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As an internationally acclaimed blacksmith, Eric Moebius, 72, has stamina, strength and talent few people possess. Using centuries-old techniques with just a hammer, steel and fire, Eric forges some of Milwaukee’s most well-known wrought iron creations, such as some of the historic gates on lakefront homes from the 1800s. But the intense physicality Eric’s craft requires is not possible without a healthy heart.

“I felt lightheaded, winded and fatigued,” Eric said. “I thought it was old age. I thought the day had come where I couldn’t be a blacksmith, and I had to give up my work and passion.”

Surgical Valve Failure

Eric had a history of heart valve disease. In 2010, he had surgery to replace his aortic valve with a surgical tissue valve. The lifespan of this type of valve is approximately 10 years, but Eric didn’t know this was the reason for his symptoms. He followed up regularly with his cardiologist, Kiran Kashyap, MD, at Froedtert Menomonee Falls Hospital. At his appointment in the summer of 2020, Eric and Dr. Kashyap discussed his symptoms, and she recommended diagnostic imaging. The tests revealed his valve had worn out and was leaking, affecting the systolic function of his heart. This means the left ventricle of Eric’s heart was not able to contract properly, so blood was not pumping efficiently through his body. Dr. Kashyap referred Eric to Michael Salinger, MD, an interventional cardiologist at Froedtert & MCW Froedtert Hospital.

“After about 10 years, mineral begins to build up in artificial tissue valves, which prevents the valve leaflets from opening and leads to restricted flow,” Dr. Salinger said. “This creates back pressure in the heart, the left ventricle starts to enlarge, pressure builds up in the lungs and you become short of breath. All of these things were happening to Eric. It is a mechanical problem that requires a mechanical solution: a new valve.”

Valve-in-Valve TAVR: A Minimally Invasive Alternative to Open Heart Surgery

Valve-in-valve TAVR within the heart

Eric hoped that another heart surgery would not stop him from his work as a blacksmith. He wanted to avoid the incision and lengthy recovery time that comes with open heart surgery, if possible. Dr. Salinger and Paul Pearson, MD, cardiothoracic surgeon for the Froedtert & MCW health network, discussed the options. They decided the best individualized therapy for Eric would be to repair his heart with a catheter-based procedure. This minimally invasive alternative, called a valve-in-valve TAVR, or transcatheter aortic valve-in-valve replacement, involves placing a new TAVR valve within the failed surgical valve from Eric’s previous surgery.

In November 2020, Dr. Salinger and Dr. Pearson installed the new valve by expanding it within the old valve, using a special balloon made from Kevlar®, a synthetic material that can withstand intense pressure. The balloon is inflated to higher and higher pressures until it breaks open the old surgical valve and creates even more room to fully expand the new TAVR valve. This technique is known as an intentional surgical valve balloon fracture.

“The result is minimal resistance to blood flow, which is why patients feel instantly better,” Dr. Salinger said. “In Eric’s case, we measured the gradient of the blood flow after the procedure, and there was zero resistance. This was a spectacular outcome.”

TAVR Procedure Recovery

Eric was walking around the hospital just three hours after his procedure. He says he immediately felt different.

“I couldn’t feel my heart – which is what it is supposed to be like!” Eric said. “Before, it was always pounding, and I felt so unsteady.”

The valve-in-valve TAVR procedure is done with local anesthetics and sedation, and it lasts about an hour. The average hospital stay is two nights, but Froedtert & MCW patients are usually only admitted for one night.

“We have built efficiencies into our program that allow us to achieve the shortest length of stay in current practice,” Dr. Salinger said.

To reduce the risk of stroke during a TAVR procedure, which can be caused by calcium or tissue debris, Froedtert & MCW patients benefit from a protective therapeutic device. The Sentinel™ Cerebral Protection System filters, captures and removes debris. The Sentinel device is the only FDA-cleared device that protects against the risk of stroke during TAVR.

Eric’s recovery was quick. After one night in the hospital, he went home. With no incision on his chest, he felt fully recovered six days later and was able to work. He got back to his anvil, gifted to him by Prince Charles of England, with a hammer in hand and grateful that his heart is healthy again.

“I feel like I’m forty again,” Eric said. “I can’t explain how amazing I feel. It’s an incredible gift to me.”

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