Holland resident receives breakthrough heart procedure at St. Mary Medical Center through conscious sedation
By Samantha Bambino
The Times
A few months ago, Joan Boland of Holland had the aortic valve in her heart surgically replaced. The 75-year old was awake the entire time.
Thanks to breakthrough research and a rethink in the use of general anesthesia, St. Mary Medical Center in Langhorne has dramatically shortened the hospital stay and surgical risks for select heart patients such as Boland through the introduction of conscious sedation.
For the past five years, St. Mary has been performing a procedure known as transcatheter aortic valve replacement, or TAVR, a less invasive treatment for older patients who cannot undergo open-heart surgery to repair a poorly functioning heart valve. Without care, the valve would lead to heart failure and permanent damage.
Previously, TAVR patients were given general anesthesia during the procedure. But with this older population suffering from lung disease and other health issues in addition to the low-functioning heart valve, having them completely put to sleep wasn’t always the safest option.
According to Dr. George Heyrich, director of Interventional Cardiology and Structural Heart Disease, St. Mary started offering the option of conscious sedation about eight months ago. Now, between 50–75 percent of Heyrich’s patients take advantage of this new technique.
Similar to an endoscopy, the patient is awake but in a comfortable twilight sleep throughout the TAVR procedure. A thin tube called a catheter is inserted near the groin into a large artery at the top of the leg and threaded into the heart. After the catheter is positioned in the heart, a balloon-expandable aortic heart valve is implanted to replace the damaged one. Once in place, the new valve will help the heart resume proper blood flow.
Though the procedure itself is unchanged, taking about 60 to 90 minutes compared to four to six hours for open-heart surgery, the prep and recovery times have been significantly shortened. When a patient is put under general anesthesia, they also require mechanical ventilation, a timely process.
“While safe, ventilated breathing does have an association with a number of respiratory issues,” Heyrich said. “When patients require general anesthesia and a ventilator, that patient must continue recovery in the intensive care unit where he or she can be monitored more closely. Patients don’t need a ventilator when they are under conscious sedation, thus keeping these patients out of intensive care.”
For Boland, the use of general anesthesia would’ve presented a huge surgical risk with her history of chronic obstructive pulmonary disease and other medical conditions, as well as a lengthy recovery time. Instead, she was discharged the next day.
“I’ve had surgeries before where you wake up groggy and nauseated, and this was completely different,” Boland said. “I felt a little pressure, but the anesthetists made me comfortable the entire time and talked me through what was happening every step of the way.”
It’s been several months since Boland experienced this breakthrough technique firsthand, and she can happily say she’s basically back to her old self.
“My breathing’s better and I can walk my dogs again,” she said. “I’m not running around the flea market like I used to, but I can feel my heart is working a lot better now.”
After seeing so much success since implementing the conscious sedation technique earlier this year, Heyrich now transitions as many patients as possible to this method who were originally set for general anesthesia. Reflecting on Boland and several other patients, he noted that many are out of bed and walking a mere few hours after the procedure.
“Many ask to go home that same day for dinner,” he said.
As one of the few health facilities in the region using conscious sedation for its TAVR procedures, Heyrich believes St. Mary, a designated Independence Blue Cross — Blue Distinction Center for Cardiac Care, will eventually expand the technique to other areas as well.
“We are always looking for ways to improve the patient experience and to become more effective and efficient,” he said. “With conscious sedation they are more comfortable, recover faster and can be sent home sooner.” ••
Samantha Bambino can be reached at [email protected]
