One of the First: Lois’s Remarkable Recovery with a New Transcatheter Valve

At 82 years old, Lois Miles was one of the first patients at Barnes-Jewish Hospital to receive a transcatheter tricuspid valve implant, a groundbreaking procedure performed in 2024. It’s one more way the hospital and its academic physician partner, WashU Medicine, are helping patients with valve disease.

For years, Lois’ leaky tricuspid valve caused blood to flow backward in her heart. She also had atrial fibrillation, a condition that caused her heart to beat too fast, adding even more complexity to her case. She often felt short of breath, became full quickly when eating, and just didn’t feel right. 

Her cardiologist, Prashanth Thakker, MD, a WashU Medicine physician at Barnes-Jewish West County Hospital, told her about an innovative transcatheter valve procedure that had shown promising results in clinical trials and recommended her as an ideal candidate. When the procedure became available, Lois didn’t hesitate to say yes.

Leader in valve innovation

The team at the WashU Medicine and Barnes-Jewish Heart & Vascular Center has been leading innovation in heart valve care for decades. The team, guided by WashU Medicine cardiologist Alan Zajarias, MD, and WashU Medicine cardiovascular surgeon Tsuyoshi Kaneko, MD, continues to lead national clinical trials that explore new treatment options for patients with aortic, mitral, and tricuspid valve disease. 

They were among the first in the nation to perform minimally invasive valve replacements, including transcatheter aortic valve replacement, TAVR, a procedure that replaces a diseased valve through a small tube inserted in the leg, rather than having open heart surgery. For many patients that means a faster recovery, less pain, and a quicker return to normal life. 

A new option for a serious condition

This leading-edge transcatheter tricuspid valve replacement is the first replacement procedure developed specifically for the tricuspid valve, the valve on the right side of the heart that regulates blood flow between the right atrium and right ventricle. By replacing the leaky valve with a new one, the procedure helps restore normal blood flow and reduce symptoms such as shortness of breath, swelling, and fatigue. 

“I wanted to feel better, and this was my chance,” Lois says. 

Patients with severe tricuspid valve disease can benefit from open-heart surgery. But for Lois, surgery carried many risks. “She wasn’t a candidate for open-heart surgery,” says Dr. Zajarias, “but her right ventricle, one of the heart’s pumping chambers, was still working well. That made her a good candidate for this new valve.”

“She was courageous to be a pioneer,” Dr. Zajarias says. “Lois trusted us, and she trusted the research. Her willingness to try this new treatment with the valve opened the door to a better quality of life.”

How the procedure works

On Nov. 14, 2024, Lois underwent a tricuspid valve replacement with WashU Medicine physicians at Barnes-Jewish Hospital, the first in the region to perform the surgery.

Dr. Zajarias and Dr. Kaneko performed Lois’s procedure by inserting a catheter through a vein in her leg and guiding the new valve into her heart. They worked in close collaboration with WashU Medicine cardiologist Nishath Quader, MD, who provided real-time imaging guidance to help position the valve precisely. Once in place, the valve was expanded and anchored, taking over the job of her leaky tricuspid valve and helping restore healthy blood flow. 

“The new valve works a little like a cork fitting into a bottle,” Dr. Zajarias explains. “It anchors into the tricuspid valve and expands to stop the backward flow of blood.”

The procedure was a success and required seamless collaboration and precision, highlighting the depth of expertise among WashU Medicine physicians at Barnes-Jewish Hospital. 

“What makes this procedure truly special is the collaborative effort of our heart team in caring for each patient,” says Dr. Kaneko. “Throughout the procedure, the cardiac sonographer, interventional cardiologist, and the cardiac surgeon, all work seamlessly as one united team. This approach allows us to pool our expertise and insights, ensuring that we achieve the best possible outcome together, with three dedicated minds focused on the patient’s health and well-being.”

Dr. Zajarias followed up with Lois 30 days after surgery and will continue to see her yearly. “She’s doing very well,” he says. “It’s incredibly satisfying to see patients like Lois benefit from new technology.” 

Expanding options for more patients

For patients like Lois, access to WashU Medicine's medical innovation as well as advanced imaging and collaborative expertise at Barnes-Jewish made all the difference. 

“Every new device and technology we have means more patients can be treated safely and effectively,” Dr. Zajarias says. “These procedures improve our patients' quality of life. That’s what excites me about what I do—helping patients feel better and live longer.”

He also offers advice for patients and families facing valve disease: “Seek out the experts. There are many treatment options available, and it’s important to be open-minded about what might be best for you.”

“I’m very thankful for Dr. Zajarias and everyone at Barnes-Jewish and WashU Medicine who took such great care of me,” Lois says. “They gave me my life and health back.”

For Dr. Zajarias, Lois’ recovery is a reminder why he does this work. “This is the most satisfying part of my job,” he says. “Helping patients feel better and live longer, and I feel honored to make a difference in their lives.” 

Learn more about the advanced care and expertise in heart valve disease at the WashU Medicine and Barnes-Jewish Heart & Vascular Center.