When asked if she was nervous about being BWH’s first patient to undergo a transcatheter aortic valve replacement (TAVR) without general anesthesia, 82-year-old Mary Walsh responded with a gentle smile.
“No, I was not at all apprehensive,” said the Pawtucket, Rhode Island, resident.
TAVR is a minimally invasive surgical procedure that repairs a damaged aortic valve. Instead of removing the old valve, TAVR inserts a replacement valve in its place using a catheter and is usually performed under general anesthesia.
Nearly two decades ago, Walsh had open heart surgery to address a congenital valve defect and coronary artery disease, but endured a long post-operative recovery period. “It took a long time for me to get my strength back,” she said.
More recently, Walsh began to feel short of breath. This worsened until she felt as though she was always struggling to breathe. In fall 2013, Walsh was hospitalized for pneumonia. Local cardiologists affiliated with BWH, including Alice Kim, MD, discovered that Walsh’s aortic valve was worn and functioning poorly.
Andrew Eisenhauer, MD, director of BWH’s Interventional Cardiovascular Medicine Service, suggested that Walsh might be a good candidate for TAVR using a sedation-based anesthetic. Patient assessment and procedural planning were a multidisciplinary effort involving interventional cardiologists Eisenhauer, Frederick Welt, MD, Pinak “Binny” Shah, MD, and Deepak Bhatt, MD, MPH; cardiac surgeon Michael Davidson, MD; cardiac anesthesiologists Charles Nyman, MD, and Douglas Shook, MD; nurses and technologists. The team smoothly placed a new valve in the deteriorated aortic valve under the watchful care of Nyman.
“Mrs. Walsh’s anesthetic was a continuum of sedation, from being responsive to my voice to being deeply sedated to unconscious, as dictated by the needs of the patient and procedure,” said Nyman. Walsh was alert less than an hour later, feeling great and experiencing no side effects.