what it needed to be doing, I couldn’t come up with a downside,” Peter said.
While the Mastroiannis consider themselves to be adventurous, they weren’t taking a higher risk in this scenario.
Dr. Agarwal says the risks of TAVR are not comparable to the risks of open-heart surgery because they depend on the health of each individual.
The non-invasive approach, according to doctors, takes less time and results in an easier recovery.
“Patients are not under general anesthesia, they are not connected to a ventilator anymore, they don’t get a urine catheter,” Dr. Agarwal said. “We do what is called a minimalist approach in a sense, we use conscious sedation, we use only absolutely essential support systems, and we are able to go through TAVR. This aids recovery, this aids people’s experience with this procedure, and it really facilitates them getting home earlier.”
The Mastroiannis were cared for at the Geisinger Hospital for Advanced Medicine in Danville. TAVR procedures are also done at Geisinger CMC’s location in Scranton, and at Geisinger Wyoming Valley Medical Center near Wilkes-Barre.
