100-year-old celebrates birthday, new heart valve
08/25/2013 12:00 AM
08/31/2013 11:47 AM
Today, Maxine Tuttle is 100, the snowy-haired belle of a birthday party with family members coming from near and far to Carmichael to celebrate her centennial.
But without the quickly evolving field of advanced medical devices, there would have been no party.
Just two months ago, Tuttle was dying of heart failure, nearly drowning as fluid filled her lungs at Sutter Medical Center.
Doctors monitored her closely and when she made it through the night, they prepped her for a new, artificial aortic valve recently approved by the Food and Drug Administration.
The procedure, called a transcatheter aortic valve replacement – or TAVR – is designed to give older people with severe clogging of the aorta a chance at a few more years of life.
As the population ages, health care professionals expect to see a lot more of these procedures, opening the door to debate over when old is too old to intervene.
Tuttle, 99 at the time, is the most senior patient to have undergone the procedure in the Sacramento region. In Chicago, doctors implanted the new aortic valve in a patient 101 years old, records show.
"I'm lucky," Tuttle said last week, as she sat up straight on her couch, smartly dressed and articulate in expressing her gratitude. "This TAVR, it saved my life. Isn't it wonderful? One day I couldn't breathe, and then just a few days later, I could breathe. I'm very happy."
She turned to her physician, Dr. David Roberts, who dropped by Tuttle's assisted-living Eskaton apartment Thursday with early birthday wishes, a cake and balloons.
"Are you proud of me?" she asked.
"I am proud of you," Roberts answered.
Tuttle didn't stumble across her new lease on life by happenstance. She was carefully chosen based on her otherwise-healthy condition, her verve, her desire to keep living and her likelihood of surviving the risks of the procedure – which include stroke, other vascular complications and bleeding, according to the medical literature.
Roberts said he's met 60-year-olds whose health was nowhere near as good as Tuttle's overall condition. And though Tuttle was deemed too fragile for open-heart surgery, he was sure she'd do fine with a small incision to accommodate the valve and a tube about the circumference of a man's finger.
"She met the spunkiness factor," he joked. "She's a firecracker."
True to form, Tuttle was quick with quips and wisecracks during her doctor's two-hour visit.
Tuttle's health was good well into her 90s. At 92, she walked in two 5K runs and didn't have difficulty with her heart until age 95.
She attributes her longevity to being a lifelong walker and hiker in the Sierra, especially near Lake Tahoe, which she and her late husband completely circled during a camping trek in 1977.
"Walking kept me going, that's for sure," Tuttle said. "Otherwise, it isn't that I've done anything great to live a long life. It was that I didn't do anything really bad. I wasn't a smoker, I didn't drink, I didn't overeat."
The average American has a healthy life expectancy of 79, according to the Centers for Disease Control and Prevention.
So, when manufacturer Edwards Lifesciences came up with a device aimed at patients 80 and up, medical ethicists pondered the consequences of extending the lives of high-risk patients near the end of their expected life span.
"Age is a very strong risk factor for any mortality," said Eric Widera, associate professor in the University of California, San Francisco, medical school's division of geriatrics.
Widera pointed to clinical trials that measured lifespans for patients treated with TAVR. In 43 percent of the cases, implantation of the device extended lives by two years, according to the American Heart Association's journal Circulation.
And although the procedure is aimed at people who could not survive open-heart surgery, TAVRs can be slightly more costly than the major invasive surgery.
Medicare reimburses hospitals $80,000 for each open-heart surgery; cumulative one-year costs for TAVR can reach $106,076, Circulation reported.
At Sutter Medical Center, Roberts said, the Medicare reimbursement for TAVR is close to the payment for open-heart surgery.
With TAVR, though, more cardiologists need to be in the operating room in case something goes awry, so the real costs are higher than with open-heart surgery, Roberts said. Cardiac surgeon Dr. Michael Ingram worked side-by-side with Roberts on Tuttle's implantation.
At any rate, Roberts said, physicians should first and foremost be advocates for their patients – and not play roles of accountants.
To those who want to argue the need to bring down soaring health care costs, Roberts said, "It's about somebody's quality of life, and you don't want physicians to be gatekeepers. You really have to treat people as individuals, not numbers."
Certainly, Tuttle is looking forward to rehabilitation and a complete recovery. Then, a priority is being able to able to travel to the Sierra and revisit Lake Tahoe, where she and her husband built a cabin "log by log, stone by stone," she said.
"We had a good life with winters in Sacramento and summers at the lake," she said.
Of her wish to travel once again to Tahoe, she said, "It's such a nice place with a beautiful lake – I really miss it. I've been a Lake Tahoe person all of my life. I would like to see it again."
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