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Male suffering from bad pain in his chest heart attack at home - heart disease

“Surgery Without Surgery” For Your Heart

By Himanshu Agarwal, MD August 21, 2023 Posted in: Heart Health

It’s not unusual to slow down a bit as we age. But if you feel easily tired or weak, struggle to breathe while exercising or notice chest discomfort or pronounced heartbeats, you may have early symptoms of a leaky or tight heart valve. 

Left undiagnosed and untreated, these two cardiac conditions can become more serious than all the cancers combined. But, too often, people ignore troubling symptoms or put off care because they think major surgery will be the only solution. 

The good news is treatment is possible with no major incision, a minimal hospital stay and no lengthy recovery. I call it “surgery without surgery” and it’s possible for people with leaky or tight heart valves. 

Tight Heart Valves (Aortic Stenosis)

Imagine a door in your heart that gets hardened and doesn’t open very well. That’s aortic stenosis. 

The aortic valve – the “door” between your heart’s left atrium and left ventricle – is one of the gatekeepers of blood flowing through your heart. When it becomes calcified it hardens. As it doesn’t easily open, the heart tries to force blood through that tight valve. 

The increased exertion and reduced blood flow and oxygen causes symptoms, including: 

  • Chest discomfort
  • Cough, possibly bloody
  • Breathing problems with exercise
  • Becoming easily tired
  • Feeling the heartbeat (palpitations)
  • Fainting, weakness, dizziness with activity

It’s very common after age 65 for the aortic valve of the heart to become calcified. It happens in 5 percent of the population as they age. The condition leads to heart failure, which typically carries a prognosis of not more than two years of survival without treatment. 


The “surgery without surgery” solution for aortic stenosis is four simple letters: TAVR. This stands for transcatheter aortic valve replacement, a procedure that’s been around for a decade. 

CHI Health was first in the region to perform TAVR for severe aortic stenosis. It involves a small incision in the groin. A catheter is used to transport the valve to the heart and replace the disease valve while the heart continues to beat. 

It’s a short procedure that doesn’t require general anesthetic. Patients go home the same day and experience a relatively quick recovery. The best news is that you can enjoy not only an improved quality of life, but also an improved length of life. 

Leaky Heart Valves (Mitral Regurgitation)

Mitral regurgitation is the opposite problem. The heart’s door doesn’t close properly and leaks. This condition occurs when the valve on the left side of the heart lets blood flow backward into the atrium when it should go to the ventricle and on to the body. 

For example, with every heartbeat, 100 ccs of blood should go to the left ventricle and on to the lungs. But instead 50 ccs of blood leaks back in the left atrium. As a result, your body does not get enough blood flow and you begin to experience:

  • Shortness of breath
  • Heart palpitations
  • Swelling of hands and feet
  • Fatigue 

About one in 10 people age 75 and older have mitral valve regurgitation, which is more likely to happen after a heart attack. Eventually, the condition leads to atrial fibrillation, heart failure and pulmonary hypertension. 

MitraClip & PASCAL

The “surgery without surgery” solution for mitral regurgitation is transcatheter mitral valve repair using a MitraClip or the newer PASCAL device. While the Mitraclip has been around for more than seven years, CHI Health is first in the region to implant the PASCAL device. 

Both are essentially high-tech staples which help faulty leaflets of the mitral valve to close properly. The devices are delivered to the heart through a small incision in the groin and placed using a catheter.

The procedure doesn’t require general anesthesia and typically lasts around 30 minutes. Most patients are walking the same day and go home from the hospital the next day. After a brief recovery, people experience an improved quality and length of life. 

Don’t Wait To Seek Treatment

As a cardiologist, I meet people who have put off seeking treatment every week. Sometimes they think they are simply getting older and have to accept slowing down. Or they ignore symptoms because they don’t want bad news. Meanwhile, the condition goes downhill quickly. 

They’re often surprised to learn that it’s possible to treat these serious heart conditions and regain their lives without a major procedure. 

If you or a loved one are experiencing troubling symptoms, don’t hesitate to talk to your provider. Thanks to “surgery without surgery,” cardiologists have effective solutions that can add years to your life. 

Himanshu Agarwal, MD
Himanshu Agarwal, MD

Dr. Himanshu Agarwal is an Interventional Cardiologist and currently serves as Director of the Structural Heart Program at CHI Health Heart and Vascular Institute in Omaha, Nebraska.

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