Waiting for This Life-Saving Procedure Wasn't an Option

Posted July 10, 2020

Daniel Novembrino, 83, could barely make it across the kitchen of his home without fighting for breath.

His aortic valve was damaged and constricted to the point that his heart could no longer pump enough blood -- and the oxygen it carries -- throughout his body. Most of his major heart arteries were in trouble too, all showing signs of blockages that could be life threatening if left untreated.

Fortunately, Greg Ehle, a cardiology physician assistant at University of Vermont Medical Center, had been monitoring Novembrino for months. They started talking with him about surgery to repair both his heart valve as well as the blockages in his arteries. The tentative date was scheduled for April.

But then COVID-19 struck, and everything changed. As COVID-19 hit our region, hospitals were ordered to cease all non-elective surgeries and procedures. However, some of the more critical patients couldn’t wait.

“People like Dan, the clock is ticking and we had to get them in,” says Harold Dauerman, MD, Director of Interventional Cardiology at the University of Vermont Health Network who helped pioneer a ground-breaking procedure known as TAVR (Trans Aortic Valve Replacement) at the UVM Medical Center.

Normally, someone in Novembrino’s situation would undergo open-heart surgery for the valve replacement, as well as triple bypass followed by a month of recovery. As the primary caretaker for his wife, the idea of being away from home for more than a month recovering from open-heart surgery was terrifying to Novembrino. But without surgery, Novembrino was risking his life.

“I don’t think he would have lasted six months,” says Dauerman, who presented another option.

The TAVR procedure is a life-saving cardiac procedure that drastically reduces recovery time. In fact, Dauerman says, 90 percent of patients are home and mobile the next day.

Dauerman explains the procedure to patients by describing the heart as a pump with a quarter-sized valve and all the blood from that pump has to flow out through that quarter. For patients like Novembrino, that quarter was shrunk down to the size of a dime. It’s like a clogged kitchen drain, and can be fatal. To correct this, the TAVR procedure uses a catheter, basically a small tube, inserted through a 3 mm incision in the groin area to access the femoral artery. Dauerman can then maneuver the tube all the way into the heart of a patient, deploying stents to open blocked heart arteries and even insert a new heart valve inside Novembrino’s damaged one.

Compared to open-heart surgery where a patient is under anesthesia, a patient undergoing a TAVR procedure is awake the whole time. The recovery time is only one night in the hospital, with patients typically back to full activity in just four to five days, not weeks.

And that was particularly critical for Novembrino who wanted to be back home with his wife as soon as possible. On April 3 he had the procedure and he was home the next day.

Smiling from a lawn chair tucked into a shady patch in his backyard, he says he still sometimes can’t believe that he even went through anything at all.

“The pain was gone,” he says, the same day he underwent the TAVR procedure. Before that, he was constantly taking pain medication and household activities were daunting tasks. Novembrino said that because of his experience with Dauerman and the staff that cared for him, he considers the UVM Medical Center to be the safest place in town to go outside of his home and that people who need care should not be afraid to go, especially if it is urgent.

“Boy I’m glad I got it done, I’ll tell you that,” he says.