Hans Fleischner, 90, with his wife, Leslie, at home in Squirrel Hill.

High Tech, Soft Touch

Heart valve repair without opening the heart. How patients get the best from UPMC Shadyside’s “ability to embrace the new.”

As 88-year-old Hans Fleischner and his wife, Leslie, were leaving a Pens game last year, Mr. Fleischner suddenly felt he could not take another step. “I was having trouble breathing,” he remembers. “I thought I was going to pass out.”

“We are taking care to new levels of innovation.”
- Thomas G. Gleason, MD

With help from another hockey fan, the Fleischners made it to their car, and Mrs. Fleischner called 911 for an ambulance. When they got to UPMC Shadyside, Mr. Fleischner’s longtime cardiologist, Dr. Lawrence Adler, had left him a phone message in the Emergency Department.

“You’re not going home tonight,” he told them.

Mr. Fleischner’s problem was aortic stenosis, a narrowing of the valve opening in the heart. The most common and most serious valve disease in Western countries, aortic stenosis restricts blood flow to the body’s largest artery, the aorta, which carries oxygen-rich blood from the heart to all other organs.

Dr. Adler had previously diagnosed Mr. Fleischner’s condition, explaining that at some point, his heart valve would need to be replaced. He also told his patient that the latest therapy was a procedure that allowed surgeons to repair or replace a defective heart valve without having to open the chest. But at that time, TAVR (Transcatheter Aortic Valve Replacement) was not yet performed in Pittsburgh.

Fast-forward to 2016. TAVR now had come to UPMC Shadyside, and Mr. Fleischner benefited from it. A cheerful and charming retired U. S. Steel manager and strong supporter of the Neighborhood Academy, he says that after his TAVR procedure he “started feeling like myself again immediately. There was no pain. I went home in three days. I even have a warranty card that guarantees my new valve for 15 years. After that, I understand that they can put another new one inside this one!” He celebrated his 90th birthday in July.

A partnership of innovators

TAVR is a partnership of innovators, among them cardiothoracic surgeon Thomas G. Gleason, MD, one of the country’s top experts in minimally invasive aortic valve repair, and his talented colleagues —in addition to investments by UPMC to make Shadyside a national leader in heart care. After carrying out clinical trials that led to FDA approval, Dr. Gleason and cardiologist Joon Sup Lee, MD, introduced TAVR at Shadyside in 2013 — along with a new, highly specialized hybrid operating room where surgeons and interventional cardiologists work as a team.

“With TAVR, surgeons and cardiologists use a catheter to place a new valve within the patient’s own aortic valve via some route that doesn’t require us to open the heart,” explains Dr. Gleason, who co-directs the program with cardiologist John Schindler, MD.

Approximately 90 percent of the TAVRs performed at UPMC are done at Shadyside, making it one of the busiest TAVR programs in the country. The team also includes surgeons Forozan Navid, MD, and Ibrahim Sultan, MD. “It is truly a privilege to be part of one of the most innovative aortic surgical centers in the world,” Dr. Sultan says.

Interventional cardiologists, in addition to Drs. Lee and Schindler, include Dustin Kliner, MD.

“TAVR can provide a real advantage for patients, including older patients who otherwise have limited choices for repair of their aortic valve, with the added bonus of a shorter hospital stay and a faster recovery in most cases,” Dr. Schindler states.“The procedure not only can prolong life but actually improve the quality of life as well.”

One of the busiest TAVR programs in the country

For instance, when 92-year old Leola Broderick found herself feeling increasingly weak and tired, her doctor in Uniontown diagnosed aortic stenosis but told her there was nothing that could be done for her. She was too old for surgery, he said.

However, Mrs. Broderick’s granddaughter, Beth Windsor, CRNP, a nurse practitioner at Children’s Hospital of Pittsburgh of UPMC, had heard about TAVR. She called Lisa Henry, DNP, CRNP, the program’s clinical project director. Dr. Schindler pronounced Mrs. Broderick a good candidate for the procedure. Now she has much more energy and goes up and down stairs at home to do her laundry or put away her summer clothes. An avid card player and sports enthusiast, she is also again enjoy.ing family functions and celebrations with her children, grandchildren, and great-grandchildren — and currently holds fourth place in the family’s NASCAR pool.

“TAVR is such a good option for people who might not do so well with open heart surgery,” says Dr. Henry. “Another benefit is that patients sometimes do not need general anesthesia, which is not always a good choice for older patients. Instead, we are now using a monitored anesthesia care which offers a safe alternative to general anesthesia.”

Dr. Lee, who is co-director of the UPMC Heart and Vascular Institute and chief of the Division of Cardiology at the University of Pittsburgh School of Medicine, takes pride in the growth of the TAVR program he helped to start.“Today about 40 percent of the aortic valve replace.ments are done through the catheter at UPMC Shadyside,” he says. “We will do at least 250 cases this year.”

“Ten years ago, TAVR was not an option,” marvels Dr.Forozan Navid, Mr. Fleischner’s surgeon.“But in four years it’s literally become the preferred option for many of our patients.”