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Heart valve procedure transforms care of older patients

Marie Baffa of Port Jefferson. Baffa underwent a

Marie Baffa of Port Jefferson. Baffa underwent a procedure last year to replace her aortic valve with an artificial one. The new valve dramatically improved her heart function. 12/14/2018 Credit: Jim Lennon

David Golden, who is celebrating his 104th birthday this weekend, is putting in two miles a day on the Long Beach boardwalk after a heart procedure five months ago repaired a calcified valve — and, doctors say, will help boost his longevity.

Golden lives independently, takes part in activities at his synagogue, plays the violin and keeps up to date on politics. He underwent a minimally invasive insertion of an artificial aortic valve in February. The device assumed the workload of his native valve and cured his problems with shortness of breath, fatigue and chest pain. The disorder had reduced his daily strolls to only a half-mile a day.

Now all that has changed.

“I am very busy and doing whatever I can,” said Golden, who is an avid gardener. He still drives and shops for his own groceries.

“I love to read and I am reading all the time. I read so many books I can’t remember them all,” he said with a laugh.

Heart valve disorders of all kinds, involving the mitral, aortic or tricuspid valves, once were considered the mystery killers of old age, developing imperceptibly over many years. By the time the constellation of symptoms manifested, death wasn’t far away.

Elderly patients traditionally were not considered candidates for open-heart surgery. But the emergence of minimally invasive technologies has had a transformative effect on the cardiac care of a growing number of people of advanced age.

Golden underwent a procedure called transcatheter aortic valve replacement, or TAVR for short, which is adding years to the lives of many older people, including centenarians.

While TAVR can be performed on patients of any age whose aortic valve has been damaged by calcium, the disease most commonly affects the elderly. On the Island, TAVR is performed at several institutions, including St. Francis in Flower Hill, the Northwell Health system, based in New Hyde Park, and Stony Brook Heart Institute, which is one of only six centers in the country that treats low-risk patients with aortic valve disease.

“We use this technology the way it is meant to be used, and I think we have helped a lot of people,” said Dr. George Petrossian, co-director of the John Brancaccio Heart Valve Center at St. Francis, who is one of Golden’s physicians.

“David is mentally sharp and independent,” Petrossian said. “If patients can benefit, age is not a concern. This treatment will improve his longevity and quality of life. We may have patients who are 40 years younger than he is who have dementia or a terrible malignancy with a prognosis of six months. In those cases, we wouldn’t do it.”

TAVR repairs the diseased valve without removing it. The device is deployed by threading it on a catheter either through a vessel in the leg or one in the chest, as was the case for Golden. The implant is wedged into place inside the natural valve. The calcium in the diseased valve holds the implant in place, Petrossian said.

A healthy aortic valve has three “leaflets” that flutter to open and close. When the valve is closed, the lower left chamber of the heart fills with oxygen-rich blood to be pumped into circulation. Aging can cause calcium to build up in the valve, a condition known as aortic stenosis, the disorder that afflicted Golden.

The disease produces a series of hallmark symptoms — shortness of breath, chest pain and fainting. Patients with this severe disease have a death rate that ranges between 25 percent and 50 percent after two years of symptoms.

St. Francis has scheduled a party Monday for Golden to celebrate his 104th birthday.

The retired treasurer for a real estate development company in Manhattan, Golden lists his favorite composers as Beethoven, Mozart and Bach, whose music he enjoys playing on the violin. His wife, Ethel, died when he was 90. He described her as the love of his life. They met when she was 19 and he was 21.

Dr. Meyer Abittan, Golden’s cardiologist, who has known him all his life, said Golden is the oldest patient to undergo TAVR at St. Francis. The second-oldest patient was a woman who was 101.

Abittan said he thinks it’s possible for Golden to reach the biblical age of Moses — 120 years.

Marie Baffa of Port Jefferson, more than three decades younger than Golden, is another TAVR success story, according to her physician, Dr. Henry Tannous, chief of cardiothoracic surgery and co-director of the Stony Brook University Heart Institute.

Baffa’s TAVR procedure last September cured her of aortic stenosis and allowed her heart to strengthen in preparation for a second operation in November to remove a carcinoid tumor on her right lung. That procedure also was performed by Tannous.

Carcinoid tumors are rare malignancies that can emerge anywhere in the body. They are slow-growing and don’t initially produce symptoms. Hers was found by accident during imaging tests for TAVR.

She and her husband Robert, like Golden, are avid walkers. Although Marie’s aortic stenosis was considered low-risk, the daily activity had become difficult. The couple started shying away from Port Jefferson Village Beach, their favorite site for daily strolls.

“Marie wasn’t enjoying these walks as much as she had in the past,” said Robert Baffa, who noted that they met as teenagers in the early 1960s.

“I was Marie’s [health care] advocate,” he said. “I wanted the best care for her. Her heart is in great shape now.”

Marie, 72, said TAVR and the removal of the tumor have given her a new lease on life.

“I am very happy it’s all over,” she said.

Tannous, like Petrossian and Abittan, said TAVR is changing the way aortic stenosis is treated and has become the procedure of choice for older patients.

Golden, meanwhile, said he is taking his doctors up on their guarantee of more life ahead.

“I want to do a little good while I am still here,” he said of contributing to his community and family.