With clock ticking, surgery saves woman whose heart wasn’t
HYANNIS, Mass. (AP) — Ann Bodio of Dennis knows she’s lucky to be alive after repeatedly going into cardiac arrest at Cape Cod Hospital.
But it was only after she woke up with a new aortic valve that the 71-year-old retired nurse learned of the remarkable chain of events that led to her survival, which involved a rare emergency catheterization — performed during chest compressions in the middle of the night — and technical advice offered over a phone, via FaceTime.
The drama began on a Friday in August, when Bodio passed out at her home near Mayflower Beach. She’d been feeling dizzy and short of breath and had an appointment with her regular heart specialists in Framingham the next Wednesday.
“I suspected something was going on. But I couldn’t pinpoint it,” said Bodio, who had received a new aortic valve during open-heart surgery 15 years ago.
Her husband, Robert “Bob” Bodio, called 911 around 9 p.m.
The word “scary” for what happened next isn’t strong enough, Bob Bodio said: “I was just so worried.”
Arriving at the Cape Cod Hospital emergency department, Ann Bodio, an expert seamstress and beach walk enthusiast, went into cardiac arrest.
“Her heart stopped,” said Dr. Richard Zelman, the hospital’s well-regarded interventional cardiologist.
Bodio was resuscitated and put, unconscious, on a ventilator.
Zelman suspected Bodio suffered from a damaged aortic valve that had degraded over time. Dr. Dan Loberman, a cardiac surgeon, said the odds of the comatose woman surviving open heart surgery were slim.
A trip to Boston was out of the question. Despite medications and other interventions, Bodio’s blood pressure kept dropping and the cardiac team had to resort to old-fashioned CPR to keep her alive.
With minutes ticking by, Zelman considered the possibility of taking Bodio to the catheterization lab and threading a new aortic valve up through her femoral artery. He and his interventional cardiology team have performed the procedure about 245 times since it debuted at the hospital two-and-a-half years ago, Zelman said.
Known as transcatheter aortic valve replacement, or TAVR, the procedure is a lifesaver for people too sick or frail for open heart surgery, Zelman said.
But it involves a big team of people including perfusionists, nurses, an interventional radiologist and cardiac technicians, and is usually only performed after a careful series of tests, Zelman said.
“It takes so many different people and so many different specialists,” Zelman said. “It’s very unusual for someone to come in the ER and need emergent valve replacement. It’s a unique situation.”
But with an ultrasound showing the aortic valve in Bodio’s left heart ventricle opening a few scant millimeters to let blood through — and with defibrillator paddles unable to restore her heart rhythm — Zelman and his team decided it was time to act.
“It’s a vicious spiral at that point in time,” Zelman said. He said people in Bodio’s predicament “virtually always die in the ER. It’s almost always a fatal event.”
Bodio’s condition was deteriorating so rapidly Zelman felt he and his team couldn’t wait even one hour for the arrival of the representative from Edwards, the heart valve manufacturer, to guide them through the steps of mounting the new valve inside a balloon at the tip of a catheter.
Tanner Pulsifer, a cardiology technician, came up with the idea of having the representative guide him through the process via FaceTime as she drove up from Providence at midnight.
“There was no other way to do it,” Pulsifer said. He said he had an operating room technician hold the phone up so the manufacturer’s rep could see what he was doing and prompt him to make changes.
“It was almost a surreal kind of thing” to see the representative’s face on the screen surrounded by darkness, Zelman said. The representative walked through the door just in time to secure the final crimp on the Sapien 3 aortic valve.
Then the team sped into action. Normally installing a new aortic valve takes about an hour and 15 minutes, Zelman said. “We did that procedure in about 10 minutes on her.”
As he guided the valve near Bodio’s heart, the cardiac team ceased chest compressions for about 30 seconds.
It took only three to four minutes after the valve was implanted, opening and closing its three leaves with the rhythm of the blood flow, that Bodio’s heart beat came back.
“The next morning she woke up and was perfectly fine neurologically,” Zelman said. “It was literally an unbelievable save.”
“At 1:30 a.m. he came out and said ‘It’s all done. Her heart is working perfectly. Her valve is working perfectly,’” said Bob Bodio, who was waiting at the hospital with the couple’s three adult children.
“I would not be here without Dr. Zelman,” Ann Bodio said. She said the vigorous CPR broke a few of her ribs, but she is done with her visiting nurse visits and expects to be back to normal stamina levels in a few months.
“They kept me alive,” Bodio said.
Information from: Cape Cod (Mass.) Times, http://www.capecodtimes.com