There was a time when mowing the yard seemed to be "too much" for Roger Elbert.

"My feet would start to drag after the first half-hour of walking behind my mower," says Elbert, 76. "I'd be really pooped, but I figured that's just my age, I guess."

A discussion with his physician, Hamid Amjadi, DO, an internist at Covenant Clinic in Waterloo, revealed that Elbert had not received an echocardiogram in more than 25 years, when he was first diagnosed with atrial fibrillation.

Amjadi ordered a new test at Allen Hospital in Waterloo. The good news was that Elbert's irregular heartbeat had not worsened. However, the test showed aortic stenosis, a narrowing of the aortic valve that makes it extremely difficult for the heart to pump blood to the rest of the body. Left untreated, it can lead to congestive heart failure, even sudden death. Elbert said the specialists at Allen said his aortic stenosis was serious, and surgery was needed to replace the partially blocked valve.

"That scared the liver out of me," Elbert says. "So I went back and talked to Dr. Amjadi, and we decided to get a second opinion."

Amjadi referred Elbert to the UI Heart and Vascular Center, where cardiovascular specialists Ademola Abiose, MD, Chad Williams, MD, and Richard Kerber, MD, ran echocardiograms and other tests to fully assess Elbert's condition. Their evaluations confirmed the Allen Hospital specialists' diagnosis of aortic stenosis.

Elbert met with UI cardiothoracic surgeon Mark Iannettoni, MD, who reviewed the case and determined that Elbert was a good candidate for minimally invasive aortic valve replacement (AVR) surgery.

A traditional AVR procedure requires a full sternotomy, in which a vertical incision is made along the entire length of a patient's sternum to split the breastbone in order to gain access to the heart. Minimally invasive AVR involves an upper hemi-sternotomy, with an incision about six to eight centimeters long, notes Robert Saeid Farivar, MD, the UI cardiothoracic surgeon who performed Elbert's AVR surgery.

"Essentially, we take a small piece from the breastbone and use special cannulae and retractors to create a small opening near the patient's aorta," says Farivar, who came to UI Hospitals and Clinics in July from Brigham and Women's Hospital in Boston, where he performed numerous minimally invasive AVR surgeries.

Farivar and the surgical team successfully accessed Elbert's aorta, where they replaced his calcified heart valve with a new tissue valve.

"It's a very meticulous procedure, but the beauty of this technique is that it delivers outcomes equivalent to a full sternotomy, and the benefits to the patient are substantial," Farivar says.

The benefits include reduced trauma from surgery, faster recovery, better mobility, a smaller scar, and minimal pain.

Elbert was back home only three days after his surgery. Moreover, he felt "no pain whatsoever" following the procedure. Soon he was back to his normal activities–push-mowing his half-acre yard, digging in his garden, and "gallivanting" around the neighborhood.

"I still can't believe it," Elbert says. "I feel like I'm 50 years old again."

For questions, patients and families should call UI Health Access at 319-384-8442 or 800-777-8442 and ask for the UI Heart and Vascular Center, or e-mail ui-heart-vascular@uiowa.edu.

For consultation or referral, physicians should call UI Consult at 319-384-8008 or 800-322-8442.

—David Pedersen

Quick Recovery
Minimally invasive heart surgery got Roger Elbert home and active again in only a few days.

Above: Robert Faravar, MD, is the only surgeon in Iowa who specializes exclusively in minimally invasive heart-surgery procedures. Farivar also performs minimally invasive surgery for mitral valve and aneurysm repairs.