Patient experienced crisis overseas; came home to experience a great outcome
Robert McKee knows the heart team at Munson Medical Center. He’s put his life in their hands on more than one occasion.
“You have a good group up there,” he said from his winter home in Florida. He had just walked a mile-and- a-half on his treadmill.
In 1991, the Frankfort-area retiree had open heart bypass surgery. He returned to the hospital in 2005 to have his aortic valve replaced with a porcine one after living with a heart murmur since childhood. In the summer of 2016, during a checkup he said cardiologist Anne Hepner, M.D., FACC, informed him the valve showed signs that it might need to be replaced again.
During an August vacation in Italy, Dr. Hepner’s earlier observation became reality.
“I woke up and I was having trouble breathing,” he said. He went to the local hospital and thankfully had a cardiologist who could speak English. An examination that included an MRI showed his aortic valve failed. After spending some days in the hospital there, he got on a plane for Traverse City with a DVD full of examinations.
“They were in contact with Munson until I got back,” he said. After reviewing the DVD of exams, and giving him additional tests, Munson Medical Center’s Structural Heart Clinic team scheduled a transcatheter aortic valve replacement, or TAVR procedure, for Nov. 1.
Interventional cardiologist Nicklaus Slocum, M.D., FACC, said McKee was a good candidate for the minimally invasive procedure. “TAVR offers a good opportunity to replace a valve without going through an open heart procedure when people reach their 80s and 90s,” he said.
As medical director of the Structural Heart Clinic, Dr. Slocum and the TAVR team specialize in treating usually older patients with severe heart valve abnormalities. In addition to cardiologists, members of the team include anesthesiologists, cardiothoracic surgeons, nurses, and other support staff.
During a TAVR procedure, patients receive a replacement aortic valve via catheter. Dr. Slocum said the team recently began doing it with conscious sedation, similar to what a patient would experience in a heart catheterization. They previously used general anesthesia similar to what occurs during open heart surgery.
“What we’ve found is that patients recover a lot faster and leave the hospital faster,” he said. “During the procedure they can talk to the anesthesia team. With this procedure, we are mostly dealing with patients in their 80s and 90s, so we want to get them through the anesthesia, then walking and back to their routine.”
The Structural Heart Clinic began in 2012. In 2016, staff cared for 245 patients with severe heart valve issues. The clinic allows patients the opportunity to be seen comprehensively by cardiologists, cardiothoracic surgeons, and nurses. Diagnostic tests are performed on the same day and evaluated by multiple specialists. Patients receive a care plan that is developed and agreed upon by the team of experts.
In 2016, 51 patients received a TAVR procedure, double the number from 2015.
Dr. Slocum said the TAVR procedure reflects the advances in heart care and offers a future blueprint for more minimally invasive heart procedures as technology and medicine advance. Typically, a TAVR patient spends three to four days in the hospital versus five or six for those who undergo open heart surgery.
“Patients go back to their lifestyle quickly,” he said.
In annual rankings released in August 2016, U.S. News and World Report characterized Munson Medical Center as in the top 50 programs nationally for cardiology and heart surgery and as high performing in aortic valve surgery. The hospital ranked fifth in quality in the State of Michigan.
Learn more about the hospital's quality efforts.