New TAVR heart procedure gives Jacqueline Barley a new lease on life.
Jacqueline Barley, age 67, had made up her mind. When she checked into
Torrance Memorial Medical Center on December 9, 2014, for surgery, she
reaffirmed to her family and the medical staff that she and her husband,
Ed, would host her four sons, their wives, 10 grandchildren, extended
family and friends for Christmas Eve—as was their tradition. Jacqueline
was determined to make her body cooperate with her mind, but it was an
Just a few months prior, Ed had begun to notice a dramatic decline in Jacqueline’s
health. He initially thought it might just be her asthma flaring up. Doctors
even suggested it might be depression. But as her condition worsened,
he and his family feared something more serious was to blame.
“She wasn’t getting up much during the day. She couldn’t
get from the bed to the bathroom without becoming out of breath,”
Ed says. “Her life basically consisted of going to and from doctors’
Because Jacqueline had become close to bedridden, Ed took an early retirement
from his 40-year job at the Long Beach Harbor so he could focus on her care.
Jacqueline had long been challenged with two autoimmune diseases: lupus
(a systemic disease in which the body’s immune system mistakenly
attacks healthy tissue) and rheumatoid arthritis (a disease that leads
to loss of joint function). In need of knee replacement, her mobility
was also limited to using a walker—and often a wheelchair—to
get around. However, because of her suppressed immunity, her primary physician,
infectious disease specialist
Eric Milefchik, MD, told her the risk of post-surgery infection was too high for any major surgery.
During a weekly appointment at Dr. Milefchik’s office, nurse practitioner
Izzat Alamdar (Dr. Milefchik’s wife) was concerned about Jacqueline’s
fatigue and shortness of breath. After discussing her symptoms with Dr.
Milefchik, their office made an appointment for her to see interventional
Salman Azam, MD, who specializes in
structural heart disease.
Dr. Azam put Jacqueline through a series of diagnostic tests, including
an echocardiogram, a chest X-ray and an angiogram to diagnose any major
heart abnormalities contributing to her symptoms. The tests revealed her
heart valve had become severely calcified—a condition known as aortic
stenosis. Dr. Azam didn’t mince words. He told the Barleys that
Jacqueline would have a 50% chance of surviving the next two years unless
she underwent immediate heart valve replacement.
The aortic valve allows blood to flow from the heart’s lower chamber
(left ventricle) into the aorta and to the rest of the body. Aortic stenosis
prevents the valve from opening properly, forcing the heart to work harder
to pump blood through the valve. This causes pressure to build in the
left ventricle and thickens the heart muscle.
The heart can make up for stenosis and the extra pressure for a period
of time. But at some point, the extra effort it is making to pump blood
through the narrowed valve can cause the heart to fail. Symptoms of aortic
stenosis include shortness of breath, fatigue, chest pain, light-headedness,
loss of consciousness and water retention.
According to Dr. Azam, aortic stenosis is more frequently diagnosed among
patients in their 80s and 90s. Jacqueline is younger than most aortic
stenosis patients, but her mother—as well as her mother’s
brothers and sisters—had also developed heart problems at a young age.
Because of her other health problems, Jacqueline was considered a very
high-risk patient for traditional heart valve replacement surgery, which
requires opening the chest through an incision while the patient is supported
by a heartlung (cardio-pulmonary bypass) machine. “She would have
experienced a very difficult postoperative course, which would have required
a prolonged rehabilitation,” Dr. Azam says.
He recommended that Jacqueline undergo a relatively new, minimally invasive
surgical procedure called
transcatheter aortic valve replacement (TAVR). Last year Torrance Memorial Medical Center launched the TAVR program,
which has since “grown tremendously,” according to Dr. Azam.
During TAVR a catheter slightly larger than the size of a pen is inserted
in the artery in the leg/groin and carefully passed up into the heart.
A replacement valve made of bovine (cow) tissue and supported on a metal
stent is then implanted inside the narrowed aortic valve, resulting in
a normal functioning aortic valve.
The procedure is conducted in Torrance Memorial Medical Center’s
new state-of-the art Hybrid Operating Room located in the Lundquist Tower. The
Hybrid OR features sophisticated imaging systems for catheter-based procedures,
but it also meets the sterility standards and has the equipment of a traditional
operating room. This enables providers to perform high-risk, minimally
invasive procedures and switch to open surgery without moving the patient
if a dire complication arises.
“Torrance Memorial has a dedicated, multidisciplinary heart team
focused on thorough evaluation of each patient to determine the most appropriate
course of treatment,” Dr. Azam says. “Our team is committed
to making a personal connection with each patient and their family. We
really encourage family members to be involved at every step of treatment
because it makes a significant difference in a patient’s recovery.”
A TAVR procedure is not without risks, but it provides beneficial treatment
options to people who may not have been candidates for valve replacement
a few years ago. It also provides the bonus of a faster recovery in most
cases—on average three to five days.
While Ed was apprehensive about moving forward due to the risks, with Dr.
Milefchik’s approval Jacqueline had no hesitation about scheduling
the procedure as quickly as possible. Dr. Azam’s office scheduled
her procedure within just three weeks of diagnosis.
“There were a lot of necessary precautions due to Jacqueline’s
previous surgery complications with anesthesia, but the doctors and staff
were so positive and fantastic,” says Ed. “Susan Robinson,
RN, (TAVR coordinator) and the anesthesiologist’s staff were so
thorough and patient with all of her prep work. They explained everything
we should expect from A to Z. It was very reassuring and helpful.”
The procedure, from prep to operation to recovery, took just less than
three hours. Following the operation, Jacqueline was put on a respirator
for a short time as a precaution to ensure she didn’t have an adverse
reaction to the anesthesia.
Because of her other health issues, Dr. Azam anticipated her post-operative
stay might extend beyond Christmas Eve. But with her sights set on not
breaking her family’s holiday tradition, Jacqueline’s resiliency
surprised everyone. The day following her procedure, she was walking the
hospital halls using her walker.
“It was like night and day before and after (the procedure). She
was a like a new person immediately after,” Ed says.
“They (the staff) told me if I used my walker to walk every day,
if my oxygen levels were good and there were no complications, ‘We’ll
see,’” Jacqueline says of meeting her release date goal. “I
walked four times per day. When I couldn’t sleep at night, the aid
came in and said, ‘Let’s go walk.’ I was told I was
the only patient (admitted for the procedure at the time) who got up and
She continues, “Before the surgery, I had become so pasty, my face
was whiter than the walls.
When my son Christopher saw me for the first time following surgery, he
noticed that my feet were pink (a sign that normal circulation was returning
to her body).”
On day six post-surgery, Jacqueline received good news from Dr. Azam. She
was ready to return home with two weeks to spare before Christmas Eve.
Christmas Eve 2014 was a holiday to remember for the Barleys. And so has
been the year 2015. Dr. Azam’s most recent prognosis for Jacqueline
is a normal lifespan from a cardiac standpoint.
“I still can’t get outside as much as I used to because of
my knees,” Jacqueline says. “But I have so much more energy,
and I’m able to enjoy my grandkids.” One favorite activity
she’s been able to resume is cooking orange chicken with her granddaughter
Victoria after school during the week.
“I was told if this happened a year earlier, I would not have been
a candidate (because TAVR was so new),” Jacqueline says. “I
went from having just a two-year life expectancy to having a new lease
on life. It’s been a godsend and a blessing.”