I was one of the estimated 2.5 million Americans over the age of 75 with aortic stenosis, or AS, a hardening and narrowing of the aortic valve — the primary valve that helps deliver blood through the body. AS is a progressive disease, and I learned that without treatment, a patient with symptomatic AS has a 50 percent chance of dying within three years. The hallmark symptom is shortness of breath, which gets worse over time and prevents you from doing many of the things you enjoy.
A little over three years ago, my cardiologist said that my condition had reached the point where I should look at treatment options. I was 85 years old at the time and had no symptoms. I was a competitive singles tennis player in my age group and had a very active life. I was not a candidate for open heart surgery because of complications from previous heart surgery, so my only option was transcatheter aortic valve replacement, known as TAVR. It’s a minimally invasive way to replace your failing heart valve using catheters, instead of open heart surgery.
My doctors scheduled me for a TAVR procedure but, as a retired physician, I did my homework. I found that stroke is a significant potential side effect of TAVR, and there’s no way to predict which patient will suffer a stroke after TAVR.
[See: 6 Signs You’re Having a Heart Attack.]
During the process of replacing the heart valve, material like calcium and pieces of the valve or heart tissue can come loose. Some of that material can travel through the arteries to the brain, where it can lodge and cause damage. Studies have shown that up to 99 percent of TAVR patients show signs of material headed to the brain after the procedure.
Depending on the size and nature of the material, they can be absorbed by the body and cause no damage, they can cause minor strokes that have the potential to cause long-term impact or they can cause a major stroke with long lasting disability. I saw three outcomes for myself: 1.) I could do great, 2.) I could have one or more small strokes and potentially get dementia, or 3.) I could have a major stroke and be disabled for life or die. I’d rather die than be a burden on my family and myself.
I’m told that stroke is random and unpredictable — people with a high risk for stroke may never have one, while those with a low risk can suffer a stroke without warning. That’s what makes it so frightening.
TAVR seems to help many patients, but the risk was too high for me, so I canceled my procedure and began looking at other options. I’m not afraid to die, but I am afraid of a stroke.
In my research, I found a device called the Sentinel Cerebral Protection System, which at the time was in clinical studies in the U.S., although it was commercially available in Europe. The device is placed in the main arteries that carry blood to the brain during the TAVR procedure to protect the brain from the risk of stroke. It filters, captures and removes the material headed to the brain before it can get there, and has shown it can reduce the risk of procedural stroke by 60 percent. That sounded good to me!
[See: 10 Ways to Lower Your Risk of Stroke.]
I reached out to the main centers that were conducting clinical trials of Sentinel in the U.S. and was told it would take a year and a half for the studies to be completed. Having been given three years to live, I decided to wait to have the procedure until I could have the extra layer of stroke protection.
As I waited, my aortic valve started closing down, and I began to feel the symptoms. I had to slow down my tennis game, moving from singles to doubles, and then stopping altogether — my tennis partners didn’t want to be responsible for me dying on the court. Eventually, I had to stop to catch my breath even with no greater exercise than a leisurely walk. My heart rhythm was also getting erratic when I did any exercise.
During this time, because I had been so vocal in getting information, the company behind the technology asked me if I would speak at a Food and Drug Administration public panel meeting to articulate how badly patients need stroke protection. There, I met one of the leading TAVR experts in the country, Dr. Samir Kapadia from the Cleveland Clinic, who had responded to me earlier. I told him that I would be calling him as soon as the FDA granted clearance for the cerebral protection technology. I didn’t have to. As soon as the device was cleared by the FDA, his nurse called me to tell me my appointment had already been scheduled. With the new technology to protect me, I now felt confident to undergo the TAVR procedure. I went to Cleveland, had the procedure and was home in Corpus Christi and feeling normal again three days later.
I’ve seen pictures of the material that was captured by the Sentinel device on the way to my brain, and I am thankful that I waited. I had no stroke, and I haven’t looked back since.
I returned to tennis right away but injured my shoulder, so I’ve had to quit for the time being, but I hope to get back there. I could barely walk without stopping after a few steps, and now I can run. I do yard work with no trouble. I can walk the beautiful bay front of Corpus Christi without resting. And I have no problem walking up the steps to the Corpus Christi Cathedral, which I couldn’t do before.
[See: 9 Reasons You Should Return to Work After a Stroke.]
During Stroke Awareness Month, I urge patients to take their health in their own hands and learn about their stroke risk, as I did, before undergoing procedures where stroke is a known complication. I have no way of saying if I would have had a stroke had I undergone the procedure without protecting my brain, but I’m glad I didn’t have to find out.
Jim McCutchon is a retired physician and Sentinel patient in Corpus Christi, Texas.
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How One Patient Protected Himself Again Stroke After TAVR originally appeared on usnews.com
