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A new aortic valve

Robert Bjurstrom received a new aortic valve without undergoing open-heart surgery.

A little less than a month after his procedure, Bob Bjurstrom plays a cheerful melody at his home. As he continues to regain his strength, he looks forward to playing the piano more, watching Gator sports and enjoying the classes offered at Oak Hammock’s Institute for Learning in Retirement.

Bob Bjurstrom knew for more than 20 years that he had aortic stenosis, a condition in which the aortic valve narrows. Over time, this requires the heart to work harder as it pushes blood through the narrowing valve. The continuous extra strain on the left ventricle to pump the blood can lead to heart failure, a heart attack or sudden death.

Traditionally, the condition is followed conservatively until it requires intervention. Bjurstrom, 85, reached this point in fall 2011. His physician, Henrique Kallas, M.D., a geriatric-specialist at UF, had been monitoring Bjurstrom’s aortic valve through routine echocardiograms and found the condition had evolved to the point where he was not only very symptomatic, but at risk for developing congestive heart failure.

“I was getting myself into a corner, because…the flow through was faster and faster and the space it could pass through was getting smaller,” said Bjurstrom, whose primary symptom was shortness of breath, especially while eating.

The gold standard way to repair the problem is replacing the valve through open heart surgery, but for some people this procedure is not an option because of co-existing health issues that do not make them a candidate for traditional surgery. Bjurstrom fell into the inoperable category, so Kallas referred him to R. David Anderson, M.D., M.S., a UF interventional cardiologist, to be evaluated for a new type of procedure to correct the problem.

Anderson was collaborating with fellow interventional cardiologist Anthony Bavry, M.D., M.P.H., and UF thoracic and cardiovascular surgeons Thomas Beaver, M.D., M.P.H., and Charles Klodell, M.D., to bring the Edwards SAPIEN Transcatheter Heart Valve, in a procedure called transcatheter aortic valve replacement, TAVR, to UF&Shands. The Food and Drug Administration approved use of TAVR, also known as a percutaneous minimally invasive valve procedure, in November 2011 for patients with symptomatic severe aortic stenosis who can’t undergo open heart surgery and in whom co-existing health conditions would not preclude the expected benefit from the correction of the aortic stenosis.

“Such a dramatic innovation in our ability to treat a specific disease comes along rarely, and likely less than once in a physician’s career,” Anderson said. “We are very lucky to be a part of it.”

While the new procedure offers a potential option to patients who previously had no other option to correct their worsening valve condition, it is important to note there are risks associated with it, such as death, stroke, damage to the artery used for insertion of the valve, and major bleeding. Also data about how long the valve will hold up needs to be determined. Weighing the benefit versus risk is something the UF team will evaluate with each patient.

Bjurstrom was one of the initial patients evaluated for the new procedure, and after a series of tests and evaluations, Anderson and Klodell inserted his new aortic valve on March 20, 2012, the first day the procedure was performed at UF&Shands.

Klodell said it felt exhilarating to be involved with the first of these procedures at Shands. “Seeing a patient this age, with his overall health, bounce right through the procedure is revolutionary.”

The cardiologist-surgeon team worked together to guide the valve via a catheter in the leg up to the heart and then anchor it inside the diseased valve by inflating a balloon. The team placed an artificial 26 millimeter valve; Bjurstrom’s native valve opening had shrunk to less than one centimeter.

Bjurstrom, an anesthesiologist for 30 years, is familiar with advancing the practice of medicine. In 1956, he and another anesthesiologist set up a practice in Eau Claire, Wis., with the both of them covering two local hospitals. Over the years the practice grew, and even after he retired he continued to advise the group, which now consists of nearly 60 anesthesiologists and nurse anesthetists.

He proudly reflected on the cooperation and harmonious relationship of the team he built. Klodell emphasized a similar sentiment about bringing TAVR to UF&Shands.

“It is the ultimate in collaborative disease-specific care,” said Klodell. “It is only through true cooperation, mutual respect and trust that procedures like this are possible.”

Bjurstrom and his wife Dorothy will be married for 66 years this August. The couple married just before he attended medical school. They emphasized their bond, saying it gets stronger as they age.

“I am very excited,” Bjurstrom said, “to be given this opportunity to be with Dorothy.