Robert Grovijahn

Robert Grovijahn, center, listens as cardiologist Dr. Robert Terry, right, and vascular surgeon Dr. Arne Olsen discuss his surgery. Grovijahn underwent surgeries for a valve replacement and an abdominal aortic aneurysm at the same time.

JAMES WOODCOCK, Billings Gazette

BILLINGS – When doctors at St. Vincent Healthcare first spotted the abdominal aortic aneurysm below Robert Grovijahn’s kidney about 10 years ago, there was nothing to indicate that it would lead to a medical first in Montana, and possibly the nation.

But last fall, Grovijahn’s doctor’s decision to operate on the 85-year-old to address the aneurysm led to a second procedure to fix a heart problem, all through the same minimally invasive surgery and in just two hours.

“It’s the first one we know of anywhere like that,” said Dr. Robert Terry, a St. Vincent cardiologist who, along with two other doctors and a team of more than 20 other medical professionals, performed the surgeries. “To do both in one sitting is just incredible.”

Grovijahn first learned of the aneurysm – a bulging or enlargement of his abdominal aorta that, if ruptured, can be deadly – about a decade ago, and doctors monitored it to see if it increased in size.

In 2015, they noticed the aneurysm was getting bigger and decided it was time to operate and scheduled a surgery for early October. First, though, he had to go through routine health checks and tests.

“We decided we should take care of it,” Grojivahn said. “But they found a heart murmur, and they didn’t do it right away. We had to take care of both.”

That heart murmur turned out to be a severe case of aortic stenosis, a disorder that narrows the aortic valve at the heart, causing it to not fully open. A valve replacement was needed.

Normally, addressing both conditions requires two surgeries over days or weeks. But at 85 years old, Grojivahn was a higher-risk patient and a team of St. Vincent doctors came up with a different solution.

They’d do both surgeries – an endovascular aneurysm repair for the aneurysm and transcatheter aortic valve replacement for the heart issue – in a combined procedure.

Vascular surgeon Arne Olsen, Terry and cardiothoracic surgeon Dr. Jason Fitzgerald performed the procedures at St. Vincent Healthcare’s year-old Steve and Debbie Reger Hybrid OR Suite.

“To do that here in Billings just highlights the level of care we have here,” Olsen said. “I know it’s the only one that’s been done like that in Montana and probably in the region.”

They started by making small incisions of less than two inches long near Grojivahn’s pelvic area. Those cuts allowed them access to femoral arteries on each side of his body.

Using an upside-down Y-shaped tube that connects to each artery through the small incisions, Olsen was able to use special wires and needles to graft a closed stent in the vessel to address the aneurysm.

From the same incisions and using similar equipment, Terry and Fitzgerald performed the valve replacement – a procedure that traditionally requires doctors to open a patient’s chest.

“Through that technology, we can go in and deliver this new valve,” Terry said. “All of the sudden, where you had this old and inoperable valve, you’ve got one that should last 30 years.”

The entire combined procedure took just two hours and Grovijahn spent three days recovering in the hospital before returning to his Billings home instead of having one hourslong procedure followed by several days of recovery, another procedure and more recovery days.

“For my age, I feel great,” he said. “And I was really happy with that, rather than doing two separate deals. I’m just happy with the way it all turned out. I had excellent care and I’m going to be OK.”

Before St. Vincent brought in the TAVR program and technology last year, Grojivahn would’ve had to travel to another city, Denver or Seattle usually, for similar surgeries, and he probably wouldn’t have had them done at the same time.

Terry credited St. Vincent overall with being willing and on board to combine the procedures.

“It was extremely satisfying,” he said. “It’s really a comprehensive program and approach. Everyone worked together. There’s a team of probably 20 people when we work on something like this.”

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