After 63 years together, Frank and Margaret Tokas know that any marriage has its challenges. But for or the energetic couple, that challenge became a physical one when they both began suffering from congestive heart failure.
“Both Margaret and her husband came to us at different times suffering from congestive heart failure due to their valve disease. They are a remarkable couple who keep each other going and who are now able to enjoy their quality of life. They are exercising every day since their TAVR procedures,” said Grace LaValley, a nurse practitioner in Baystate Medical Center’s TAVR (transcatheter aortic valve replacement) Program.
Signs of Congestive Heart Failure
Some 5 million Americans are currently living with congestive heart failure – resulting in a feeling of tiredness and shortness of breath – and about 550,000 new cases are diagnosed in the U.S. every year.
“When we saw Margaret, and later Frank, they both had significant shortness of breath and a decreased tolerance for exercise, more so for Frank,” LaValley said.
Both developed severe thickening and calcification of the aortic valve in the heart. When calcium deposits form, the opening of the aortic valve becomes narrower – a condition called aortic stenosis. This narrowing can reduce blood flow from the main pumping chamber to vital organs and the rest of the body.
“It got to a point where my energy levels were decreasing significantly. It was difficult to walk up the stairs in our home or carry any groceries into the kitchen,” Margaret said. “That’s when the possibility of TAVR surgery was brought up to me.”
What is TAVR?
For people with certain health conditions, open heart surgery is not an option. In those cases, TAVR makes it possible to replace the heart valve with a minimally invasive procedure.. TAVR has many benefits, including a quicker recovery and better outcomes compared to medical therapy alone.
During the TAVR procedure, a surgeon inserts a thin tube (catheter) through a small cut in the patient’s leg, replacing the failing aortic valve without the need to crack open the patient’s chest.
Qualifying for TAVR
Some patients with aortic valve disease can be treated with medicine, but these medicines cannot reverse damage to the heart valve.
And while open heart surgery has been the typical treatment for severe aortic valve stenosis for decades, it is not an option for a growing number of patients. Open heart surgery is too risky for many people who have aortic calcification, lung disease, or frailty. The Baystate care team needed to figure out if Frank, 84, and Margaret, 80, were candidates for TAVR.
Surgery was considered low risk for Margaret and high risk for Frank. Still, their doctors recommended TAVR as the best option for treating them both.
Thankfully for Margaret and others, the success of TAVR over the years led to the procedure being expanded and approved by the U.S. Food and Drug Administration (FDA) in 2019 to include patients like Margaret who are at low surgical risk.
TAVR for Two
“I trusted my doctors that TAVR was right for me. I felt fine when I woke up and I had no pain. I did have to stay in the hospital longer than other patients because I’ve always had high blood pressure and it acted up, so they were trying different medications to get it under control,” Margaret said.
Frank, too, eventually reached the point where he needed to consider a valve replacement and found himself on the doorsteps to his wife’s cardiologist – Dr. Ash Islam at Baystate Cardiology – who performed the TAVR surgery on both of them.
Today, Frank says he has his energy back:
“On Saturdays, I used to meet my daughter and son-in-law for breakfast at the Dam Café in Holyoke where we live. It wasn’t a very far walk from our house, but it became more difficult for me to walk there and I knew that something was wrong,” Frank said, whose energy has now returned to normal.
Studying TAVR
Earlier last year, results of the landmark PARTNER 3 and EVOLUT clinical trials – in which Baystate Medical Center and Margaret were participants – showed that outcomes after TAVR were better or at least as good as the outcomes after surgical aortic valve replacement among patients with severe aortic stenosis at low surgical risk.
“I was there at the right time when they needed patients for the low-risk trial, and I am fortunate to have been chosen. My energy levels are tremendous once again,” says Margaret.
Expert Heart Care in Western Massachusetts
In 2012, Dr. Islam brought the TAVR procedure exclusively to western Massachusetts. He and the TAVR team have since performed the procedure on nearly 1,000 patients, both high and low risk. The program at Baystate has also expanded catheter-based therapies similar to TAVR in the treatment of other valve conditions.
“Today, on average, we are doing 6-7 TAVR procedures a week. When I performed the procedure on Margaret in 2017, I never thought that in December last year that I would be doing the same for her husband. I was happy to provide a better quality of life for both of them for many years to come,” Dr. Islam said.
Baystate’s TAVR program is the only such valve program in western Massachusetts and the team has consistently scored better patient survival and lower stroke rates compared to the national average.
‘Broken Hearts’ No Longer
Thanks to modern medical technology, Frank and Margaret are continuing their love affair of 63 years.
“We can’t say enough about the care we received at Baystate from the doctors and nurses right down to the cleaning staff. And we were elated that we didn’t have to travel further than our own backyard to undergo this special procedure. Even today we still get calls to make sure we are doing okay. And we are,” says Frank, noting that he would recommend the procedure to anyone needing it.
Learn more about the Baystate Heart & Vascular Program.