A valve replacement without open heart surgery

TAVI procedure gives retired doctor ‘a new lease on life’
Rearview shot of an unrecognizable senior couple walking together while holding hands in a park during the day

Paul Keane was feeling lethargic. The 85-year-old former marathon runner recalls “generally not feeling well.” He was constantly tired and had lost interest in activities he used to enjoy with his wife, Shirley, including golf, bridge and wine group gatherings.

His daily walks of up to five kilometres were down to one kilometre at most. “People noticed the change in me more than I noticed it myself,” admits Paul, a retired physician. “There was quite a lot of denial on my part.”

Paul had been seeing a cardiologist in Mississauga, Ont., for aortic stenosis. That means the valve from the left ventricle of his heart that connects to the aorta had narrowed, restricting blood flow to his body. He was also being treated for atrial fibrillation (Afib), a type of irregular heart rhythm.

Disease progression

In the fall of 2019, an echocardiogram revealed that Paul’s aortic valve was functioning at 24% of its ideal level. This concerned his cardiologist, who felt some intervention was needed.

Until recently this would have been open heart surgery to repair or replace his valve. But that would be risky for someone of Paul’s age. “Had I been a candidate, I would have declined,” he says, understanding the dangers of a lengthy surgery under general anaesthetic.

Instead, his doctor offered a less invasive alternative: transcatheter aortic valve implantation (TAVI), in which a new valve is implanted using a catheter threaded through a blood vessel from the groin into the heart. The valve is made of re-engineered animal heart tissue attached to a mesh frame. 

TAVI is offered to patients believed to be inoperable or at high surgical risk. It is only available in some hospitals.

<p>Paul Keane with his wife, Shirley</p>

Paul Keane with his wife, Shirley

Simple surgery

Within about five weeks of diagnosis, Paul had his surgery at Hamilton General Hospital in October, 2019. He had a local anesthetic and the surgical team spoke to him throughout the procedure, explaining every step. He felt a slight pulling in his groin area, where the surgeon inserted the catheter, but it didn’t hurt. 

“It was less intrusive than a visit to the dentist,” says Paul. “It was hard to believe that after 45 minutes in surgery, I had a new heart valve.” 

After the procedure he had to lie down for four hours but then he was encouraged to get up. He went home from the hospital the next morning. Recovery from TAVI typically involves medication and lifestyle changes.

Back to being active

By early 2020, Paul was back to being active. He began attending special exercises classes to improve his balance. “I know that I could not have managed the classes without my new heart valve.”

Paul began to feel like his old self, rejoining social activities and resuming his walks. He currently walks 15 to 20 kilometres a week. 

With his 86th birthday approaching, Paul and Shirley were planning to celebrate his renewed health by taking an extended cruise. “This has given me a new lease on life,” he says.