About nine years after quadruple heart bypass surgery, Geraldine Siemens noticed she was short of breath and exhausted after simple, everyday tasks such as changing bed sheets.

In April, her cardiologist in Kalispell insisted she go to the International Heart Institute of Montana at Providence St. Patrick Hospital for tests.

In mid-June, a year after she first noticed the fatigue, Siemens underwent a transcatheter aortic valve replacement procedure to replace the valve that pumps blood out of the heart but had stopped functioning properly.

Typically, aortic valve issues are a matter of wear and tear, said Joseph Knapp Jr., managing partner of the heart institute.

“It’s like a door when the hinges get stiff and it doesn’t open as easily,” Knapp said.

As a result, the heart works harder to pump blood, he said.

Based on Food and Drug Administration guidelines that require patients be high risk or unable to undergo traditional valve replacement procedures, Siemens, a 76-year-old Kila resident, was a good candidate for the TAVR therapy.

The relatively new procedure allows cardiologists to replace a patient’s aortic valve in a manner similar to how stents are placed in clogged arteries percutaneously, or without opening the chest cavity.

During the procedure, a catheter is used to insert the new valve, entering either through a vein in the groin or from between two ribs.

Missoula’s International Heart Institute became the first center in Montana to offer the therapy about a year and half ago, while Billings Clinic began offering TAVR more recently, Knapp said.


This week, more than 120 Rocky Mountain Valve Symposium attendees, including cardiac surgeons, interventional cardiologists, echo-cardiologists, nurses, physician assistants and anesthesiologists, are learning more about TAVR.

Symposium attendees also are hearing from experts in the field about surgical decision making, advanced imaging and interventional options, as well as have hands-on opportunities to demonstrate aortic valve repair and advanced imaging techniques.

The event, in its 24th year, draws attendees from across the U.S. and Canada, as well as often internationally, to learn from experts.

“These are the thought leaders in the world of valvular heart disease,” Knapp said.

While cardiac surgeons are notoriously competitive, they’re also collaborative and recognize the importance of broadening their knowledge bases, he said.

Without professional development and symposiums, such as this week’s at St. Pat’s, doctors would quickly become dinosaurs in their field, he said.

Professionals at the International Heart Institute are dedicated to bettering their capabilities, Knapp said, and their work shows in the center’s preeminence both across the state and nationwide.

“Meetings like this are an example of how we’ve been able to get there,” he said.

TAVR technology is only a few years old, Knapp said, and questions still swirl around whether it’s a good option for a wide breadth of patients or if the expense is worth the quality of life gained for already elderly and aging patients.

Although the procedure costs in the range of $60,000 to $75,000 – a valve itself costs $30,000 – it makes sense to offer TAVR at the heart institute, Knapp said.

With a state population of 1 million people and only two hospitals offering TAVR, there is enough demand to justify the cost of technology, he said.

Over the past year and a half, International Heart Institute doctors have performed more than 70 similar procedures with positive results, he said, adding that as part of a Top 50 heart hospital, the heart institute has an obligation to state residents to offer high-end services.

Siemens said she’s grateful the procedure is available close to home and didn’t require another open-chest surgery.

“Your quality of life is just so much better, because I feel like I can do a lot of the things that I did before, and that makes me feel better about myself,” she said.

Reporter Alice Miller can be reached at 523-5251 or at alice.miller@missoulian.com.

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