A Special TAVR Patient

When Johanna Wiggins came to see James B. McClurken, MD, FACC, a member of ACC’s Surgeons’ Section, for transcatheter aortic valve replacement (TAVR) evaluation due to shortness of breath and declining activity capacity, he had no idea that she would have such a profound impact on him. At 87 years old, Wiggins had a significant medical history that included several prior coronary stents, hypertension and four operations on her back. But she didn’t let that slow her down.

“When I saw Ms. Wiggins for evaluation, my immediate concern – as it is with all older patients – was for significant frailty and signs of cognitive decline,” says McClurken. “She clearly had neither. Ms. Wiggins was remarkably spry, active and cheerfully engaging.”

In fact, Wiggins informed her heart team that she still drives, lives independently in her own home, cuts her own grass with her prized John Deere tractor, cares for her two friends with Alzheimer’s disease and generally has a very active life. Even after McClurken disclosed the risks associated with the TAVR procedure, she still wanted to continue, explaining that she wasn’t afraid to die but wanted her prior level of activity back if she was going to live.

“She exhibited genuine motivation to keep going,” remarks McClurken. “She told me, ‘I have things to do and people to look after. I’ve got to keep moving.’ I was astounded by her tenacity and zest for life, even despite major personal adversity, including the death of her husband and all four of her children.”

The heart team decided that Wiggins was an excellent candidate for TAVR. Along with fellow surgeon Joe Auteri, MD, and two interventionalists – Dave Boland, MD, FACC, and Steve Guidera, MD, FACC – percutaneous placement of a 26mm Edwards Sapien XT was performed transfemorally. The procedure went smoothly and Wiggins was discharged three days post-TAVR.

Two and a half weeks later, Wiggins drove herself to her follow-up appointment with McClurken and the heart team. She was as positive as ever and asked to be cleared for full activity, including caring for her friends and riding her beloved tractor. McClurken was happy to oblige and said she was free to resume her normal routine.

Wiggins, a hugger, embraced the entire heart team and office support staff. The whole team was amazed at her will and positive outlook.

“We all have a few patients who stand out in a most positive way. It was a privilege to help Ms. Wiggins stay the course of continuing to live an active lifestyle,” notes McClurken. “She is certainly someone I shall not forget and I have been positively impacted by her attitude. She personifies grace.”

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Aortic Surgery, Cardiac Surgery and Heart Failure, Hypertension

Keywords: ACC Publications, Cardiology Magazine, Aortic Valve, Dyspnea, Heart Valve Prosthesis, Hypertension, Life Style, Poaceae, Stents, Transcatheter Aortic Valve Replacement, Surgeons

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