Not long ago, a diagnosis of severe aortic stenosis (AS) was almost a death sentence for many patients. Survival after the onset of symptoms is 50% at two years and 20% at five years. With the advent of transcatheter aortic valve replacement (TAVR) for high-risk structural heart disease patients who are deemed inoperable, more patients have the opportunity to extend their lives. Now a new minimally invasive open heart procedure, available at the Larry D. Johnson Heart & Vascular Institute at Memorial Hermann-Texas Medical Center, allows lower-risk patients to enjoy good outcomes and avoid the long recovery time associated with sternotomy.
George Grabowski, PhD, a physically active 64-year-old, is among those who benefited from the minimally invasive option. Last August, his internist Clifford Yut, MD, heard a heart murmur and referred Dr. Grabowski to Memorial Hermann The Woodlands Hospital for an echocardiogram. A diagnosis of severe aortic valve stenosis led to a consult with Gary Coleman, MD, FACC, a well-known cardiologist with a longstanding practice in The Woodlands and North Houston.
“When I first saw Dr. Grabowski, he had recently become symptomatic,” Dr. Coleman says. “We measured the severity of valve narrowing with a heart catheterization, and it was clear that he needed an intervention. Because he was young, healthy and vigorous, he didn’t meet the criteria for TAVR.”
A week later Dr. Grabowski was downtown in the office of Tom C. Nguyen, MD, director of minimally invasive valve surgery at Memorial Hermann-Texas Medical Center and McGovern Medical School at UTHealth. Dr. Coleman had learned of Dr. Nguyen’s expertise in minimally invasive valve replacement after meeting the cardiothoracic and vascular surgeon six months earlier. Dr. Nguyen and other members of the structural heart disease team at the Heart & Vascular Institute have performed more than 1,000 TAVR implants and hundreds of minimally invasive aortic and mitral valve operations.
“The majority of aortic stenosis cases are still done with midline sternotomy,” Dr. Coleman says. “Dr. Grabowski had no coronary artery disease and no need for arterial intervention. He had a straightforward case of pure aortic valve disease and was a good candidate for the minimally invasive procedure Dr. Nguyen performs.”
A native Houstonian and graduate of Rice University, Dr. Nguyen developed his cardiovascular techniques at Johns Hopkins University, Stanford University, Columbia University and Emory University, and is now one of only a handful of surgeons who consistently performs all three procedures available to treat AS: TAVR, minimally invasive surgery and traditional open heart surgery. He is actively engaged in research and lectures nationally and internationally on valvular heart disease; he also proctors TAVR procedures and minimally invasive surgery across the country. His background and training in all three approaches to aortic valve replacement allows him to remain unbiased and choose the right procedure for each of his patients.
Dr. Grabowski, who had already done his own research, became more educated as he worked his way through the evaluation process. “When I learned that my only options were minimally invasive valve surgery or dividing the sternum for open heart surgery, the choice was obvious.” He remembers it as “all happening very fast. I had become very symptomatic. I was out of breath when I swam and had a raspy feeling in my chest,” he says. “There was so little space left in the aortic valve that it felt like the blood was shooting through it at high speed.”
On Sept. 8, 2016, Dr. Nguyen and his team performed a minimally invasive aortic valve replacement through a small incision in Dr. Grabowski’s chest. To preserve the sternum, he gained access to the aortic valve through a 5-centimeter anterior thoracotomy. “I believe this approach provides the best opportunity for an expeditious recovery and return to normal function,” Dr. Nguyen says. “I’m particularly diligent about minimizing postoperative pain and do everything I can to make sure my patients are comfortable.”
Dr. Grabowski’s recovery was uneventful. “The first thing I noticed after the surgery was that the raspy feeling I associated with blood shooting through the valve was gone,” he says. “I did extremely well with the small incision. I had very little pain and soreness, and didn’t have to worry about not being able to drive for six weeks. I relaxed at home for the first week after leaving the hospital and was out walking in my neighborhood the second week.”
A geologist with ExxonMobil, Dr. Grabowski returned to work a month after the procedure. He and his wife Debbie have resumed their active lifestyle, swimming regularly in the summer months and walking or bicycling the neighborhood in the cooler seasons.
Dr. Coleman continues to see Dr. Grabowski in follow-up. “He’s a very pleasant and intelligent man who had done some good research on his condition and kept an open mind in making his treatment choice,” he says. “I was happy to be able to refer him to Dr. Nguyen, who is an innovative surgeon actively promoting the minimally invasive aortic valve replacement technique around the country by training other physicians.”
Up to 1.5 million Americans suffer from aortic stenosis, and approximately 500,000 have severe aortic stenosis. Of those, an estimated 250,000 patients with severe AS are symptomatic. “Most people fear having their chest cracked open,” Dr. Nguyen says. “Now there are two good options to avoid it – minimally invasive valve surgery or TAVR. It’s important that patients be evaluated by an unbiased team like ours, where surgeons are skilled in performing all the procedures available for valve replacement. It allows us to choose the right procedure for the patient, rather than trying to fit the patient to the only procedure we perform.”
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