How innovation and compassion saved one heart patient’s life

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Wednesday, August 4, 2021

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How innovation and compassion saved one heart patient’s life

Mike Scott, mscott@stph.org

: Janet and Irvin Keller enjoy the morning on their spread off Lee Road. Just weeks before this photo was taken, Mr. Keller underwent a TAVR procedure, a relatively new, minimally invasive surgery to replace a faulty heart valve. The procedure,  his doctors say, saved his life. (Photo by Tim San Fillippo / STHS)

Irvin Keller had been there before.

The retired New Orleans firefighter, now living on a 51-acre spread off Lee Road, had gone through open-heart surgery in 2004 for a double bypass. He did it again in 2014 for another bypass and an aortic valve replacement.

But when he was wheeled into the St. Tammany Health System Emergency Department in April, it was different. This time, it was dire.

“He was in bad shape,” his wife, Janet Keller, said. “He couldn’t breathe, and he was so fatigued. He couldn’t eat. … He was rapidly declining at home.”

So, the Kellers headed to the hospital. It was a decision that would end up with Mr. Keller undergoing a relatively new, minimally invasive heart valve replacement surgery that he described as “night and day” when compared to open-heart surgery.

“The results were almost immediate,” he said. “When I woke up I could feel the difference immediately.”

It also, according to his doctors, saved his life.

“He was going to die,” said Dr. Smita Patel, an Ochsner physician and one of Mr. Keller’s army of care providers dating to his bout with kidney failure in 2018. “If he would have been sent home, he would have gone back into failure. I think he would have died in maybe a couple of months. It was getting too far gone.” 

Like many people, the Kellers had never heard of Transcatheter Aortic Valve Replacement, or TAVR, as the procedure Mr. Keller would undergo is more commonly called. They know all about it now, though. They’re big fans of it, too.

I know they say, ‘We’re just doing our job,’ but the way that they do it makes a big difference. They do it with great love.”

- Janet Keller

Unlike conventional heart surgery, a TAVR procedure doesn’t require the opening of a patient’s chest. Rather, surgeons perform their work through small incisions in the groin, neck or between the ribs, threading a catheter through the arteries to place a new heart valve where a diseased valve exists.

Usually, that means a much, much faster recovery time. 

According to Karolina Ruthner, coordinator of the valve replacement program at St. Tammany Health System – or “the orchestra conductor,” as Mrs. Keller fondly describes her – the process requires the involvement of a whole team of surgeons, nurses and medical technicians.

That said, the procedure itself takes only a couple of hours to complete. What’s more, an estimated 95% of those patients who undergo TAVR surgery are sent home the next day, where they can usually resume many of their normal, day-to-day activities.

“Coming home, you don’t have to limit yourself to bed or getting up and shuffling around when you can,” Mr. Keller said. “I brought my appetite home. My appetite was good within 12 hours.”

He’s in good company. Since late 2019, when St. Tammany Health System became the first to offer TAVR surgery on the Northshore, more than 100 TAVR procedures have been performed at the Covington hospital.

It wasn’t long after Mr. Keller’s arrival at the hospital that he was identified as a candidate for the surgery.

“He’s one of those cases where it was a live-or-die situation. It was kind of a last resort,” said Ruthner, who was called in with Ochsner cardiologist Dr. Ali 

Janet and Irvin Keller. (Photo by Tim San Fillippo)

Amkieh to consult on Mr. Keller’s case that first day. “We knew he was not going to go home. We had to work him up real fast and get him done.”

One of the first calls was to Ochsner cardiologist Dr. George Isa of Ochsner Health. He would be the lead surgeon in Mr. Keller’s case, working alongside Drs. Samy Abdelghani and Gregory Eckholdt, Ochsner specialists.

Because he was in such bad shape, Mr. Keller had to stay in the hospital for several days to get his body ready for surgery, under the supervision of Dr. Patel and others. But once the day arrived and the surgery was completed, things improved with remarkable speed.

“When Dr. Isa came out to talk to me after the procedure, he said, ‘The moment I got the stent and the new valve in place, his blood pressure immediately resumed to be normal,’” Mrs. Keller remembered. “That’s how quick this works. Now, the heart was in bad shape for being in that state that it was in for the months that he was suffering, but all it’s doing now is healing.”

On a recent July day, Mr. Keller was enjoying his spread off Lee Road, communing with Beaux, one of the Kellers’ horses, as well as a family of chattering woodpeckers that has adopted them. Both he and Mrs. Keller had nothing but praise for their doctors, nurses and everyone else at St. Tammany Health System and its partner since 2014, Ochsner Health.

“Man, I was blessed, there’s no doubt about that -- blessed with the right people,” Mr. Keller said. “It’s so much like a family at that hospital. It’s a family atmosphere, but also extremely technically competent.”

Mrs. Keller feels the same way.

“I could leave the hospital at night and know he would be well cared for,” she said.

When asked two months after her husband’s surgery what she’d say to his care team if given the chance, she responded: “I’d give them all a hug, which I do if I ever see them. Our hearts will be forever grateful to Dr. Patel, Karolina, Dr. Isa and his team.”

Both of the Kellers went on to rattle off a list of others to whom they feel indebted: Dr. Eckholt, Dr. Libeau Berthelot, Dr. John Angelo, nurse Brittany. The list goes on.

“The entire care team was phenomenal,” Mrs. Keller said. “They worked together with no egos. If one of them had a suggestion, they listened and they evaluated it for the best care of the patient. And that’s what makes you walk away happy and smiling and owing a debt of gratitude to these people. I know they say, ‘We’re just doing our job,’ but the way that they do it makes a big difference. They do it with great love. They do. … I thank everybody from the food team to the nurses to the cleanup team, people taking your temperature – everyone was so kind.”  

That’s music to the ears of Dr. Patel, who said compassion and respect for patients has always been at the core of her practice – and who is proud of her association with St. Tammany Health System and its TAVR program.

“Mr. Keller has been a true success story. I think this gave him 10 to 20 more years,” Dr. Patel said. “And it’s right here at St. Tammany Health System. I’ve been in this community for 20 years, and nobody else is doing TAVR the way they are.”

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