From a New Heart Valve to Chopping Firewood in 10 Days

TAVR procedure gets patients back to enjoying their lives.
TAVR patient Varney splits and cuts wood at his home

It’s safe to say that Doug Varney hasn’t slowed down in retirement: He played ice hockey into his late 60s, cut eight cords of firewood this winter and built an 80-foot raised garden bed with cinder blocks.

“Having a serious heart problem didn’t quite fit the mold,” Varney, a retired professor from Underhill, Vermont, says with a laugh. “I’ve had a heart murmur for many years, but it never held me back. OK, maybe I felt like I was slowing down a little, but at 75, could you blame me? I certainly didn’t think I had the symptoms of something serious.” 

Jennifer Gilwee, MD, Varney’s primary care physician, wasn’t so sure.

“Some heart murmurs are caused by innocent conditions and are fairly harmless,” says Dr. Gilwee, who also serves as division chief of general internal medicine at The University of Vermont Health Network. “Others, like Varney’s, which is caused by aortic stenosis, deserve a more proactive approach.”

Aortic stenosis is the gradual narrowing of the heart’s aortic valve opening, which restricts its ability to pump oxygen-rich blood to the rest of the body. In its early stages, some people may not experience any symptoms, but as it progresses it can cause various issues – like shortness of breath, chest pain or feeling faint – that can impact quality of life and ultimately pose a serious health threat.

During Varney’s annual check-up in December, Dr. Gilwee listened to his heart, searching for the telltale murmur that accompanied the sound of his aortic valve opening and closing. She noticed that his heart murmur had grown more pronounced, so she referred him for an echocardiogram, an ultrasound of the heart, at UVM Health Network’s cardiology offices in South Burlington. 

Over the years, Varney had grown accustomed to echocardiograms – also known as echos – as he and Dr. Gilwee kept an eye on his aortic stenosis. His last one, in 2019, showed only minor narrowing of his aortic valve. But aortic stenosis can be unpredictable in its progression, and this echo revealed that Varney’s had reached a critical stage. 

“The narrowing of Doug’s valve was in the critical range,” says Tanush Gupta, MD, the structural and interventional cardiologist who evaluated Varney’s echo that day. “At that stage, you’re looking at a failing valve that in 50% of cases leads to a dire outcome in less than two years without valve replacement. He really needed a new artificial valve installed to head off that eventuality.” 

Not long ago, Varney’s best option would have been open-heart surgery to replace his narrowed aortic valve. But that day, Dr. Gupta presented another option, one which dozens of Vermonters and northern New Yorkers are now turning to each month: the transcatheter aortic valve replacement, also known as TAVR. 

A Christmas TAVR 

Two days after Christmas, Varney went to The University of Vermont Medical Center, where Dr. Gupta would perform the TAVR procedure.

“It’s our goal to get our patients a new valve within 30 days of their EKG,” says Dr. Gupta, who, along with Harold Dauerman, MD, and Rony Lahoud, MD, leads the structural heart team at the UVM Medical Center. Together with a tight-knit team of nurses, nurse practitioners, fellows, anesthesiologists and cardiac surgeons, they perform TAVR procedures multiple times each week. “We know how much of a difference this procedure can make in peoples’ lives, resolving many of the issues that negatively impact their quality of life,” continues Dr. Gupta. “And thankfully, we’ve been successful at getting our patients treated quickly.”

TAVR patient Varney with chainsaw and firewood

Varney’s procedure took about two hours, during which time the structural heart team used continuous imaging and a series of catheters to insert a new artificial aortic valve into his heart. The new valve – about the size of one’s thumb – began its journey to his heart through a small incision near his leg, where catheters were used to slowly move it into position. The artificial valve is placed without Varney’s heart ever missing a beat.

Fewer than 24 hours later, Varney was back at home. Ten days later, he was cutting firewood again, moving and feeling better than he had in a long time. 

“I think most of us associate heart surgery with a really intense and difficult recovery, so I was amazed at how quickly I was back to my normal daily routines,” says Varney. “It wasn’t until my recovery that I realized how much my stenosis was affecting me prior to my procedure. I was breathing easier, breathing deeper and had a lot more energy to do all the things I was accustomed to.” 

Dr. Gilwee says that TAVR has helped many of her patients live longer, more active lives – from older individuals with complex medical issues to younger, comparatively healthier people. Looking back at Varney’s case, she says it also serves as a reminder to never shortchange your symptoms. 

“Always talk to your doctor about even the smallest symptoms – don’t just chalk it up to getting older,” says Dr. Gilwee.

TAVR is a Clinical Essential 

Only a decade ago, TAVR was something of a rarity in the world of interventional cardiology and cardiac surgery; it was a procedure reserved for high-risk patients. In most cases, these were individuals that were simply too ill to undergo conventional heart valve replacement surgery, a comparatively invasive operation with longer recovery times. Consistent with Varney’s experience, recovery from TAVR typically only takes a few days. 

Now the TAVR procedure has become a clinical essential for the UVM Health Network and a viable treatment option for even low-risk patients like Varney. Today, cardiology experts at UVM Medical Center perform approximately 300 TAVR cases a year, up from 24 in 2012, the first year it offered the procedure. UVM Medical Center remains the only hospital in Vermont and northern New York to offer the procedure, and in 2022, US News & World Report recognized it for its work in interventional cardiology, designating its TAVR and heart attack programs as high-performing care.

“We’ve been a part of the TAVR story from the very beginning,” says Dr. Gupta, referring to the structural heart team’s longstanding and ongoing involvement in national trials to expand the use of TAVR and other catheter-based valve replacements. “This is a field with a lot of promise, not just for those with aortic valve problems, but other valve issues as well. It can help us to treat more people and get them back to enjoying their lives with their families.”

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