John Soditus started to suspect something was wrong in June 2020. He was taking twice as long to mow his lawn as he normally would, and he needed to stop and rest multiple times along the way...
Eighty-two-year-old Soditus, who lives in West Bradford Township in Chester County, PA, leads an active life in retirement. An avid camper, he also exercised three to four times a week before the pandemic, between spinning classes and weight training. He had been seeing cardiologist William Clay Warnick, MD, FACC, the Medical Director of Cardiovascular Services at Chester County Hospital, for a heart murmur and angina.
Soditus soon found that his new health struggles could be addressed with an advanced procedure right at his local hospital.
To correct his severe aortic stenosis, Soditus was referred to The Heart Valve Center at Chester County Hospittal for a minimally invasive procedure called TAVR.
WHAT IS TAVR?
Transcatheter Aortic Valve Replacement.
An alternative to open-heart surgery, TAVR is a minimally invasive procedure where a new, fully collapsible replacement valve is placed inside the diseased heart valve through a catheter. Although there are several approaches for inserting the new valve, the most common is the transfemoral approach. A very small incision is made and a catheter is inserted into the large artery in your groin.
A specialized x-ray camera is utilized to help the doctor guide the new valve into the heart.
Once it's in place, the new valve is expanded, at which point it pushes the old, stiffened leaflets out of the way and takes over regulating blood flow.
TAVR is designed to correct severe aortic stenosis, and it's available to patients who are otherwise in good health and those who are elderly or have other complications that would make a traditional open-heart surgery risky. Penn Medicine was an early adopter of TAVR beginning in 2007, running clinical trials and gaining experience that has made Penn one of the top five programs in the country. The Heart Valve Center at Chester County Hospital began offering TAVR in mid-July of 2020, though it had been evaluating patients for whom the procedure was a possibility for several years and referring patients that were considered good candidates for the procedure to sister hospital, Penn Presbyterian Medical Center, in Philadelphia.
With TAVR now available at Chester County Hospital, candidates for the minimally invasive procedure who live in this community can remain close to home not only for their treatment but also for the necessary appointments beforehand and their follow-ups. That convenience lessens potential distractions, like travel, and allows candidates and their families to focus on their recovery.
Julie Pitts, CRNP, MSN, the Program Manager at The Heart Valve Center, conducts a thorough review of each patient’s records as they're referred to the center for the procedure. Beyond confirming the patient’s diagnosis, she also needs to ensure their anatomy is suited to the procedure. Good transfemoral access is important, as is the size of the aortic valve. Certain constraints arise if it's too large or too small.
If the patient is a good candidate for TAVR, Pitts will plot out the next steps, the first of which is generally arranging a meeting between the patient and Muhammad Raza, MD, FACC, an interventional cardiologist at Chester County Hospital, and surgeon Deon W. Vigilance, MD, MBA, Clinical Assistant Professor of Surgery at Penn Medicine. During the session, Raza describes what will happen during the procedure and what needs to come before it.
Compared to open-heart surgery, there's an extra step involved in the preparation for TAVR: a CT scan of the chest, abdomen, and pelvis, which creates a kind of internal roadmap for the interventional cardiologist and helps them better assess the transfemoral access.
After that, the patient undergoes a heart catheterization, which provides the interventional cardiologist with a better understanding of the heart's anatomy and allows the physician to identify and treat certain other heart conditions.
Everything is scheduled by a patient navigator, who is meant to serve as a liaison between the patient, Pitts, and the doctors. "Our navigators are what set our program apart," Pitts says. "Our main goal is to make sure that our practice is very patient-focused. We want every patient to feel fully supported throughout their treatment. We're a community-based hospital, after all. And we want to maintain that feel — while providing next-level care.”
"Our navigators are what set our program apart," Pitts says. "Our main goal is to make sure that our practice is very patient-focused. We want every patient to feel fully supported throughout their treatment. We're a community-based hospital, after all. And we want to maintain that feel — while providing next-level care."
GETTING BACK TO NORMAL
Soditus says that once the decision was made to move ahead with his procedure, the process moved very quickly.
"I have nothing but great things to say about Julie and her team," he says. "They’ve been tremendous. They coordinated everything for me, every test, every appointment. If I was left to do it on my own, it would have taken a month or two. With them, it was a few days."
Within one month of his procedure, Soditus noticed a marked difference in his health. He was back to taking regular long walks and ready for more, but heeded Pitts' advice to follow his recovery instructions closely and to be cautious about pushing himself. Now, a year removed from his procedure he has been back to all of his regular activities including gardening, bowling, fishing, and camping.
His advice for those in need of TAVR, he says, "even though TAVR is a scary idea, the surgeons and staff are well-versed in what is being done, and it goes a lot smoother than you think it will."
He has been very pleased with his experience at Chester County Hospital and states, "throughout the process, all of the staff that were involved – navigators, nurses, doctors – they were all top notch people. They were with me the whole way and they continue to call and check in on my progress."