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Essentia Health brings lifesaving procedure to Northland

When doctors diagnosed 86-year-old Delores “Dolly” Stepan with aortic stenosis, the prognosis was grim. The disease narrows the aortic valve, and without a replacement valve, half of untreated patients die within 12 to 24 months.

“Aortic stenosis is a common problem,” said Dr. Nizar Saleh, Essentia Health cardiologist and director of echocardiography. “Many people do not realize they have it, and just attribute it to slowing down as they get older.”

Stepan, who lives in Nashwauk, Minn., had very little hope. She was too frail with other medical problems, making open-heart surgery too risky. Then she found out about a revolutionary new procedure at Essentia Health St. Mary’s-Heart & Vascular Center in Duluth. The center is one of only five facilities in Minnesota to perform transcatheter aortic valve replacement, or TAVR.

“I was getting progressively worse and at my age, and after triple-bypass surgery, I didn’t want to do another open-heart surgery,” said Stepan. Known for her July Fourth parties and cookie-baking sessions with family, she knew something wasn’t right when she started getting so tired. After a heart attack in August, doctors told her about TAVR, and how it might work for her.

“It sounded a lot simpler than open heart surgery and yet would take care of my heart problem,” Stepan said.

The TAVR procedure uses tissue from cows’ hearts. The valve is fed through arteries in the body via the groin, neck or under the breast or ribs. Once inside the heart, the valve expands to about an inch in size and begins working immediately. All while the heart is beating.

“Before, we’d have to open up the chest and put the patient on a heart-lung bypass machine, which many patients cannot handle,” said Dr. Antonio Laudito, Essentia Health’s section chairman of cardiothoracic surgery “TAVR opens up new possibilities in the future of heart care. This is a game changer, and only the beginning of what we’ll be able to do in the future.”

Essentia Health St. Mary’s-Heart & Vascular Center has performed nine TAVR procedures since October 2013. Stepan was patient No. 4.

“My nickname’s Dolly, but I’m also known as TAVR No. 4,” Stepan said.

The operation is covered by most insurance, including Medicare.

Stepan said she was so grateful to all of her doctors, and her amazing registered nurse Amanda Hunker, the TAVR coordinator at Essentia Health Heart & Vascular Center. “She was there always for me, night or day, so comforting.” Stepan also appreciates the advanced skills of the medical team.

The procedure is a team effort. Interventional cardiologists, cardiothoracic surgeons, echo cardiographers, anesthesiologists, catheter lab and operating room staff all receive special training and must be certified before performing the TAVR procedure.

“When someone comes to the Heart Center for a consultation, the very first time and every time, they are met by all of us,” said Dr. Mudassar Ahmed, Essentia Health’s director of the catheterization lab and interventional cardiologist. “We meet with each patient and their families together as a team to discuss the procedure, so they are comfortable and confident going in.”

Most TAVR patients are home in half the normal time of conventional open-heart surgery.

“Often on day four after open-heart surgery, you’d still be in the intensive care unit,” said Dr. Ahmed. “Now our patients are home in that timeframe.”

And for Stepan that’s what’s important, baking cookies with her grandchildren and great-grandchildren, hosting another party on the Fourth of July and celebrating her own independence.

“I know I’m getting stronger every day. It’s lifesaving,” she said.

“It’s wonderful being able to provide this option,” said Dr. Laudito, “To give someone the gift of life. It’s amazing.”