Mary Walsh is BWH's first patient to undergo a transcatheter aortic valve replacement without general anesthesia.

Nearly two decades ago, Mary Walsh had open heart surgery to address a congenital valve defect and coronary artery disease. The surgery was successful, but she endured a long post-operative recovery period. “It took a long time for me to get my strength back,” she said.

While hospitalized for pneumonia last fall, cardiologists discovered that Mary’s aortic valve was worn and functioning poorly. Her doctors recommended she undergo transaortic valve replacement (TAVR). Instead of removing the old valve, TAVR inserts a replacement valve in its place using a catheter and is usually performed under general anesthesia.

Andrew Eisenhauer, MD, director of Brigham and Women’s Hospital’s Interventional Cardiovascular Medicine Service, suggested that Mary might also be a good candidate for TAVR using a sedation-based anesthetic, rather than general anesthesia. A team of interventional cardiologists, including cardiac surgeon Michael Davidson, MD, cardiac anesthesiologists Charles Nyman, MD, and Douglas Shook, MD, nurses, and technologists placed a new valve in the deteriorated aortic valve under the watchful care of Nyman.

“Mrs. Walsh’s anesthetic was a continuum of sedation, from being responsive to my voice to being deeply sedated to unconscious, as dictated by the needs of the patient and procedure,” Dr. Nyman said.

The collaboration between Cardiology, Cardiac Surgery, and Cardiac Anesthesia is also a good example of efforts to tailor care to each patient’s needs. “Our practice is to design the optimal anesthetic plan for each patient based on his or her needs and the constraints of the procedure,” said Dr. Shook. “Mrs. Walsh was the first patient we encountered for whom a sedation-based anesthetic was a preferable choice. We will continue to use the technique for appropriate patients, in consultation with our colleagues.”

“I can’t believe how much better and stronger I feel,” said Mary, the day after surgery. Added Mary’s daughter, Veronica Walsh: “I was so impressed by how good she looked when she came out of surgery. Her physicians and nurses were incredibly helpful and reassuring.”

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– Michelle C.

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