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Mary Walsh is BWH's first patient to undergo a transcatheter aortic valve replacement without general anesthesia.
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," Nyman said. Walsh was alert less than an hour later, feeling great and experiencing no side effects.
BWH patient Mary Walsh (center), with husband, Joe Walsh, and daughter, Veronica Walsh
The team expects the procedure will be a model for continued cooperation and multidisciplinary efforts among Cardiology, Cardiac Surgery and Cardiac Anesthesia. "Our practice is to design the optimal anesthetic plan for each patient based on his or her needs and the constraints of the procedure," said Shook. "Mrs. Walsh was the first patient we encountered for whom a sedation-based anesthetic was a preferable choice. We will continue to use the technique for appropriate patients, in consultation with our colleagues."
Eisenhauer predicts that, "like many procedures, the miniaturization of equipment and improvements in procedure will require less and less invasiveness as technology matures, and more patients will become appropriate candidates for new approaches to patient care."
In the future, these collaborative efforts will likely lead to more efficient procedures, reduced costs, faster recovery, improved outcomes and happier patients.
"I can't believe how much better and stronger I feel," said Walsh, the day after surgery. "My doctors explained everything so well to me. It gave me a lot of confidence in them."
Added daughter, Veronica Walsh: "I was so impressed by how good she looked when she came out of surgery. Her physicians and nurses were incredibly helpful and reassuring."