Intravascular Lithotripsy Leads to Successful TAVR Procedure
Author: Sherry Farney
Deborah Burns, 71, of Grand Blanc was having trouble breathing. After a visit to her family doctor, she was referred to a cardiologist who discovered that she had a severely narrowed aortic valve and possible blockages in her coronary arteries that were causing her to be short of breath.
After a full work up and two heart catherization procedures, Dr. Fouad Azoury, who is a member of the multi-disciplinary structural heart team at McLaren Flint, discussed her results and initially decided on performing open heart surgery to bypass the blockages and place a new valve in Deborah’s heart. But after Dr. Azoury reviewed her CT scan, there was evidence of a significant amount of calcium on her aorta, meaning open heart surgery was no longer an option.
The next option was to do a minimally invasive transcatheter aortic valve replacement (TAVR) procedure through the groin to replace her diseased aortic valve and possibly place stents in her coronary arteries. However, after additional imaging was done, it was discovered Deborah had significant calcium in her leg and pelvic vessels that was making them very narrow. Now the delivery of the transcatheter valve through the groin and pelvic vessels, which is the traditional route, was going to pose a high risk for vascular rupture due to narrowing and calcium. This would not allow the valve to be delivered through the groin and up to her heart.
Deborah is under the care of Ahmad Munir, M.D., board-certified interventional cardiologist and director of structural heart disease at McLaren Flint. After a second discussion with Dr. Azoury and other members of the structural heart team, it was decided Dr. Munir would perform an innovative intravascular lithotripsy procedure to soften the calcium and dilate the narrowing in the vessels in the leg and pelvic arteries, making it a first-of-its-kind procedure at McLaren Flint.
On January 18, 2022, Dr. Munir performed the intravascular lithotripsy on Deborah’s groin and pelvic arteries to facilitate the delivery of the transcatheter valve.
“The procedure involves a balloon technique which uses a high frequency ultrasound shockwave source to soften calcium build up and dilate the arteries,” said Dr. Munir. “In Deborah’s case, it was the only way to make room for the TAVR delivery system.”
The arteries in the groin and pelvis would only be used for valve delivery if the intravascular lithotripsy was successful. Fortunately, it was, and after a two-week recovery period, Dr. Munir was able to insert the TAVR device through the main artery in her left groin on February 1, 2022.
“Intravascular shockwave lithotripsy is an FDA approved procedure, that is still a fairly new option for people with severely calcified arteries who may not have been eligible for a procedure in the past or would be told that anything they had done would be much more high risk,” said Dr. Munir. “This technology is a now an option to offer patients with severe calcification of the arteries. If the procedure sounds familiar it’s because lithotripsy has been used for several years to break up calcium in kidney stones of patients suffering from that condition.”
Three weeks after her second surgery, Deborah is feeling brand new.
“I feel better than I have in a long time,” said Deborah. “Recently, I walked up to my apartment complex office because they were giving away pizza and during the entire walk there and back, I never got out of breath.”
Deborah is really looking forward to getting back to doing the things she loves once her incisions are all healed up.
“I cannot wait to be totally healed up so I can spend time with all my great grandchildren,” said Deborah. “I’m also really looking forward to being able to go camping this summer and just being able to walk around and carry wood from the car to the firepit without feeling out of breath. All the things other people had to do for me, I’m looking forward to doing those things for myself again.”
To learn more about the comprehensive heart procedures offered at McLaren Flint visit, mclaren.org/flintheart.