Home for the Holidays

When Dan Plesniarski, 67, found out in November 2019 that he needed his aortic heart valve replaced, he never imagined he’d have a new valve and be back on his feet before Christmas.

Plesniarski, a resident of Andreas, was a candidate for transcatheter aortic heart valve replacement (TAVR), a nonsurgical alternative to open heart surgery offered through Lehigh Valley Heart and Vascular Institute. The procedure typically does not require an incision or general anesthesia, making recovery quick. For Plesniarski, that meant spending Christmas with his twin grandsons just six days after his procedure.

A timely diagnosis

Plesniarski has a family history of heart disease and had been experiencing shortness of breath and fatigue for a while. When the symptoms increased, his wife and daughter urged him to see a cardiologist. “I ran out of breath really quickly,” he says. “I didn’t have chest pains, but I was tired all the time. It just seemed to be getting worse.”

Cardiologist Cheri Silverstein Fadlon, MD, with LVPG Cardiology–Lehighton, ordered a cardiac catheterization, a noninvasive procedure used to diagnose certain heart conditions. It revealed severe aortic valve stenosis, a narrowing of the aortic valve that can develop with age or be caused by a congenital birth defect.

“Even though you may not have a clear hereditary disorder, you can inherit risk factors for aortic stenosis,” Silverstein Fadlon says. “Anyone with a family history of valve disease should tell their doctor about it so we can take proactive measures, identify the symptoms early and provide treatment.” In Plesniarski’s case, the best treatment was valve replacement using the TAVR procedure.

What is the TAVR procedure?

TAVR is a minimally invasive procedure used to insert a new heart valve, typically without making a chest incision. It provides an alternative to open heart surgery, which involves cutting through the chest to gain access to the heart.

During TAVR, an interventional cardiologist puts a catheter (thin tube) into the femoral artery, which is located in the groin. That tube is used to transport a biologic valve (made from animal tissue) up to the heart, where it is placed into position.

Turning to an expert

Within a month of his initial appointment and just days before Christmas, Plesniarski arrived at Lehigh Valley Hospital–Cedar Crest to have his valve replaced by William Combs, MD, an interventional cardiologist with LVH Cardiology–1250 Cedar Crest. Combs and his colleagues were early adopters of TAVR and have used it since 2012. They perform over 200 procedures a year.

“Dan was a good TAVR candidate. He had severe aortic stenosis,” Combs says. “But he didn’t have any other conditions that would have made surgery a better option, such as significant coronary artery disease or other valvular problems.”

The road to a rapid recovery

The valve replacement was a success, though Plesniarski developed a hematoma (bleeding under the skin) in the days following surgery. “Hematomas happen about 1% of the time,” Combs says. “They can cause discomfort and discoloration, but they typically resolve on their own.”

Even with the complication, Plesniarski was home and feeling better by Dec. 24, just six days after his procedure. “I had to take it a little easier around the grandkids, but I got to enjoy our Christmas traditions,” he says. “My experience was great. I can’t say enough about the nurses and medical team. They were amazing throughout the entire process.”

Considering TAVR

While benefits of TAVR (such as rapid recovery and reduced risk for complication) are attractive, Combs reminds people that there are many aspects to consider.

Patients should understand that TAVR:

• Increases the need for a pacemaker, with 10% of TAVR patients receiving a pacemaker at some point
• May require patients to adopt a permanent regimen of low-dose aspirin (but not prescription blood thinners)
• Uses biologic valves that have a limited lifespan, so younger patients may eventually need another valve replacement

Combs recommends discussing your valve replacement options with your cardiologist to understand the best choice for you.