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Through a Small Incision, a New Lease on Life

John Soditus

John Soditus started to suspect something was wrong with him this past June. He was taking twice as long to mow his lawn as he normally would, and he needed to stop and rest multiple times along the way.

Soditus, who lives in West Bradford Township in Chester County, Pa. and will turn 80 later this year, leads an active life in retirement. An avid camper, he also exercised three to four times a week prior to the pandemic, between spinning classes and weight training. He had been seeing a cardiologist, William Clay Warnick, MD, FACC, the medical director of the Cardiovascular Service Line at Penn Medicine Chester County Hospital, for a heart murmur and angina.

Soditus soon found that his new health struggles could be addressed with an advanced procedure right at his own community hospital.

Anne Caporale

Not far away and around the same time, Downingtown resident Anne Caporale made a similar discovery. At 94, Caporale continues to do most of her own housework. She also cooks every day and usually drives herself when she runs errands and has appointments. The diagnosis didn’t come as a complete surprise to her. Four years earlier, Caporale’s cardiologist, Gregg L. Neithardt, MD, FACC, informed her that she had developed mild aortic stenosis. He had been monitoring it since.

An echocardiogram in July showed that her condition had worsened.

An echocardiogram likewise revealed what that severe aortic stenosis was also sapping Soditus’ stamina. In this condition, the aortic valve’s leaflets — think of them as little doors that open and close as blood is pumped through the heart — become stiff and thickened and, as a result, have a hard time moving. The heart ends up having to work harder to pump blood to the rest of the body.

To correct their severe aortic stenosis, both Soditus and Caporale were recommended for a minimally invasive procedure at the Heart Valve Center at Chester County Hospital called TAVR.

What is TAVR?

TAVR stands for transcatheter aortic valve replacement.

An alternative to open-heart surgery, TAVR is a minimally invasive procedure where a new, fully collapsible replacement valve is placed inside the diseased heart valve through a catheter. Although there are several approaches for inserting the new valve, the most common is the transfemoral approach.  A very small incision is made and a catheter is inserted into the large artery in your groin.  A specialized x-ray camera is utilized to help the doctor guide the new valve into the heart. 

Once it’s in place, the new valve is expanded, at which point it pushes the old, stiffened leaflets out of the way and takes over regulating the blood flow.

TAVR is designed to correct severe aortic stenosis, and it’s available to patients who are otherwise in good health and those who are elderly or have other complications that would make a traditional open-heart surgery risky. Penn Medicine was an early adopter of TAVR beginning in 2007, running early clinical trials and gaining experience that has made Penn one of the top five programs in the country. The Heart Valve Center at Penn Medicine Chester County Hospital began offering TAVR in mid-July, though it had been evaluating patients for whom the procedure was a possibility for several years and referring patients that were considered good candidates for the procedure to sister hospital Penn Presbyterian Medical Center, in Philadelphia.

With TAVR now available at Chester County Hospital, candidates for the minimally invasive procedure who live in this community can remain close to home not only for their treatment but also for the necessary appointments beforehand and their follow-ups. That convenience lessens potential distractions, like travel, and allows candidates and their families to focus on their recovery.

Julie Pitts, CRNP, MSN, the program manager at the Heart Valve Center, conducts a thorough review of each patient’s records as they’re referred to the center for the procedure. Beyond confirming the patient’s diagnosis, she also needs to ensure their anatomy is suited to the procedure. Good transfemoral access is important, as is the size of the aortic valve. Certain constraints arise if it’s too large or too small.

If the patient is a good candidate for TAVR, Pitts will plot out the next steps, the first of which is generally arranging a meeting between the patient and Muhammad Raza, MD, FACC, an interventional cardiologist and the medical director of the Structural Heart Disease Program at Penn Medicine Chester County Hospital, and surgeon Deon W. Vigilance, MD, MBA, clinical assistant professor of Surgery at Penn Medicine. During the session, Raza describes what will happen during the procedure and what needs to come before it.

Compared to open-heart surgery, there’s an extra step involved in the preparation for TAVR: a CT scan of the chest, abdomen, and pelvis, which creates a kind of internal roadmap for the interventional cardiologist and helps them better assess the transfemoral access.

After that, the patient undergoes a heart catheterization, which provides the interventional cardiologist with a better understanding of their heart’s anatomy and allows them to identify and treat certain other heart conditions.

Everything is scheduled by a patient navigator, who is meant to serve as a liaison between the patient, Pitts, and the doctors.

“Our navigators are what set our program apart,” Pitts says. “Our main goal is to make sure that our practice is very patient-focused. We want every patient to feel fully supported throughout their treatment. We’re a community hospital, after all. And we want to maintain that feel — while providing next-level care.”

Getting back to normal

Caporale says that once the decision was made to move ahead with her procedure, the process moved very quickly. Soditus had a similar experience.

“I have nothing but great things to say about Julie and her team,” he says. “They’ve been tremendous. They coordinated everything for me, every test, every appointment. If I was left to do it on my own, it would have taken a month or two. With them, it was a few days.”

A month removed from his procedure, Soditus says he’s feeling back to his normal self. He’s been taking long walks regularly, and he says he’s ready for more. But he’s been cautious about pushing himself. “I was feeling good after the first week. I think I could have done a lot more, but as I was leaving the hospital, Julie reminded me that I had major surgery, even though I didn’t have a big scar to show for it,” he says. “So I’ve made sure to follow my recovery instructions closely.”

Two weeks removed from her procedure, Caporale is also taking it slowly, even though it’s not in her nature. Deciding to undergo TAVR was, she says, “a no-brainer.” She told Raza, “Do what has to be done.” She had a large family to get back to: five grown children, 10 grandchildren, 24 great-grandchildren, and two great-great grandchildren. She says she feels fortunate to have providers of the highest caliber right in her own Chester County community.

“My surgical team was wonderful. Dr. Raza and Dr. Vigilance, particularly, were informative and clear at every turn,” she says. “And, obviously, I came through alright. I have Julie and the hospital floor staff who looked after me to thank for that, too. Julie’s support has been great, both with managing the scheduling of my tests and procedures beforehand and her valuable evaluation since my surgery.”



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