Issue link: http://digital.copcomm.com/i/551105
H E A RT B E AT S J acqueline Barley, age 67, had made up her mind. When she checked into Torrance Memorial Medical Center on December 9, 2014, for surgery, she reaffirmed to her family and the medical staff that she and her husband, Ed, would host her four sons, their wives, 10 grandchildren, extended family and friends for Christmas Eve—as was their tradition. Jacqueline was determined to make her body cooperate with her mind, but it was an ambitious timetable. Just a few months prior, Ed had begun to notice a decline in Jacqueline's health. He initially thought it might just be her asthma flaring up. But as her condition worsened, he and his family feared something more serious was to blame. "She wasn't getting up much during the day. She couldn't get from the bed to the bathroom without becoming out of breath," Ed says. Because Jacqueline had become close to bedridden, Ed took an early retirement from his 40-year job at the Long Beach Harbor so he could focus on her care. Jacqueline had long been challenged with two autoimmune diseases: lupus (a systemic disease in which the body's immune system mistakenly attacks healthy tissue) and rheumatoid arthritis (a disease that leads to loss of joint function). In need of knee replacement, her mobility was also limited to using a walker—and oen a wheelchair—to get around. However, because of her suppressed immunity, her primary physician, infectious disease specialist Eric Milefchik, MD, told her the risk of post-surgery infection was too high for any major surgery. During a weekly appointment at Dr. Milefchik's office, nurse practitioner Izzat Alamdar (Dr. Milefchik's wife) was concerned about Jacqueline's fatigue and shortness of breath. Aer discussing her symptoms with Dr. Milefchik, an appointment was made with interventional cardiologist Salman Azam, MD, who specializes in structural heart disease. Dr. Azam put Jacqueline through a series of diagnostic tests, including an echocardiogram, a chest X-ray and an angiogram to diagnose any major heart abnormalities contributing to her symptoms. e tests revealed her heart valve had become severely calcified—a condition known as aortic stenosis. Dr. Azam told the Barleys that Jacqueline would have a 50% chance of surviving the next two years unless she underwent immediate heart valve replacement. Because of her other health problems, Jacqueline was considered a very high- risk patient for traditional heart valve replacement surgery, which requires opening the chest through an incision while the patient is supported by a heart- lung machine. Dr. Azam recommended that Jacqueline undergo a relatively new, minimally invasive surgical procedure called transcatheter aortic valve replacement (TAVR). Last year Torrance Memorial Medical Center launched the TAVR program, which has since "grown tremendously," according to Dr. Azam. During TAVR a catheter slightly larger than the size of a pen is inserted in the artery in the leg/groin and carefully passed up into the heart. A replacement valve is then implanted inside the narrowed aortic valve, resulting in a normal functioning aortic valve. e procedure is conducted in Torrance Memorial Medical Center's new state-of-the art Hybrid Operating Room located in the Lundquist Tower. e Hybrid OR features sophisticated imaging systems for catheter-based procedures, but it also meets the sterility standards and has the equipment of a traditional operating room. is enables providers to perform high-risk, minimally invasive procedures and switch to open surgery without moving the patient if a dire complication arises. A TAVR procedure is not without risks, but it provides beneficial treatment options to people who may not have been candidates for valve replacement a few years ago. It also provides the bonus of a faster recovery—on average three to five days. While Ed was apprehensive about moving forward due to the risks, with Dr. Milefchik's approval Jacqueline had no hesitation about scheduling the procedure as quickly as possible. Dr. Azam's office scheduled her procedure within just three weeks of diagnosis. e procedure, from prep to operation to recovery, took just less than three hours. Because of her other health issues, Dr. Azam anticipated her post-operative stay might extend beyond Christmas Eve. But with her sights set on not breaking her family's holiday tradition, Jacqueline's resiliency surprised everyone. e day following her procedure, she was walking the hospital halls using her walker. "It was like night and day before and aer [the procedure]. She was a like a new person immediately aer," Ed says. On day six post-surgery, Jacqueline received good news from Dr. Azam: She was ready to return home with two weeks to spare before Christmas Eve. Christmas Eve 2014 was a holiday to remember for the Barleys. Dr. Azam's most recent prognosis for Jacqueline is a normal lifespan from a cardiac standpoint. "I went from having just a two-year life expectancy to having a new lease on life," says Jacqueline. "It's been a godsend and a blessing." • "I WENT FROM HAVING JUST A TWO-YEAR LIFE EXPECTANCY TO HAVING A NEW LEASE ON LIFE. IT'S BEEN A GODSEND AND A BLESSING." torrancememorial.org PULSE | 43