Amherst man tries out a minimally invasive alternative to open heart surgery

  • “I’m still in that ‘wow’ phase,” said Simon Keochakian of his recent transcathetor aortic valve replacement that gave him renewed energy. STAFF PHOTO/JERREY ROBERTS

  • Simon Keochakian stacks wood at his home in Amherst. He recently underwent a procedure called transcatheter aortic valve replacement, but was able to return to activity, like cutting wood, two weeks later. STAFF PHOTO/JERREY ROBERTS

  • Simon Keochakian at his home in Amherst. STAFF PHOTO/JERREY ROBERTS

Staff Writer
Published: 10/19/2018 12:17:34 PM

The last thing that Simon Keochakian of Amherst remembered was talking to technicians in the operating room. And then, there was nothing.

About an hour later, Keochakian, 83, awoke with a new aortic valve, and went home the next day.

A decade ago, an aortic valve replacement procedure would have required hours-long open heart surgery and months of recovery time, Keochakian said. But through a minimally invasive surgical procedure called transcatheter aortic valve replacement, or TAVR, surgeons replaced his aortic valve by threading it through a catheter in the femoral artery.

“‘Wow’ is the appropriate reaction. I’m still in that ‘wow’ phase. I’m still astonished,” Keochakian said recently about his Aug. 30 surgery. “My wife came down and picked me up. I was driving the next day.”

While this procedure has been around for about a decade (it was first performed in France in 2002), it’s only been available to patients who weren’t eligible for open heart surgery.

More recently, the procedure has been opened up to “moderate-risk” patients by the U.S. Food and Drug Administration. It isn’t widely available yet for “low-risk” patients. Keochakian, who was rated as a “low-risk” patient, and otherwise would have had to undergo open heart surgery to replace his damaged valve, signed up for a research study and underwent TAVR at Hartford Hospital.

Keochakian is a retired psychologist at the University of Massachusetts Amherst and was diagnosed with aoritic stenosis in the spring. Aortic stenosis is a condition that happens when the heart’s aortic valve becomes stiff from calcium build-up, and worn out by age, making it harder for the heart to pump blood.

Before his condition, Keochakian said he often worked outside, cutting and stacking wood for the winter. Gradually, though, “I tired easily. I fatigued, but I figured, ‘That’s old age, I’m 83 years old.’ When I’m chainsawing, I got tired, and so I said, ‘The next day I have to rest,’” he continued.

But when his cardiologist recommended that Keochakian take a stress test on a treadmill, and he could only handle the physical activity for a minute and a half, he knew that something had to change.

“You either get surgery or you die. The ultimate prognosis for aortic stenosis is death if it’s untreated,” Keochakian said. “I was a candidate for open heart surgery. But open heart surgery is very barbaric, and the recovery time is very long. You lose a good chunk of your life for a year.”

With open heart surgery, he noted, doctors have to crack open the chest and make an incision from the clavicle to the belly button.

Coincidentally around that time, Cooley Dickinson Hospital held a public presentation on TAVR by Dr. Ali Haider, a cardiologist who practices at Hampshire Cardiovascular Associates in Northampton, which is affiliated with the hospital.

“(Haider) was very clear, very thorough, and I said to my wife, ‘Joan, that’s me. TAVR is my solution,’” Keochakian said. But after researching what it would take to get the procedure, he learned that it was only available for people who might die from open heart surgery.

After consulting with Haider, Keochakian went to Hartford Hospital to find out about a less invasive surgery. Haider’s practice does TAVR procedures, but only on at-risk patients.

While Keochakian was in Hartford, he learned the FDA had recently given Hartford Hospital permission to open enrollment and perform TAVR on a few hundred patients classified as low-risk.

The experience has left Keochakian, who is still a licensed psychologist, with a better appreciation for recent medical advancements and the importance of biomedical engineering.

Before the procedure, surgeons take CAT scans to measure the arteries and make sure the valve will fit. They make incisions in the femoral arteries, at the groin, and insert a catheter into the artery. Once that’s in place, the new valve, which is crimped to fit through the artery, is snaked up through the catheter and positioned inside the valve. Then, the new aortic valve is opened, crushing the old valve against the artery’s walls.

“This procedure has been a game-changer in cardiology,” Haider said. “As the technology improves, I think this is going to become the gold standard, and very few people will be getting open heart surgery for this problem.”

Many patients that Haider treats now aren’t candidates for open heart surgery because it’s too risky, he said, noting that he recently completed the procedure on a 97 year-old patient.

It’s beneficial across the board, requiring an hour under-the-knife as opposed to around three hours for open heart surgery; the hospital stay afterward averages around three days. What’s more, Haider said TAVR costs less money than open heart surgery because it requires less time in the operating room and afterward for recovery.

When the procedure was first being done, Dr. Anthony Russo, a cardiac surgeon at Baystate Medical Center (which also offers the procedures for at-risk patients), said the catheters often leaked around the edges. Comparatively, patients who underwent open heart surgery didn’t have that problem because the valves were sewn in.

“We sort of tolerated that because the people were too sick to have open heart surgery,” he said. But as the technology has progressed, “the catheters have gotten smaller, and the valves themselves have a skirt around them that prevents leaking.”

Aortic stenosis is very common in elderly patients, Russo said. And, if untreated, “it can be very dangerous,” he continued.

“Previously, primary doctors and some cardiologists were reluctant to send these older people (into surgery), because they couldn’t withstand open heart surgery,” he said.

With TAVR, though, which Haider predicted will be widely approved for all patients by the FDA in the next few years, “this has opened a door to improve quality of life.”

For Keochakian, that means more quality time with his three sons and their wives, and three granddaughters. It’s now been more than two months since his procedure, and Keochakian said his energy levels have rebounded. He’s able to work outside again, and can often be found stacking wood.

“I can do consecutive days of vigorous work now, where I couldn’t do it before. One day I would work, the next I was a wreck,” he said. “I have energy. My work tolerance is much greater.”

Learn more

Simon Keochakian is willing to discuss his transcatheter aortic valve replacement with anyone who’s interested in knowing more about the procedure. Email him at simonk@acad.umass.edu. To find out more about the research study at Hartford Hospital, where Keochakian had the procedure, visit bit.ly/2ItitB1.


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