At 92, Jack Hofstra has overcome challenges.
A soldier in World War II, he fought in the Battle of the Bulge, dodged bullets fired from enemy aircraft and survived a close encounter with a hand grenade.
“It never went off,” he said. “Otherwise I wouldn’t be here today.
“I think God was looking out for me.”
In the past few years, Hofstra has fought a new battle―this one much, much closer to home.
A failing aortic heart valve narrowed the flow of blood from his heart to the point where even a short walk across the room left him exhausted and weak. He needed a new valve, but he was considered too high-risk for open-heart surgery.
Again, he believes, “God was looking out for me.”
Hofstra received a new aortic valve through a minimally invasive procedure, in which the valve was placed through a catheter inserted in the groin. He was the 1,000th person at Spectrum Health to undergo the innovative valve-replacement procedure.
“It’s a miracle to be able to have that done,” he said.
A week later, at his home in the Royal Atrium Inn assisted living center in Zeeland, Michigan, Hofstra said he already felt stronger. Overall, he noticed “a very great improvement over what I was.”
For the heart specialists at the Spectrum Health Structural Heart and Valve Center, Hofstra’s recovery is immensely rewarding. They have been involved in the development of the innovative TAVR procedure since the first research studies began in the U.S. in 2011.
“To see it develop and progress and to be able to help so many patients this way―we feel really blessed to be part of it,” said John Heiser, MD, FACS, division chief of cardiothoracic surgery at Spectrum Health.
“If this technology wasn’t available, Mr. Hofstra would not have had (valve replacement) therapy,” said William Merhi, DO, FACS, an interventional cardiologist and director of the Structural Heart and Valve Center. Without a new valve, “typically quality of life suffers tremendously and ultimately leads to the patient’s demise.”
A Greatest Generation journey
The technology that made his heart repair possible would have seemed like science fiction when Hofstra was a child, growing up nearly a century ago on a dairy farm in Dutton, Michigan. He plowed the field with a team of horses, milked cows by hand and walked to school.
“We were very poor,” he said. “It was the 1930s, and that was a tough time.”
At 18, with World War II raging, he was drafted into the Army.
He served in the 84th Infantry Division, fighting across Belgium and Germany.
“The worst was going through Belgium in the winter time. It was below zero. We were out in weather all the time,” he said.
He fought in a number of battles during his 28 months in Europe, somehow managing to avoid injury.
“I came awful close a lot of times,” he said. “I had shrapnel come through the canteen I was holding. I had shells come very close to me different times.”
And then there was the grenade in Germany. While on patrol in a small town, he came upon a group of German soldiers, who started firing.
A grenade landed on the narrow cobblestone street beside Hofstra. With no place to hide, he quickly lay flat. He heard a click. Mercifully, the grenade did not explode.
Once he returned home, Hofstra got a job as a truck driver. On a blind date, he met Frances, the blue-eyed girl who became his wife. They have been married 69 years, have four children, 10 grandchildren “and a lot of great grandkids,” he said.
After driving 18-wheelers for 35 years, Hofstra retired. But a quiet retirement wasn’t for him. He promptly got a job driving for an auto auction service and kept working well into his 80s.
A failing valve
Seventeen years ago, Hofstra underwent quadruple bypass surgery. And about seven years ago, he learned about problems with his aortic valve.
As the main valve that exits the heart, the aortic valve serves as the gateway providing blood flow to the rest of his body. For years, Hofstra’s doctors managed his failing valve with medication.
But in the past few months, his health declined. He was in and out of the hospital, dealing with heart failure and pneumonia.
Spectrum Health’s multidisciplinary team of heart specialists, which includes cardiac surgeons, cardiologists and interventional radiologists, evaluated his condition.
He had a “heavily calcified, very thickened, rock-hard aortic valve,” Dr. Merhi said. “He had increasing difficulty with breathing with activity.
“If you don’t treat that with a new valve, it gets worse. Soon you’re having increasing difficulty breathing even with no activity. That is pretty miserable for the patient.”
A new aortic valve often resolves the congestive heart failure. But because of his medical history, Hofstra fell in the “extremely high-risk” group.
The team determined the minimally invasive TAVR approach would be his best option for a new valve.
“We can do (the TAVR procedure) now with a risk of about 1 or 2 percent to his life,” Dr. Heiser said. “The risk to his life if he didn’t have (a valve replacement) is close to 50 percent death rate at one year.”
‘Millimeters can make the difference’
The Spectrum Health heart specialists began performing the TAVR procedure in 2011, as part of a Food and Drug Administration clinical trial that targeted high- and extreme-risk patients. Extreme-risk patients are those who are not candidates for open-heart surgery.
Since then, the FDA has approved TAVR procedures for patients at high and intermediate risk for open heart surgery. And the Spectrum Health team now is taking part in a trial testing its application in low-risk patients.
The team performs more than 250 TAVR procedures a year. That experience has proved crucial in honing their expertise.
“You want to make sure you have the experience to place (the valve) where it needs to be and where you feel it is best for the patient,” Dr. Merhi said. “Millimeters can make the difference between a good outcome and a bad outcome.
“Over the years, you get a level of experience that really helps you optimize the patients’ procedural cadence, safety and outcomes.”
On a morning in early June, Dr. Heiser and Dr. Merhi performed the valve replacement procedure on Hofstra at Spectrum Health Meijer Heart Center. The procedure took place in a hybrid room designed for both catheterization procedures and surgery.
If complications occur, “we are prepared to do surgical intervention quickly in the same room,” Dr. Heiser said.
No such complications occurred in Hofstra’s TAVR procedure. His physicians placed the new aortic valve while he remained under conscious sedation.
Once the new valve was implanted, it began doing its job right away, opening the blockage that had been created by the diseased valve.
Resting at home the next week, Hofstra said his challenge is not doing too much too fast. He walks—using his walker—through the halls of the assisted living center.
He recalled the open heart surgery he had nearly two decades ago. He remembered the line of staples in his chest and the three months he spent recovering from surgery.
After the minimally invasive TAVR procedure, he felt better in days.
“This is a lot quicker,” he said. “It’s a marvelous way they can do that.”