New Device Gives New Life to Mount Sinai Heart Patient
When she was 45 years old, Golda Silvera had a severe heart attack that set off a host of problems with blood flow and breathing. She was unable to work and could barely walk two blocks. Fortunately, the U.S. Food and Drug Association (FDA) approved a new technology—a transcatheter tricuspid valve replacement device—in February 2024. The Mount Sinai Hospital was one of the first sites to use the device, and it turned Golda’s life around.
When she had the heart attack, in 2017, Golda went into cardiogenic shock, a relatively rare condition that left her heart unable to pump enough blood to meet her body’s needs. Only about half of the people who go into cardiogenic shock survive. Her heart surgeon at another New York hospital performed a coronary artery bypass surgery, an open-heart procedure that creates a new blood flow path around the blocked arteries. Later, the team performed a second open-heart procedure, inserting a temporary right ventricular assist device (called an RVAD) to support the right side of the heart as she slowly recovered.
Golda also had other medical problems. She was obese, had diabetes, and was a heavy smoker. After the heart attack, she stopped smoking—cold turkey—and lost some weight. She underwent extensive medical therapy, and the doctors inserted a defibrillator/pacemaker to improve the quality of her life and heart function.
For Golda, the major problem was on the right side of her heart—specifically the tricuspid valve, which directs blood from the right upper chamber to the right lower chamber. In addition, Golda’s overall heart function was down to 23 percent of normal. This forced her heart to work harder and left her feeling as if she couldn’t get enough air into her lungs. “I was always tired and out of breath,” Golda says. “I begged them to send me to an expert.”
Finally, Golda was referred to physicians at Mount Sinai Fuster Heart Hospital. “I give God thanks for these doctors,” she says. James Youssef, MD, a specialist in advanced heart failure, used medication to stabilize her mitral valve, bringing Golda’s heart function up to 46 percent. But her tricuspid valve continued to leak. Golda still had shortness of breath; swollen legs due to edema; and deteriorating kidneys because of the medication.
Dr. Youssef sent Golda to interventional cardiologist Sahil Khera, MD, MPH, and cardiac surgeon Gilbert H. Tang MD, MSc, MBA, to see if they could improve the function of her tricuspid valve. Dr. Khera and Dr. Tang determined that Golda was not a good candidate for a procedure known as tricuspid transcatheter edge-to-edge repair, due to a massive gap between leaflets, or for conventional tricuspid valve surgery (because the damage to the right side was too far gone and made the third open heart surgery extremely risky). They also thought about an experimental device (transcatheter bicavalve valve system) but she was not considered a candidate due to poor function of the right ventricle. Golda, personally, could not withstand another open heart procedure; she needed a minimally invasive approach. When the FDA approved the new transcatheter tricuspid valve replacement device, hope was in sight: this device is a type of heart valve that can replace the tricuspid valve without open-heart surgery.
On July 16, 2024, Dr. Khera and Dr. Tang implanted the new valve through a small incision in Golda’s groin using a narrow tube called a delivery catheter. They threaded the catheter through the femoral vein, which is a large blood vessel that goes from the thigh all the way up to the heart. Images from an echocardiography machine, which uses ultrasound waves, guided them to the right spot. Then Dr. Khera deployed the new valve, and it took over for the diseased tricuspid valve immediately. The innovative procedure took about 45 minutes. “This was a patient who had no other options—and the artificial tricuspid valve gave her a second lease on life,” Dr. Khera says. “Tricuspid valve disease is fairly common and associated with poorer outcomes; we are glad we were able to offer her a minimally invasive therapy with excellent clinical outcomes,” says Dr. Tang says.
Golda was very pleased with her care. “I love the hospital,” she says. “The staff were all so polite and so nice.” And she is thrilled to have her life back.
“God is good—there’s no more swelling in my legs and I can walk four or five blocks easily,” says Golda says. Now that she can walk more, Golda is exercising regularly and has lost more weight. “My doctors are so happy, and I’m so happy. If someone is thinking about the procedure, I say go for it,” she says of any person who has a condition like hers. “You have to have confidence. It can be a little scary, but it is worth it.”