Minimally invasive heart surgery helped Spring woman stay active

Vita Malloy, 81, returns the ball during a volleyball game at Lone Star State

Vita Malloy, 81, returns the ball during a volleyball game at Lone Star State North Harris Campus on April 21 in Houston. Malloy was diagnosed with aortic stenosis, but a minimally invasive procedure known as transcatheter aortic valve replacement helped her return to the volleyball court in a few days.

Spring resident Vita Malloy is so averse to sitting still that she calls herself the Energizer Bunny.

Malloy, 81, always says "yes" when a friend calls to ask if she’d like to go out for lunch or to a movie. She also keeps herself active by playing in a senior volleyball league three times a week and taking a walk almost every day.

Last fall, though, Malloy started having to take a break and catch her breath while walking. She knew something was wrong.

"I was scared because I couldn't breathe right," she said, "and I was getting pains in my chest. I couldn't walk much."

The Energizer Bunny's batteries were just fine, but doctors at St. Luke's Health — The Woodlands determined she needed a new heart valve.

Malloy's aortic valve had narrowed to the point where it was restricting blood flow, a condition known as aortic stenosis. It typically develops over time and is seen in approximately 2 percent of adults over age 65, but it can lead to heart failure and death if it's left untreated.

Replacing an aortic valve used to require open-heart surgery, followed by a long and difficult recovery. But the development of a minimally invasive alternative known as transcatheter aortic valve replacement, or TAVR, has changed the standard of care for many patients with failing aortic valves.

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Vita Malloy, 81, poses for a photo at Lone Star College's North Harris Campus before her volleyball game on April 21 in Houston. Malloy was diagnosed with aortic stenosis, but a minimally invasive procedure known as transcatheter aortic valve replacement helped her return to the volleyball court in a few days.

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The surgery — which involves accessing the heart via a blood vessel in the groin — often results in better outcomes, faster recovery times and lower risk for complications, said Dr. Robert Aertker, a cardiologist at St. Luke's Health.

The surgery was first approved in 2013 for patients at high risk for surgical complications, such as those who are older, frail or have preexisting health conditions. The approval was extended to medium- and low-risk patients by 2019, and TAVR is now used to treat the vast majority of St. Luke's Health patients with aortic stenosis, Aertker said.

"Open-heart surgery is a huge undertaking. The recovery is very hard and arduous," Aertker said. "But TAVR is so much less invasive and so much easier to recover from. It's really expanded who we can treat for aortic stenosis."

Malloy only needed to stay in the hospital for one night after undergoing the procedure Oct. 19. Malloy said she felt "fantastic" the morning after the procedure. She was feeling well enough to go out for lunch and to the grocery store later that day.

She didn't need to take a long break from her active lifestyle, either, because she was back to walking and playing volleyball in about a week.

"I went out the next day," she said, "and I was just zoom, zoom, zooming around. I didn't have to stop at all."

Malloy has kept herself active after undergoing quadruple-bypass heart surgery seven years ago. The typical recovery from the procedure is six to 12 weeks, and Malloy needed to use a walker to help her get around. Once she recovered, she was happy to leave rest and relaxation behind her.

She started playing volleyball at her apartment complex, then joined a senior league so she could play three times a week. She also plays cards and bingo, goes to church every Sunday and likes going out to lunch with friends, her daughter JoMarie Miller said.

"She cannot stand to be sitting there at the apartment doing nothing," said Miller, the youngest of her mother's three daughters. "She likes to be doing something all the time."

Maintaining that active lifestyle started to become more difficult last year when Malloy began to experience shortness of breath on her walks. Eventually, it became difficult for her to take a shower without feeling fatigued afterward, Miller said.

The news that Malloy had aortic stenosis didn't come as a surprise. Doctors first noticed the narrowing of her aortic valve roughly 18 months earlier, but people with mild to moderate aortic stenosis may not experience symptoms like shortness of breath, pressure in their chest or dizziness until their condition worsens.

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Before the development and approval of TAVR, replacing an aortic valve required a sternotomy, where the surgeon cuts through the breastbone to access the heart. Patients need to stay in the hospital for five to seven days after the procedure, and it can take more than a month for them to fully heal.

"You kind of feel like a truck has run over you for about four to six weeks," Aertker said.

TAVR, on the other hand, does not involve cutting through the breastbone. During the procedure, a surgeon inserts a catheter into a blood vessel in the patient's groin, then guides the catheter to the patient's heart. The surgeon next threads a replacement valve to the heart. The replacement valve expands and pushes the old valve out of the way so it can take over the job of regulating blood flow.

A TAVR procedure can be done in an hour, and 95 percent of patients return home the next day, Aertker said. They’re instructed not to lift more than 10 pounds for about one week but can return to normal activities afterward.

The morning after Malloy's procedure, a nurse came into her hospital room and told her she wanted to see Malloy walk before discharging her. Malloy got dressed, laced up her sneakers and started moving.

"The nurse said, ‘Hold on, hold on, you’re going too fast for me. I can't keep up,’" Malloy said.

Miller said she was amazed when she heard her older sister had taken their mother to lunch and then to the grocery store on their way home from the hospital. "She's just been doing wonderful," Miller said. "It's been really amazing that she bounced back that fast."

Most patients with aortic stenosis are interested in TAVR, but it's not an ideal option for everyone, Aertker said. Some patients will be having another procedure that requires open-heart surgery, like coronary artery bypass, and it's easier to replace the aortic valve at the same time.

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Other patients have anatomical reasons, such as an aorta that is too narrow, that would make them better candidates for open-heart surgery, Aertker said.

Overall, though, Aertker said he prefers TAVR when possible because it's easier to recover from than open-heart surgery. In addition, studies have found similar outcomes and risk for complications from TAVR and open-heart surgery.

It's also been a "huge paradigm shift" for patients like Malloy, who, at 81, might have had more difficulty recovering from open-heart surgery, Aertker said.

"We’re keeping her volleyball spike in prime form, doing it through TAVR instead of through open-heart surgery," he said.

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Minimally invasive heart surgery helped Spring woman stay active