Michael Logan bounced back from open-heart surgery to replace a heart valve in 2010. Thirteen years later, at age 81, he recovered even more quickly when he needed a second valve replacement, thanks to a new procedure and expert clinical team. Logan was discharged after only a day at Community Hospital of the Monterey Peninsula following a minimally invasive valve replacement; within a week, he was golfing and walking up to two miles.
Logan was the first patient at Community Hospital to undergo transcatheter valve-in-valve replacement for a failing surgically implanted valve. With the recent opening of two new state-of-the-art hybrid operating rooms, the procedure is likely to become more common.
It was a big success. The procedure was easy. I was awake during it, or at least most of it. The recovery was one day, as far as leaving the hospital.
— Michael Logan, patient
Hybrid operating rooms combine the advanced imaging technology used in minimally invasive procedures with all the features of a surgical suite. This creates a single environment that can be used for “open” surgeries, with larger incisions, and procedures done through small incisions, guided by the advanced imaging systems
Logan’s procedure was a “big success,” he says. “The procedure was easy. I was awake during it, or at least most of it. The recovery was one day, as far as leaving the hospital.”
While Logan’s first valve replacement involved opening his chest, his second was minimally invasive, using a catheter threaded to his heart through only a small incision in his leg. Cardiologists have been performing transcatheter aortic valve replacement at Community Hospital since 2018, but Logan received a transcatheter heart valve with a twist — valve-in-valve transcatheter aortic valve replacement (ViV-TAVR).
The procedure involves inserting a new valve directly into the failing surgical valve. The valve-in-valve replacement was done by Dr. Ahmad Edris, Director of Tyler Heart Institute’s Interventional Cardiology and Structural Heart Disease program at Community Hospital, where the hybrid operating rooms recently replaced the hospital’s cardiac catheterization labs.
Logan’s first valve replacement came after a routine doctor’s visit revealed a potential problem. His doctor didn’t like what he heard when he listened to Logan’s heart and sent him to a cardiologist. Logan had an echocardiogram to check the blood flow through his heart and valves and the results were so concerning that the cardiologist called him later that night.
“He told me I had severe valve stenosis [narrowing] of my aortic valve and needed surgery,” Logan says. The opening in his valve was only about the size of the lead in a pencil, a fraction of a normal opening.
The diagnosis was a surprise to Logan, who worked out regularly, took walks with his dog, and golfed often.
His valve was replaced with open-heart surgery at Community Hospital, followed by a four-day hospitalization and a recovery of several months.
“I was told the surgery was a success and it was,” says Logan, a retired stock, insurance, and real estate broker from Pebble Beach. “I have had a very enjoyable life all the way through, up until about two months ago.”
That was fall 2023, when Logan began coughing, had swelling in his stomach and chest, and could only sleep when sitting at a 45-degree angle. He eventually went to Community Hospital’s Emergency department.
“Within minutes, the doctor on call told me I had congestive heart failure,” he says. He was hospitalized for about a week, put on medications including diuretics, and lost 18 pounds of fluid weight.
Logan and his wife met with Edris, who explained that Logan’s surgically implanted aortic valve had degenerated, was now failing, and needed to be replaced. Bioprosthetic or tissue surgical valves generally have an average life expectancy of about 10 years, with Logan’s valve lasting 13 years. Edris told the couple that a second open-surgical valve replacement was possible, but carried higher risk compared to the first open-heart intervention. He also told them about an alternative — ViV-TAVR.
“It was an easy decision,” Logan says. “The only thing I worried about was when they put the new valve in the old valve, would it seal or would I end up with leakage? Dr. Edris said I would not have any leak and the [follow-up] echocardiogram proved him right.”
Soon after the procedure, Logan returned to his gym and attended the hospital’s Cardiac Rehabilitation program to rebuild strength. The second replacement was much easier on him and his wife.
“She was as nervous as could be for both procedures, but this time when she came to see me afterward, I was wide awake, sitting up in bed,” he says. “The first time I was unconscious, lying in bed with all kinds of tubes in me. She was very pleased.”
Learn more about heart and vascular care at Montage Health.
