89-year-old WWII veteran Ray Tollefson was able to attend the 70th reunion of the invasion of Normandy after TAVR restored his cardiovascular function.
Twice a survivor
Transcatheter aortic valve replacement helps D-Day veteran attend reunion at Normandy
issue 22 | Fall 2014
A LEADING PROGRAM
Ray Tollefson is no stranger to battling for his life. The 89-year-old World War II veteran trained as an Army Ranger, and was wounded in the June 1944 invasion of Normandy while attempting to storm Omaha Beach. He was hospitalized for two years because of his wounds. After the war, Tollefson became an accountant and eventually managed one of the largest luxury car dealerships in Detroit. Later in life, his service during the war was recognized and appreciated by several American presidents and the French people he fought to liberate.
Since 1984 — the 40th anniversary of D-Day — Tollefson has attended commemorative events in France every five years. However, in the fall of 2012, Tollefson was diagnosed with aortic valve stenosis by his doctors in the Petoskey area. He began to worry that he might not make the 70th anniversary event, possibly one of the last major commemorative events attended by soldiers who survived Normandy.
TAVR is currently being evaluated for patients with moderate risk for open surgery; it was originally approved only for high-risk patients.
Then Tollefson was referred to the University of Michigan. Thanks to the team at the U-M Frankel Cardiovascular Center and the newest TAVR (transcatheter aortic valve replacement) procedure, Tollefson was able to travel to France for the 70th D-Day anniversary in June of 2014. And better still, he is back to living the active life he enjoyed before his diagnosis.
A PERSONALIZED APPROACH
The U-M Frankel Cardiovascular Center has been treating aortic diseases since 1995, and the multidisciplinary team concept is central to the program. "Our program is more than just collaboration among professionals," says Stanley J. Chetcuti, M.D., one of Tollefson's physicians, an associate professor of Internal Medicine and the Eric J. Topol Collegiate Professor of Cardiovascular Medicine who serves as director of the Cardiac Catheterization Laboratory. "It's actually a true team working together."
The team is composed of physicians from across the spectrum of medical specialties, including cardiologists, non-invasive cardiologists, surgeons, radiologists and anesthesiologists, in addition to nurse practitioners and PAs. "When patients are referred to us, we initiate a specific process to diagnose the condition, understand treatment options and make risk-benefit assessments for every disease, for every treatment option," says Chetcuti. "This approach allows us to determine the best plan of treatment for each individual patient."
In Tollefson's case, his plan of treatment turned out to be more complex than anyone anticipated. The comprehensive medical assessment revealed other medical conditions that needed to be addressed before any valve intervention could be attempted.
"We found that Mr. Tollefson was anemic and getting worse, which eventually led to a diagnosis of colon cancer in April and a subsequent resection in May," says Mary Jo Boyle, DNP, ACNP-BC, nurse practitioner for the TAVR program. "Additionally, he had a blockage in the left anterior descending artery, which required insertion of a drug-eluting stent in July. Finally, in October, he was able to successfully undergo the TAVR procedure."
Although open heart surgery for valve replacement has been used successfully for many years, it is prohibitively risky for certain patients, such as those with poor lung function, poor outcomes in past surgeries, autoimmune conditions and some anatomical considerations, such as a porcelain (calcified) aorta.
"The TAVR procedure was deemed the best treatment in Mr. Tollefson's case due to his age and his medical history, which included heart disease, prior bypass surgery and peripheral artery disease," explains Chetcuti. "We were concerned about his recovery from another open heart surgery, so the team decided on the TAVR. In cases like these, the key is to ensure the quality of life after surgery."
TAVR was initially tested and approved for use in patients with prohibitive surgical risk. However, TAVR is currently being evaluated for use in patients with moderate risk for open surgery, which may expand treatment options to patients who may benefit from the minimally invasive approach of this procedure.
THE NEXT PHASE
Tollefson came through the TAVR procedure without complications. In fact, after the procedure, he rested a few days at his daughter's house in Ann Arbor, and then drove himself 300 miles home to the Petoskey area.
U-M places both the Medtronic CoreValve (shown) and the Edwards SAPIEN valve via TAVR.
These days, Tollefson stays busy, because now he can accomplish in an afternoon what would have taken him all week before the procedure. He also recently returned from a two-week Alaskan cruise.
"I think Mr. Tollefson felt like a caged animal when I saw him. Here was a witty, sharp, vibrant man who was shackled down and was not able to live to his full potential. It felt like we unshackled him by doing the TAVR procedure," says Chetcuti. "Physically, he was limited by his valve problem.
However, we were able to take care of that, without the incapacitation of a prolonged surgical procedure or a prolonged recovery period."
During the June 2014 D-Day events, Tollefson was interviewed on national television about his experience at Omaha Beach, and he also met the president. "It meant so much to the whole team to see Mr. Tollefson sitting there," says Chetcuti. "He sent me some pictures from Normandy, and they are now some of my most prized possessions."
"I had complete confidence in Dr. Chetcuti and the entire team," says Tollefson. "Every one of the people on the team treated me like family. And, the operation was amazing. I have had more bad side effects from a visit to the dentist's office than I did from the TAVR surgery, so it was a fabulous thing. It was truly unbelievable."